检验医学
檢驗醫學
검험의학
LABORATORY MEDICINE
2013年
12期
1069-1072
,共4页
杨帆%徐冰馨%郭平%陆怡德
楊帆%徐冰馨%郭平%陸怡德
양범%서빙형%곽평%륙이덕
同型半胱氨酸%原发性高血压%危险因素
同型半胱氨痠%原髮性高血壓%危險因素
동형반광안산%원발성고혈압%위험인소
Homocysteine%Primary hypertension%Risk factor
目的：了解原发性高血压患者血浆同型半胱氨酸（Hcy）水平，探讨其与传统心血管危险因素及亚临床靶器官损害之间的关系。方法收集106例原发性高血压患者的相关资料，依据《中国高血压防治指南》行超声心动图、颈动脉超声、估算的肾小球滤过率（iGFR）判断是否存在靶器官损伤（若患者同时存在2种或2种以上的靶器官损伤，则归入各组分别统计），将106例患者分为单纯高血压组（44例）、高血压伴左心室肥厚组（18例）、高血压伴颈动脉硬化组（46例）及高血压伴iGFR下降组（27例）。同时检测血浆Hcy、血糖（FPG）、血脂、血肌酐（Cr）等，并采用Spearman相关性分析及多元logistic回归对各组数据进行分析。结果 Hcy与各靶器官损害呈明显正相关（P＜0．05），且与传统心血管危险因素[性别、年龄、吸烟、收缩压（SBP）、FPG、Cr]明显相关（P＜0．05）。单纯高血压组血浆Hcy水平[（12．18±3．30）μmol/L]明显低于高血压伴iGFR下降组[（19．05±8．58）μmol/L]、高血压伴左心室肥厚组[（18．63±7．99）μmol/L]、高血压伴颈动脉硬化组[（16．80±6．34）μmol/L]（P均＜0．05）。高血压伴颈动脉硬化组年龄、Hcy、血糖、iGFR与单纯高血压组比较差异有统计学意义（P＜0．05）。以有无颈动脉粥样硬化为因变量，年龄、血糖、iGFR和Hcy为自变量，通过多元logistic回归分析，结果表明仅有年龄是高血压患者颈动脉粥样硬化的独立危险因素。按美国心脏病协会制定的 Hcy 异常临界值标准（＞15μmol/L）将Hcy区分为正常和升高，高血压伴Hcy升高者罹患颈动脉粥样硬化的风险比Hcy正常者高出2．74倍。结论年龄是高血压患者颈动脉粥样硬化的独立危险因素；Hcy升高与高血压患者亚临床靶器官损害密切相关，且罹患颈动脉粥样硬化的风险上升。
目的：瞭解原髮性高血壓患者血漿同型半胱氨痠（Hcy）水平，探討其與傳統心血管危險因素及亞臨床靶器官損害之間的關繫。方法收集106例原髮性高血壓患者的相關資料，依據《中國高血壓防治指南》行超聲心動圖、頸動脈超聲、估算的腎小毬濾過率（iGFR）判斷是否存在靶器官損傷（若患者同時存在2種或2種以上的靶器官損傷，則歸入各組分彆統計），將106例患者分為單純高血壓組（44例）、高血壓伴左心室肥厚組（18例）、高血壓伴頸動脈硬化組（46例）及高血壓伴iGFR下降組（27例）。同時檢測血漿Hcy、血糖（FPG）、血脂、血肌酐（Cr）等，併採用Spearman相關性分析及多元logistic迴歸對各組數據進行分析。結果 Hcy與各靶器官損害呈明顯正相關（P＜0．05），且與傳統心血管危險因素[性彆、年齡、吸煙、收縮壓（SBP）、FPG、Cr]明顯相關（P＜0．05）。單純高血壓組血漿Hcy水平[（12．18±3．30）μmol/L]明顯低于高血壓伴iGFR下降組[（19．05±8．58）μmol/L]、高血壓伴左心室肥厚組[（18．63±7．99）μmol/L]、高血壓伴頸動脈硬化組[（16．80±6．34）μmol/L]（P均＜0．05）。高血壓伴頸動脈硬化組年齡、Hcy、血糖、iGFR與單純高血壓組比較差異有統計學意義（P＜0．05）。以有無頸動脈粥樣硬化為因變量，年齡、血糖、iGFR和Hcy為自變量，通過多元logistic迴歸分析，結果錶明僅有年齡是高血壓患者頸動脈粥樣硬化的獨立危險因素。按美國心髒病協會製定的 Hcy 異常臨界值標準（＞15μmol/L）將Hcy區分為正常和升高，高血壓伴Hcy升高者罹患頸動脈粥樣硬化的風險比Hcy正常者高齣2．74倍。結論年齡是高血壓患者頸動脈粥樣硬化的獨立危險因素；Hcy升高與高血壓患者亞臨床靶器官損害密切相關，且罹患頸動脈粥樣硬化的風險上升。
목적：료해원발성고혈압환자혈장동형반광안산（Hcy）수평，탐토기여전통심혈관위험인소급아림상파기관손해지간적관계。방법수집106례원발성고혈압환자적상관자료，의거《중국고혈압방치지남》행초성심동도、경동맥초성、고산적신소구려과솔（iGFR）판단시부존재파기관손상（약환자동시존재2충혹2충이상적파기관손상，칙귀입각조분별통계），장106례환자분위단순고혈압조（44례）、고혈압반좌심실비후조（18례）、고혈압반경동맥경화조（46례）급고혈압반iGFR하강조（27례）。동시검측혈장Hcy、혈당（FPG）、혈지、혈기항（Cr）등，병채용Spearman상관성분석급다원logistic회귀대각조수거진행분석。결과 Hcy여각파기관손해정명현정상관（P＜0．05），차여전통심혈관위험인소[성별、년령、흡연、수축압（SBP）、FPG、Cr]명현상관（P＜0．05）。단순고혈압조혈장Hcy수평[（12．18±3．30）μmol/L]명현저우고혈압반iGFR하강조[（19．05±8．58）μmol/L]、고혈압반좌심실비후조[（18．63±7．99）μmol/L]、고혈압반경동맥경화조[（16．80±6．34）μmol/L]（P균＜0．05）。고혈압반경동맥경화조년령、Hcy、혈당、iGFR여단순고혈압조비교차이유통계학의의（P＜0．05）。이유무경동맥죽양경화위인변량，년령、혈당、iGFR화Hcy위자변량，통과다원logistic회귀분석，결과표명부유년령시고혈압환자경동맥죽양경화적독립위험인소。안미국심장병협회제정적 Hcy 이상림계치표준（＞15μmol/L）장Hcy구분위정상화승고，고혈압반Hcy승고자리환경동맥죽양경화적풍험비Hcy정상자고출2．74배。결론년령시고혈압환자경동맥죽양경화적독립위험인소；Hcy승고여고혈압환자아림상파기관손해밀절상관，차리환경동맥죽양경화적풍험상승。
