H型高血压与冠心病的关系及外源性叶酸干预效果研究  

Relationship between H-type Hypertension and Coronary Heart Disease and the Intervention Effect of Exogenous Folic Acid

作　　者：章衍达 朱林 洪梅[1] ZHANG Yan-da;ZHU Lin;HONG Mei(Department of Cardiology,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)

机构地区：[1]南京医科大学第二附属医院心内科,江苏省南京市210011

出　　处：《实用心脑肺血管病杂志》2018年第5期17-20,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：江苏省科技厅自然科学基金面上项目(SBK200921071);江苏省卫生计生委科研课题资助项目(H201611)

摘　　要：目的探讨H型高血压与冠心病的关系及外源性叶酸干预效果。方法选取2017年1—11月在南京医科大学第二附属医院心内科门诊就诊及住院的高血压患者158例,根据冠状动脉造影结果分为冠心病组78例和非冠心病组80例,并将其中98例H型高血压患者随机分为对照组40例和干预组58例。在个体化降压方案治疗基础上,对照组患者给予安慰剂治疗,干预组患者给予叶酸片治疗;两组患者均治疗3个月。比较冠心病组和非冠心病组患者性别、年龄及血浆同型半胱氨酸(Hcy)、叶酸水平;比较对照组和干预组患者治疗前及治疗后1、3个月血浆Hcy、叶酸水平,并记录随访3个月期间药物相关不良反应及不良心血管事件发生情况。结果冠心病组与非冠心病组患者性别、年龄及血浆叶酸水平比较,差异无统计学意义(P>0.05);冠心病组患者血浆Hcy水平高于非冠心病组(P<0.05)。多因素Logistic回归分析结果显示,血浆Hcy水平≥10μmol/L是高血压并冠心病的独立危险因素[OR=2.147,95%CI(1.060,4.349),P<0.05]。治疗前对照组与干预组患者血浆Hcy、叶酸水平比较,差异无统计学意义(P>0.05);治疗后1、3个月干预组患者血浆Hcy水平低于对照组,血浆叶酸水平高于对照组(P<0.05)。随访期间对照组和干预组患者均未出现药物相关不良反应及不良心血管事件。结论 H型高血压患者冠心病发生风险较高,而补充外源性叶酸可有效降低H型高血压患者血浆Hcy水平,且安全性较高。Objective To investigate the relationship between H-type hypertension and coronary heart disease（CHD）and the intervention effect of exogenous folic acid. Methods From January to November 2017,a total of 158 patients（including outpatients and inpatients）with hypertension were selected in the Department of Cardiology,the Second Affiliated Hospital of Nanjing Medical University,and they were divided into CHD group（n=78）and non-CHD group（n=80）according to the coronary angiography examination results,thereinto 98 patients with H-type hypertension were randomly divided into control group（n=40）and intervention group（n=58）. Based on individualized antihypertensive therapy,patients in control group received placebo,while patients in intervention group received folic acid tablets;both groups continuously treated for 3 months. Gender,age,plasma levels of homocysteine and folic acid were compared between CHD group and non-CHD group;plasma levels of homocysteine and folic acid were compared between control group and intervention group before treatment,1 month and 3 months after treatment,incidence of drug-related adverse reactions and cardiovascular events was recorded during the 3-month follow-up,respectively. Results No statistically significant differences of gender,age or plasma folic acid level was found between CHD group and non-CHD group（P〈0.05）,while plasma homocysteine level in CHD group was statistically significantly higher than that in non-CHD group（P〈0.05）. Multivariate Logistic regression analysis results showed that,plasma homocysteine level equal or over 10 μmol/L was the independent risk factor of CHD in patients with hypertension[OR=2.147,95%CI（1.060,4.349）,P〈0.05]. No statistically significant differences of plasma level of homocysteine or folic acid was found between control group and intervention group before treatment（P〈0.05）;1 month and 3 months after treatment,plasma homocysteine level in intervention group was statistically significantly lower than that

关 键 词：高血压 冠心病 叶酸 治疗结果 

分 类 号：R544.1[医药卫生—心血管疾病] R541.4[医药卫生—内科学]