血浆同型半胱氨酸、血脂水平和颈动脉粥样硬化对老年高血压患者发生冠心病的影响

Effect of homocysteine,blood lipid level and carotid atherosclerosis on coronary heart disease in elderly patients with hypertension

目的：探讨老年高血压患者血浆同型半胱氨酸（ Hcy）、血脂水平与颈动脉粥样硬化及冠心病之间的关系。方法纳入300例老年（＞60岁）高血压患者，其中150例确诊为冠心病的患者为冠心病组，同期住院的150例非冠心病患者为对照组。抽取空腹外周静脉血，采用全自动生化分析仪检测Hcy、血脂浓度，同时行颈动脉超声检查颈动脉硬化程度并进行相关性分析。结果冠心病组血浆Hcy浓度（23?36±6?06）μmol／L明显高于对照组（12?45±3?33）μmol／L，差异有统计学意义（P＜0?05）；冠心病组TG、TC、LDL?C 水平（2?32±0?37、6?45±0?44、4?12±0?76） mmol／L 明显高于对照组（1?56±0?51、5?56±0?73、2?98±0?56） mmol／L，差异有统计学意义（ P 均＜0?001）；冠心病组 HDL?C 水平（1?54±0?45） mmol／L明显低于对照组（1?76±0?48） mmol／L，差异有统计学意义（P＜0?05）；冠心病组颈动脉粥样硬化发生率为86?00％（129／150），高于对照组的26?00％（39／150），差异有统计学意义（P＜0?001）；两组颈动脉情况类型分布比较差异有统计学意义（ P＜0?001）；冠心病组有颈动脉硬化的患者其血浆Hcy浓度（29?58±5?76）μmol／L高于无颈动脉硬化患者的血浆Hcy浓度（16?75±4?24）μmol／L，差异有统计学意义（ t＝2?328，P＝0?026）。 Logistic回归分析显示，Hcy、血脂水平、颈动脉斑块可能是老年高血压患者发生冠心病的危险因素。结论高Hcy、高血脂与颈动脉斑块可能与老年高血压患者发生冠心病有关，三者可能对老年高血压患者发生冠心病的预测、诊疗有一定的临床参考价值。

Objective To investigate the relationship among plasma homocysteine ( Hcy ) , blood lipid levels and carotid atherosclerosis with coronary heart disease in elderly patients with hypertension?Methods A total of 300 elderly patients with hypertension( age>60 years) were selected as study objects,including 150 cases of coronary heart disease patients were diagnosed as CHD group,150 cases of non coronary heart disease patients in the same period as the control group?Peripheral venous blood was extracted,the homocysteine and blood lipid levels were detected by automatic biochemiealanalyzer,and carotid artery ultrasound examination was performed to analyze the degree of carotid artery atherosclerosis,and the correlation analysis was performed?Results The plasma levels of Hcy in CHD group was significantly higher than the control group,the difference was statistically significant((23?36±6?06) μmol/L vs?(12?45±3?33) μmol/L,P<0?05)?The levels of TG,TC,LDL?C in CHD group were significantly higher than that of the control group,the differences were statistically significant ((2?32±0?37) mmol/L vs?(1?56±0?51) mmol/L,(6?45±0?44) mmol/L vs?(5?56±0?73) mmol/L,(4?12 ±0?76) mmol/L vs?2?98±0?56) mmol/L,P<0?001)?The level of HDL?C in CHD group was significantly low?er than the control group,the difference was statistically significant((1?54±0?45) mmol/L vs?(1?76±0?48) mmol/L,P<0?05)?The carotid atherosclerosis occurrence rate in CHD group was higher than the control group, the difference was statistically significant(86?00%(129/150) vs?26?00%(39/150),P<0?001)?The carotid artery type distribution of two groups was statistically significant( P<0?001)?The plasma levels of Hcy with ca?rotid atherosclerosis in CHD group were higher than the patients without carotid atherosclerosis, the difference was statistically significant((29?58±5?76) μmol/L vs?(16?75±4?24) μmol/L,t=2?328,P=0?026)?Logistic regression showed that Hcy,blood lipid levels,carotid plaque may be the risk factors of coronary heart disease in elderly patients with hypertension?Conclusion High Hcy,high blood lipids and carotid plaque may be related to the occurrence of coronary heart disease in elderly patients with hypertension, the three may have a certain clinical value in predicting the occurrence of coronary heart disease in elderly patients with hypertension.