中老年正常高值血压人群中高同型半胱氨酸血症与脉压及冠状动脉粥样硬化性心脏病的关系

Relationship of hyperhomocysteinemia with pulse pressure and coronary heart disease in middle-aged and elderly population with high-normal blood pressure

目的探讨中老年正常高值血压人群中高同型半胱氨酸血症(HHcy)与脉压水平及冠状动脉粥样硬化性心脏病(冠心病)风险的关系。方法选择2016年1月至2017年6月在天津市胸科医院心内科接受冠状动脉造影检查的正常高值血压者422(男257、女165)人,年龄(57.5±7.7)岁。收集入选者各项临床和冠状动脉造影资料,检测入选者的同型半胱氨酸(Hcy)和血压水平。入选者按照是否存在HHcy(Hcy>10μmol/L)分为HHcy组(n=205)和非HHcy组(n=217)。结果与非HHcy组比较,HHcy组的Hcy[(16.6±9.7)比(8.8±1.6)μmol/L]、脉压[(55.3±8.9)比(51.7±9.6)mm Hg]较宽,舒张压[(75.4±7.9)比(77.7±8.6)mm Hg]较低,脉压过宽(≥60 mm Hg)比例(29.3%比19.9%)及舒张压正常(<80 mm Hg)比例(78.5%比61.3%)较高(均P<0.05)。多因素Logistic回归分析结果显示,调整性别、年龄等因素后,HHcy与脉压>53 mm Hg(中位数)独立相关(OR=2.08, 95%CI 1.36～3.19),多因素Logistic逐步回归分析发现HHcy是冠心病发生的独立影响因素(OR=1.54, 95%CI 1.02～2.31)。结论中老年正常高值血压人群中HHcy与脉压>53 mm Hg独立相关,是冠心病发生的独立影响因素。

Objective To investigate the relationship of homocysteinemia(HHcy) with pulse pressure and coronary heart disease in the middle-aged and elderly population with high normal blood pressure. Methods Four hundred and twenty-two participants with high normal blood pressure who underwent coronary angiography at Tianjin Chest Hospital from January 2016 to June 2017 were enrolled for the study. There were 257 males and 165 females with a mean age of(57.5±7.7) years. The subjects were divided into HHcy group(n=205,Hcy>10 μmol/L) and non-HHcy group(n=217,Hcy≤10 μmol/L). Detailed clinical and coronary angiography data were collected. Results Compared with the non-HHcy group, Hcy [(16.6±9.7) vs(8.8±1.6) μmol/L] and pulse pressure(PP) [(55.3±8.9) vs(51.7±9.6) mm Hg] were higher, while diastolic blood pressure [(75.4±7.9) vs(77.7±8.6) mm Hg] was lower in the HHcy group. The prevalence of the wide PP(≥60 mm Hg)(29.3% vs 19.9%) and normal diastolic blood pressure(<80 mm Hg)(78.5% vs 61.3%) were significantly different between two groups(all P<0.05). After adjustment for factors such as gender and age, multivariate Logistic regression analysis showed that HHcy was associated with PP>53 mm Hg(median)(OR=2.08, 95% CI 1.36-3.19), and was an independent risk factor for coronary heart disease(OR=1.54, 95% CI 1.02-2.31). Conclusion HHcy is independently associated with PP>53 mm Hg in the middle-aged and elderly population with high normal blood pressure, and is also an independent risk factor for the occurrence of coronary heart disease.