CAJ | 학술논문

目的探讨老年人高同型半胱氨酸(Hcy)高血压(H型高血压)与不稳定型心绞痛(UA)的关系.方法收集2010年10月至2011年10月齐齐哈尔医学院附属第三医院心内科住院的符合入选标准的老年原发性高血压合并心绞痛患者147例,Hcy水平≥10 μmol/L为老年H型高血压组72例,Hcy水平＜10μmol/L为老年单纯高血压组75例；所有患者均行冠状动脉造影检查,用酶法测定Hcy水平,比较血清Hcy水平的差异.结果 H型高血压组与单纯高血压组UA发生率[44.4％(32/72)与12.0％(9/75)]、冠状动脉病变积分[(44.2±21.3)分与(31.9±18.4)分]、高敏C反应蛋白水平[hsCRP,(4.3±2.1)与(2.0±1.9)μg/L]比较,差异有统计学意义(均P＜0.01);H型高血压组中血清Hcy的水平在UA发作期与缓解期比较[(22.2±7.1)与(13.7±3.7)μmol/L]、UA发作期与稳定型心绞痛(SA)组比较[(22.2±7.1)与(12.0±4.2)μmol/L],差异有统计学意义(均P＜0.01).单纯高血压组中UA患者的血清Hcy水平高于SA患者[(8.9±2.2)与(6.6±1.2) μmol/L,P＜0.01],且UA患者的血清总胆固醇水平高于SA患者[(6.9±0.7)与(4.5±0.5)mmol/L,P＜0.01],血清低密度脂蛋白胆固醇水平高于SA患者[(4.6±0.8)与(2.7±0.6)mmol/L,P＜0.01].多元线性逐步回归分析结果显示,老年H型高血压是UA的独立影响因素(OR=5.691,P＜0.01).结论老年人H型高血压与UA密切相关,是老年人UA独立危险因素.血浆Hcy水平与冠状动脉粥样斑块稳定性和冠状动脉病变严重程度相关.
목적 탐토노년인고동형반광안산(Hcy)고혈압(H형고혈압)여불은정형심교통(UA)적관계.방법 수집2010년10월지2011년10월제제합이의학원부속제삼의원심내과주원적부합입선표준적노년원발성고혈압합병심교통환자147례,Hcy수평≥10 μmol/L위노년H형고혈압조72례,Hcy수평＜10μmol/L위노년단순고혈압조75례；소유환자균행관상동맥조영검사,용매법측정Hcy수평,비교혈청Hcy수평적차이.결과 H형고혈압조여단순고혈압조UA발생솔[44.4％(32/72)여12.0％(9/75)]、관상동맥병변적분[(44.2±21.3)분여(31.9±18.4)분]、고민C반응단백수평[hsCRP,(4.3±2.1)여(2.0±1.9)μg/L]비교,차이유통계학의의(균P＜0.01);H형고혈압조중혈청Hcy적수평재UA발작기여완해기비교[(22.2±7.1)여(13.7±3.7)μmol/L]、UA발작기여은정형심교통(SA)조비교[(22.2±7.1)여(12.0±4.2)μmol/L],차이유통계학의의(균P＜0.01).단순고혈압조중UA환자적혈청Hcy수평고우SA환자[(8.9±2.2)여(6.6±1.2) μmol/L,P＜0.01],차UA환자적혈청총담고순수평고우SA환자[(6.9±0.7)여(4.5±0.5)mmol/L,P＜0.01],혈청저밀도지단백담고순수평고우SA환자[(4.6±0.8)여(2.7±0.6)mmol/L,P＜0.01].다원선성축보회귀분석결과현시,노년H형고혈압시UA적독립영향인소(OR=5.691,P＜0.01).결론 노년인H형고혈압여UA밀절상관,시노년인UA독립위험인소.혈장Hcy수평여관상동맥죽양반괴은정성화관상동맥병변엄중정도상관.
Objective To investigate the relationship between H-type hypertension and unstable angina (UA).Methods Totally 147 elderly inpatients with hypertension and angina in our hospital were selected.Patients were divided into H-type hypertension group [n=72,serum homocysteine (Hcy) level ≥10 μmol/L] and primary hypertension group [n=75,serum homocysteine (Hcy) level ＜10 μmol/L].All patients underwent coronary angiography.Serum Hcy level was measured by enzyme method and compared between groups.Results There were statistical differences in the UA incidence,Gensini's score and high sensitive C-reactive protein (hsCRP) level between the H-type hypertension group and primary hypertension group [(44.4％ (32/72) vs.12.0％ (9/75),(44.2± 21.3) vs.(31.9±18.4),(4.3±2.1) μg/L vs.(2.0±1.9) μg/L,respectively,all P＜0.01].Serum Hcy level in H-type hypertension group was higher during UA attack than during UA remission [(22.2±7.1)μmol/L vs.(13.7±3.7)μmol/L,P＜ 0.01].Serum Hcy level during UA attack was increased in H-type hypertension group than in stable angina group [(22.2±7.1)μmol/L vs.(12.0± 4.2) μmol/L,P ＜ 0.01].Serum levels of Hcy,total cholesterol and low density lipoprotein cholesterol in primary hypertension group were higher in UA patients than in stable angina patients [(8.9±2.2)μmol/L vs.(6.6± 1.2)μmol/L,(6.9±0.7)mmol/L vs.(4.5±0.5)mmol/L,(4.6±0.8)mmol/L vs.(2.7 ± 0.6) mmol/L,respectively,P＜ 0.01 or P＜0.05].Logistic regression analysis showed that H-type hypertension was the independent risk factor for unstable angina in the elderly (OR =5.691,P ＜ 0.01).Conclusions H-type hypertension is closely correlated with unstable angina,which is the independent risk factor for unstable angina in the elderly.Serum Hcy level has significant correlation with coronary atherosclerotic plaque stability and the severity of coronary artery disease.