血压变异性与血浆同型半胱氨酸对高血压患者颈动脉粥样硬化的影响  

Influence of blood pressure variability and plasma homocysteine on carotid atherosclerosis in patients with hypertension

作　　者：林从娟[1] 郑建清[1] 蔡川奇[1] 陈锡得[1] 林志鸿[1,2] LIN Cong-juan;ZHENG Jian-qing;CAI Chuan-qi;CHEN Xi-de;LIN Zhi-hong(Emergency Department of the First Affiliated Hospital of Fujian Medical University;Fujian Hypertension Research Institute,Fuzhou,Fujian 350005,China)

机构地区：[1]福建医科大学附属第一医院急诊医学中心 [2]福建省高血压研究所,福建福州350005

出　　处：《中华高血压杂志》2021年第12期1238-1244,共7页Chinese Journal of Hypertension

基　　金：福建医科大学苗圃科研基金项目(2015MP031)。

摘　　要：目的探讨H型高血压患者的血压变异性(BPV)与血浆同型半胱氨酸(Hcy)对颈动脉粥样硬化的影响。方法连续入选2015年1月到2018年12月在福建医科大学附属第一医院急诊科病房和/或心血管内科门诊就诊的首次确诊尚未服药或已确诊但已自行停用降压药2周以上的原发性高血压患者共287例,同时纳入55名正常血压的健康体检者作为对照。收集常规生化指标,检测血浆Hcy水平,同时进行24h动态血压监测及彩色多普勒颈动脉超声检查,然后根据Hcy水平将入选的原发性高血压患者分为正常Hcy高血压组(Hcy<15μmol/L,n=212)和高Hcy高血压组(Hcy≥15μmol/L,n=75)。采用Pearson相关分析、析因设计方差分析、多元逐步线性回归分析和二元logistic回归分析Hcy和BPV与颈动脉内膜中层厚度(IMT)的关系。结果与正常血压组比较,Hcy正常高血压组和高Hcy高血压组诊室血压、动态血压、24h收缩压标准差(24hSSD)、白天收缩压标准差(dSSD)、夜间收缩压标准差(nSSD)升高(均P<0.05)。与Hcy正常高血压组比较,高Hcy高血压组Hcy、尿素氮、血肌酐、诊室收缩压、24hSSD较高(P<0.05)。高Hcy高血压组IMT[(1.03±0.19)cm]高于Hcy正常高血压组[(0.89±0.18)cm],两组IMT又高于正常血压组[(0.78±0.17)cm],三组比较,差异有统计学意义(F=31.169,P<0.001)。析因设计方差分析显示:高Hcy(F=5.213,P=0.023)和诊室血压增高(F=8.153,P=0.005)均对IMT有影响,但二者之间并无交互协同作用(F=0.361,P=0.548)。相关分析显示:高血压患者IMT与血浆Hcy(r=0.298)、24hSSD(r=0.207)、24h收缩压变异系数(24hSCV)(r=0.172)、dSSD(r=0.210)、白天收缩压变异系数(dSCV)(r=0.186)、nSSD(r=0.199)、夜间收缩压变异系数(nSCV)(r=0.161)呈正相关(均P<0.05);与24h舒张压(24hDBP)(r=-0.127)、白天舒张压(dDBP)(r=-0.144)呈负相关(均P<0.05)。多元逐步线性回归分析显示:年龄(β=0.282)、Hcy(β=0.251)、dSSD(β=0.147)对IMT有影响(均P<0.05),但是重Objective To study the effects of blood pressure variability(BPV)and plasma homocysteine(Hcy)on carotid atherosclerosis in H-type hypertensive patients.Methods A total of 287essential hypertensive patients were enrolled from January 2015to December 2018,and 55normal blood pressure individuals were included in control group.Routine biochemical indexes,plasma Hcy level,24-hour ambulatory blood pressure(ABP)were collected and color Doppler ultrasound was performed in all subjects.Then according to the level of plasma Hcy,all essential hypertensive patients were divided into two groups,including normal Hcy hypertensive group(NH group,Hcy<15μmol/L,n=212)and high Hcy hypertensive group(HH group,Hcy≥15μmol/L,n=75).Pearson cor-relation analysis,factorial design variance analysis,multivariate stepwise linear regression analysis and binary logistics regression were used to analyze the relationship between Hcy,BPV and intima-media thickness(IMT).Results Compared with normal blood pressure group,the office blood pressure,ABP,the standard deviation of 24hour systolic blood pressure(24hSSD),the standard deviation of daytime systolic blood pressure(dSSD),the standard deviation of nighttime systolic blood pressure(nSSD)in the HH group and NH group were all increased(all P<0.05).Compared with the NH group,the level of plasma Hcy,urea nitrogen,serum creatinine,office systolic pressure,24hSSD were higher in the HH group(P<0.05).IMT in HH group was higher than that in NH group,and the IMT of the two groups were higher than that of control group[(1.03±0.19)vs(0.89±0.18)vs(0.78±0.17)cm,F=31.169,P<0.001].The factorial design variance analysis showed that high Hcy(F=5.213,P=0.023)and high office blood pressure(F=8.153,P=0.005)had an impact on IMT,but there was no interaction and synergy between them(F=0.361,P=0.548).The Pearson correlation analysis showed that IMT in patients with hypertension was positively correlated with plasma Hcy(r=0.298),24hSSD(r=0.207),24-hour systolic blood pressure variation coefficient(24hSCV)(r=0.172),

关 键 词：H型高血压 同型半胱氨酸 血压变异性 颈动脉内膜中层厚度 

分 类 号：R544.1[医药卫生—心血管疾病] R543.4[医药卫生—内科学]