老年单纯收缩期高血压患者血浆同型半胱氨酸与心血管危险因素相关性研究  

Relationship between homocysteine and cardiovascular risk factors in elderly patients with isolated systolic hypertension

作　　者：汪莉[1] 汪海娅[1] 胡晓晨[1] 高天[1] 陆惠华[1] 

机构地区：[1]上海交通大学医学院附属仁济医院老年病科,上海200001

出　　处：《老年医学与保健》2009年第5期295-299,共5页Geriatrics & Health Care

摘　　要：目的观察血浆同型半胱氨酸（homocysteine，tHcy）与老年单纯收缩期高血压（ISH）患者心血管危险因素和靶器官损害的相关性。方法测定90例老年ISH患者血压和血脂，并检测其血Hcy浓度、血清白介素-6（IL-6）、白介素-8（IL-8）、尿微量白蛋白（MAU），测定左室质量指数（LVMI），利用彩色多普勒超声测定肱动脉内皮舒张功能（FMD）和颈动脉内膜厚度（CIMT）。结果（1）Hcy与心血管危险因素相关性：利用单变量分析显示：Hcy与血清甘油三酯（r=0．318，P=0．003）呈正性相关，与胆固醇（r=0．238，P=0．029）、低密度脂蛋白（r=0．221，P=0．043）、脉压差（r=0．253，P=0．019）无相关性；而采用多因素逐步回归分析发现：Hcy与血清甘油三酯（r=0．302，P=0．004）呈正相关，但与脉压差、（r=0．217，P=0．038）胆固醇、低密度脂蛋白、高密度脂蛋白、收缩压及舒张压无相关。（2）Hcy与血清炎性因子相关性：Hcy与IL-6呈正性相关（r=0．426，P=0．000）.（3）Hcy与内皮功能相关性：校正年龄、血脂及血清炎性因子，利用偏相关分析表明Hcy与FMD的变化呈负相关（r=-0．332，P=0．003）。（4）Hcy与靶器官损害关系：未发现Hcy与CIMT、LVMI及MAU之间存在相关性。结论高同型半胱氨酸血症与心血管危险因素有一定相关性，是老年单纯收缩期高血压的一个独立危险因素。Objective To investigate the relationship between homocysteine and cardiovascular risk factors as well as target organ damage in elder patients with isolated systolic hypertension （ISH）. Methods Ninety patients with ISH were performed Serum concentrations of IL-6, IL-8, flow-mediated dilatation of the brachial artery, urine microalbumin, left ventricular mass index, carotid intima-media thickness, blood pressure and plasma lipids. Results In univariate analysis there was an positive relationship between homocysteineand triglycerides （r=0.318, P=0.003）, and serum concentrations ofIL-6 （r=0.426, P=0.000 ）. There is no signi？ cant correlation between homocysteineandotalsterol （r=0.238, P=0.029）, ow-density lipoprotein （r=0.221, P=0.043）, and pulse pressure （r=0.253, P=0.019）. In stepwise multivariate regression analysis, homocysteine still correlated with triglycerides （r=0.302, P=0.004） and but not with pulse pressure, total cholesterol, low-density lipoprotein, high-density lipoprotein, systolic blood pressure and diastolic pressure. In addition, homocysteine correlated inversely with FMD （r=-0.332, P=0.003 ）, which remained significant after adjustment for confounding factors such as age and inflammatory factor, homocysteine was found to be not associated with carotid intimamedia thickness, left ventricular mass index and urine microalbumin. Conclusion Elevated levels of homocysteine is correlated with cardiovascular risk factors and appears to be an independent risk factor for elderly isolated systolic hypertension.

关 键 词：老年人 高血压 高同种半胱氨酸血症 心血管疾病 内皮 血管 

分 类 号：R544.1[医药卫生—心血管疾病]