Objective To study the levels of plasma homocysteine(Hcy)in patients with primary hypertension,and to investigate the relationship of Hcy with cardiovascular risk factors and subclinical damage.Methods According to the echocardiogram,carotid artery ultrasonic inspection and isotope glomerular filtration rate (iGFR)Chinese Guidelines for the Management ofHypertension,the target damage was analyzed and evaluated (if patients had 2 or more than 2 target damages,they were classified into the groups below and analyzed statistically),and 106 primary hypertension patients were classified into the simple hypertension group (44 patients ), the hypertension with left ventricular hypertrophy group (18 patients),the hypertension with carotid atherosclerosis group (46 patients)and the hypertension with decreasing iGFR group (27 patients).Plasma Hcy,fasting plasma glucose (FPG),lipid and creatinine (Cr)were measured,and the results were compared and analyzed by Spearman correlation analysis and multi-logistic regression analysis.Results Hcy was positively correlated with subclinical damage and some traditional cardiovascular risk factors [sex,age,smoking,systolic blood pressure (SBP),FPG and Cr](P <0.05 ).The Hcy levels of the simple hypertension group [(12.18 ±3.30)μmol/L]were lower than those of the hypertension with decreasing iGFR group [(19.05 ±8.58)μmol/L],the hypertension with left ventricular hypertrophy group [(18.63 ±7.99)μmol/L]and the hypertension with carotid atherosclerosis group [(16.80 ±6.34)μmol/L](P<0.05).Age,Hcy,FPG and iGFR had statistical significance between the simple hypertension group and the hypertension with carotid atherosclerosis group (P<0.05).Non-carotid atherosclerosis was as dependent variable,and age,FPG,iGFR and Hcy were as independent variables.Multi-logistic regression analysis showed that age was independently associated with carotid atherosclerosis.If only defined Hcy as normal and increasing with the abnormal cut-off value of Hcy >15 μmol/L according to the American Heart Association,the risk of carotid atherosclerosis in hypertension patients with increasing Hcy was 2.74 times higher than than in subjects with normal Hcy.Conclusions Age is an important independent risk factor for carotid atherosclerosis in primary hypertension patients.The increasing of Hcy is closely related with subclinical damage,and has a high risk for carotid atherosclerosis.
