高同型半胱氨酸血症对原发性高血压患者冠状动脉内皮功能的影响  

Impact of Hyper-homocysteinemia on Coronary Endothelial Function in Patients With Essential Hypertension

作　　者：刘佳[1] 徐援[1] 高霞[1] 范慧[1] 贾育梅[1] 张恒[1] 杨新春[2] 王广[1] 

机构地区：[1]首都医科大学附属北京朝阳医院内分泌科,北京市100020 [2]首都医科大学附属北京朝阳医院心脏中心,北京市100020

出　　处：《中国循环杂志》2013年第8期576-580,共5页Chinese Circulation Journal

基　　金：国家自然科学基金项目(81270369);国家重点基础研究发展计划973资助项目(2011CB503904)

摘　　要：目的:高同型半胱氨酸血症(HHcy)是心血管疾病的独立危险因素。本研究观察HHcy对原发性高血压患者冠状动脉内皮功能的影响。方法:选取2012-06至2013-06就诊于北京朝阳医院的门诊及住院患者91例,其中原发性高血压患者51例为原发性高血压组,年龄性别匹配健康人40例为对照组,并根据是否合并HHcy分四个亚组:未合并HHcy的原发性高血压亚组、合并HHcy的原发性高血压亚组、未合并HHcy的对照亚组及合并HHcy的对照亚组。测定生化血脂、空腹血糖、空腹胰岛素及血同型半胱氨酸(Hcy)水平等,计算稳态模型胰岛素抵抗指数,并以冠状动脉血流储备作为评价冠状动脉内皮功能的指标。结果:原发性高血压组患者血Hcy水平高于对照组[(15.60±6.58)vs(13.08±4.13)μmol/L,P<0.05],而冠状动脉血流储备显著低于对照组[(2.88±0.70)vs(3.23±0.54),P<0.05]。相关分析显示,冠状动脉血流储备水平与血浆Hcy水平呈显著负相关(r=-0.578,P<0.01)。亚组分析显示,合并HHcy的原发性高血压亚组患者冠状动脉血流储备水平显著低于未合并HHcy的原发性高血压亚组[(2.31±0.31)vs(3.25±0.62),P<0.01],而空腹胰岛素水平[(16.11±7.94)vs(10.98±6.05)μIU/ml,P<0.05]及胰岛素抵抗指数[(3.92±2.16)vs(2.72±1.50),P<0.05]显著高于未合并HHcy的原发性高血压亚组。结论:伴高同型半胱氨酸血症的高血压患者的冠状动脉内皮功能较差,可能与促进胰岛素抵抗等机制有关。Objective： Hyper-homocysteinemia （HHcy） is an independent risk factor for cardiovascular disease, and we investigated the impact of HHcy on coronary endothelial function in patients with essential hypertension （HT）. Methods：A total of 91 participants treated in our hospital from 2012-06 to 2013-06 were studied including 51 patients （HT group） and 40 control subjects with the matched age and gender （NC group）. According to weather combining with HHcy, the participants were further divided into 4 subgroups as ① nH-HT subgroup, in which the HT patients without HHcy,② H- HT subgroup, the HT patients with HHcy, ③ nH-NC subgroup, in which the control subjects without HHcy and ④ H-NC subgroup, the control subjects with HHcy. We analyzed the fasting blood lipids, glucose, insulin （FINS） and Hcy, calculated the homeostasis model assessment-insulin resistance （I-IOMA-IR） index and assessed coronary endothelial function by measuring the coronary flow velocity reserve （CFVR） in all participants. Results： The plasma Hcy level was higher and CFVR value was lower in HT group than those in NC group （15.60 ± 6.58） umol/L vs （13.08 ± 4.13） umol/L and （2.88 ± 0.70） vs （3.23 ± 0.54）, both P〈0.05. The relevant study indicated that CFVR value was negatively related to Hcy level, r=-0.578, P〈0.01. The subgroup analysis presented that H-HT patients had lower CFVR value and higher FINS, HOMA-IR than nH-HT patients as （2.31 ± 0.31） vs （3.25 ± 0.62）, P〈0.01 and （16.11 ± 7.94） gIU/ml vs （10.98 ± 6.05） gIU/ml, （3.92 ± 2.16） vs （2.72 ± 1.50）, bothP〈0.05. Conclusion： HT patients with HHcy has the worse coronary endothelial function, and this might be related to insulin resistance.

关 键 词：高同型半胱氨酸血症 H型高血压 血管内皮功能 胰岛素抵抗 

分 类 号：R54[医药卫生—心血管疾病]