高血压患者血浆同型半胱氨酸与动脉硬化的关系  

Association between plasma homocysteine and aterial stiffening in patients with hypertension

作　　者：张杰梅 商黔惠 王晓春 张文 崔露露 ZHANG Jie-mei;SHANG Qian-hui;WANG Xiao-chun;ZHANG Wen;CUI Lu-lu(Clinical Medicine Institute,Cardiovascular Disease Institute,Hypertension Research Institute,Affiliated Hospital of Zunyi Medical University,Zunyi,Guizhou 563003,China;Department of Cardiology,Affiliated Hospital of Zunyi Medical University,Guizhou 563003,China;Department of Critical Care Medicine,Affiliated Hospital of Zunyi Medical University,Guizhou 563003,China)

机构地区：[1]遵义医科大学附属医院,临床医学研究所,心血管病研究所,高血压研究室,贵州遵义563003 [2]遵义医科大学附属医院心内科,贵州遵义563003 [3]遵义医科大学附属医院重症医学科,贵州遵义563003

出　　处：《中华高血压杂志》2021年第11期1097-1103,共7页Chinese Journal of Hypertension

基　　金：国家自然科学基金项目(81160041,81460077);贵州省优秀科技教育人才省长专项基金项目[黔省专合字(2012)15号]。

摘　　要：目的探讨高血压患者血浆同型半胱氨酸(Hcy)水平与动脉硬化的关系。方法连续纳入2018年4月至2019年12月于遵义医科大学附属医院高血压门诊就诊的高血压患者1311例为研究对象。根据Hcy不同水平分为A组(Hcy<10μmol/L,n=134)、B组(10~<15μmol/L,n=550)、C组(15~<20μmol/L,n=388)和D组(Hcy≥20μmol/L,n=239)。所有研究对象均收集其一般资料,测量身高、体质量、血压和静息心率,测定血生化指标及颈股动脉脉搏波传导速度(cfPWV)。比较不同组间患者临床资料的差异,分析不同组间患者的动脉硬化检出率,采用多因素logistic逐步回归分析Hcy对高血压患者动脉硬化的影响。结果随着Hcy水平的增高,各组间高血压患者动脉硬化的检出率逐渐升高(4.5%比11.6%比20.9%比24.7%,χ^(2)=41.272,P<0.001)。Pearson相关分析显示,cfPWV与对数转换的Hcy(lg Hcy)呈正相关(r=0.187,P<0.001)。多因素logistic逐步回归分析校正年龄、性别等混杂因素后,以A组为参照组,C组和D组患者发生动脉硬化的OR值(95%CI)分别为3.285(1.293~8.346)、3.538(1.342~9.330)。结论血浆Hcy水平升高是高血压患者动脉硬化的独立危险因素。Objective To explore the association between plasma homocysteine(Hcy)and aterial stiffening in patients with hypertension.Methods A total of 1311 hypertensive patients in the hypertension clinic of the Affiliated Hospital of Zunyi Medical University from April 2018 to December 2019 were consecutively enrolled.All subjects were divided into group A(Hcy<10 mol/L,n=134),group B(10-<15μmol/L,n=550),group C(15-<20μmol/L,n=388)and group D(Hcy≥20μmol/L,n=239)according to plasma Hcy level.Their basic information was collected,their height,body mass,blood pressure and resting heart rate were measured,and their blood biochemical indicators and carotid femoral pulse wave velocity(cfPWV)were detected.Clinical data and the occurrence of aterial stiffening were compared among groups.Multiple logistic regression analysis was implemented to analyze the effect of Hcy on aterial stiffening in patients with hypertension.Results The occurrence of aterial stiffening in four groups was gradually increased among hypertensive patients with the elevation of Hcy(4.5%vs 11.6%vs 20.9%vs 24.7%),and the difference between the groups was statistically significant(χ^(2)=41.272,P<0.001).Pearson correlation analysis showed that cfPWV was positively correlated with lg Hcy(r=0.187,P<0.001).After adjusting for age,gender and other confounding factors,multiple logistic regression analysis revealed that compared with group A,the OR(95%CI)of aterial stiffening risk in group C and D were 3.285(1.293 to 8.346)and 3.538(1.342 to 9.330)respectively.Conclusion Elevated Hcy is an independent risk factor for aterial stiffening in patients with hypertension.

关 键 词：高血压 同型半胱氨酸 动脉硬化 颈股动脉脉搏波传导速度 

分 类 号：R544.1[医药卫生—心血管疾病] R543.5[医药卫生—内科学]