高龄老年原发性高血压患者同型半胱氨酸与心室重构的关系  

Correlation between plasma homocysteine level and ventricular remodeling in elderly patients with essential hypertension

作　　者：黄姣红[1] 王林[1] 刘柏年[1] 杨丽敏[1] 郭晓坤[1] 张红梅[1] 王超[1] 

机构地区：[1]天津医科大学第二医院干部保健科,l30021

出　　处：《天津医药》2015年第12期1405-1408,共4页Tianjin Medical Journal

基　　金：天津市科技计划项目(12ZCZDSY03100)

摘　　要：目的了解同型半胱氨酸(Hcy)对高龄老年原发性高血压患者左心室肥厚的影响。方法 378例高龄老年原发性高血压患者按Hcy水平分为非H型高血压组142例和H型高血压组236例,记录身高、体质量、用药情况及收缩压、舒张压、血浆Hcy、血脂、肾功能等,彩色多普勒超声诊断仪测定左心室形态结构,分析Hcy与左心室重构的关系。结果 H型高血压患者左心室肥厚比例高于非H型高血压患者(45.8%vs 24.6%,χ~2=16.81,P<0.001)。H型高血压组收缩压、Hcy水平、左心室后壁厚度(LVPWT)、室间隔厚度(IVST)及左心室质量指数(LVMI)均高于非H型高血压组[分别为(162.20±14.97)mmHg vs(149.70±5.06)mmHg,(19.76±5.83)μmol/Lvs(9.53±0.72)μmol/L,(9.77±2.35)mm vs(9.21±2.68)mm.(9.74±3.15)mm vs(8.51±2.42)mm,(118.64±39.38)g/m^2 vs(101.85±41.71)g/m^2]。单因素分析显示Hcy与LVMI呈正相关(r=0.381,P<0.001),多变量Logistic回归显示高Hcy血症是LVMI增高的独立危险因素。结论高Hcy血症是高血压左心室肥厚的独立危险因素,与高血压协同促进心室重构。Objective To explore the correlation of serum homocysteine（Hcy）levels and hypertrophy of left ventricle in very elderly hypertensive patients.Methods According to plasma Hcy levels,patients with essential hypertension （n=378） were divided into non H-type hypertension group （n=142） and H-type hypertension group （n=236）. Height, weight, regular medication, blood pressure, renal function, blood lipid profile and the concentration of plasma Hcy were recorded. Color Doppler ultrasonic equipment was used to determine the morphology and structure of left ventricle. The correlation between plasma Hcy and left ventricle remodeling was analyzed. Results The ratio of left ventricular hypertrophy was higher in H-type hypertension group than that in non H-type hypertension group（45.8%vs 24.6%,χ2=16.81,P〈0.001）. Patients in H-type hypertension group had higher systolic blood pressure, higher plasma level of Hcy and larger left ventricular posterior wall thickness（LVPWT）, larger interventricular septal thickness （IVST） and increased left ventricular mass index （LVMI） compared to those in non H-type hypertension group（162.20 ± 14.97）vs（149.70 ± 5.06）mmHg,（19.76 ± 5.83）μmol/L vs （9.53±0.72）μmol/L,（9.77±2.35）vs（9.21±2.68）mm,（9.74±3.15）vs（8.51±2.42）mm,（118.64±39.38）vs（101.85±41.71）g/m2 respectively, all P〈0.05）. There was a positive correlation between LVMI and Hcy（r=0.381,P〈0.001）. Multivariable Logistic regression analysis showed that hyperhomocysteinemia was an independent risk factor of LVMI. Conclusion High plasma Hcy level is an independent risk factor of LVMI, which works together with hypertension to promote left ventricular remolding.

关 键 词：高血压 高同型半胱氨酸血症 心室重构 老年人 肥大 左心室 

分 类 号：R544.1[医药卫生—心血管疾病]