CAJ | 학술논문

目的：探讨老年原发性高血压患者血同型半胱氨酸（ Hcy ）水平及颈动脉斑块在预测冠心病发病及严重度中的价值，为临床老年原发性高血压患者并发冠心病的防治提供依据。方法选择2009年2月至2013年2月上海浦东医院老年科收治的老年（＞70岁）原发性高血压患者257例，根据有无高Hcy血症、颈动脉斑块分为四组：对照组（无高 Hcy血症、无颈动脉斑块）（ n ＝76），高 Hcy组（仅伴高Hcy）（n＝50），颈动脉斑块组（仅伴颈动脉斑块）（n＝46），高 Hcy血症合并颈动脉斑块组（同时伴高Hcy和颈动脉斑块）（ n＝85）。高Hcy血症合并颈动脉斑块组中血脂正常患者25例，血脂异常60例。比较各组并发冠心病的发生率及严重程度。结果高 Hcy组冠心病、冠状动脉单支病变发生率（16．0％）显著高于对照组（4．0％）（P＜0．05），颈动脉斑块组冠心病、冠状动脉单支病变及多支病变发生率（67．4％、39．1％、28．3％）均显著高于高 Hcy 组（6．6％、4．0％、2．6％）（ P ＜0．05）；高Hcy合并颈动脉斑块组冠心病、冠状动脉多支病变发生率（83．5％、50．6％）显著高于颈动脉斑块组（67．4％、28．3％）（P＜0．05）。高血Hcy合并颈动脉斑块组中血脂异常组冠心病、冠状动脉多支病变发生率（93．3％、63．3％）显著高于血脂正常组（60．0％、20．0％）（P＜0．05）。结论对老年原发性高血压患者同时检测血清Hcy、血脂及超声检查颈动脉斑块对预测冠心病的发生有较大的临床价值。在技术设备不足的情况下，联合观察血清 Hcy、血脂及颈动脉斑块可能是一个较好的方法。
목적：탐토노년원발성고혈압환자혈동형반광안산（ Hcy ）수평급경동맥반괴재예측관심병발병급엄중도중적개치，위림상노년원발성고혈압환자병발관심병적방치제공의거。방법선택2009년2월지2013년2월상해포동의원노년과수치적노년（＞70세）원발성고혈압환자257례，근거유무고Hcy혈증、경동맥반괴분위사조：대조조（무고 Hcy혈증、무경동맥반괴）（ n ＝76），고 Hcy조（부반고Hcy）（n＝50），경동맥반괴조（부반경동맥반괴）（n＝46），고 Hcy혈증합병경동맥반괴조（동시반고Hcy화경동맥반괴）（ n＝85）。고Hcy혈증합병경동맥반괴조중혈지정상환자25례，혈지이상60례。비교각조병발관심병적발생솔급엄중정도。결과고 Hcy조관심병、관상동맥단지병변발생솔（16．0％）현저고우대조조（4．0％）（P＜0．05），경동맥반괴조관심병、관상동맥단지병변급다지병변발생솔（67．4％、39．1％、28．3％）균현저고우고 Hcy 조（6．6％、4．0％、2．6％）（ P ＜0．05）；고Hcy합병경동맥반괴조관심병、관상동맥다지병변발생솔（83．5％、50．6％）현저고우경동맥반괴조（67．4％、28．3％）（P＜0．05）。고혈Hcy합병경동맥반괴조중혈지이상조관심병、관상동맥다지병변발생솔（93．3％、63．3％）현저고우혈지정상조（60．0％、20．0％）（P＜0．05）。결론대노년원발성고혈압환자동시검측혈청Hcy、혈지급초성검사경동맥반괴대예측관심병적발생유교대적림상개치。재기술설비불족적정황하，연합관찰혈청 Hcy、혈지급경동맥반괴가능시일개교호적방법。
Objective To investigate correlation between serum homocysteine(Hcy) level or carotid ar-tery plaque and coronary artery disease in elderly patients with primary hypertension ,to provide the basis for clinical prevention and cure of elderly patients with essential hypertension complicated with coronary artery disease.Methods 257 cases of elderly( >70 years) patients with primary hypertension who were received and cured in Department of Geriatrics,Pudong hospital in Shanghai city from Feb,2009 to Feb,2013 .they were divided into control group(without high Hcy hyperlipidemia and carotid plaque)(n =76),high Hcy group(only with high Hcy hyperlipidemia)(n=50),carotid artery plaque group(only with carotid plaque) (n=46),high Hcy associated with carotid artery plaque group(with high Hcy hyperlipidemia and carotid plaque) (n=85) according to presence or absence of Hcy and carotid artery plaque.Amon the patients in high Hcy associated with carotid artery plaque group there were 25 cases withserum normal lipid and 60 cases with dyslipidemia.the incidence and severity of coronary heart disease in each group were compared.Results the incidence of coronary artery disease and single vessel coronary artery pathological change in high Hcy group(16.0%) were significantly higher than those in control group(4.0%) (P<0.05),the incidence of coronary artery disease, single and multivessel vessel coronary artery pathological change in carotid artery plaque group(67.4%、39.1%、28.3%) were significantly higher than those in high Hcy group(6.6%、4. 0%、2.6%) (P<0.05);the incidence of coronary artery disease and multivessel vessel.coronary artery pathological change in high Hcy associated with carotid artery plaque group (83.5%、50.6%) were signifi-cantly higher than those in carotid artery plaque group(67.4%、28.3%) (P<0.05).the incidence of coro-nary artery disease and multivessel vessel coronary artery pathological change of dyslipidemia group (93. 3%、63.3%)were significantly higher than those of serum normal lipid group in high Hcy associated with ca-rotid artery plaque group(60.0%、20.0%)(P <0.05).Conclusion serum Hcy,blood lipid and carotid artery plaque by ultrasound examination in elderly patients with primary hypertension has important clinical value for prediction of coronary artery disease.In lack of technology and equipment,observing serum Hcy, blood lipid and carotid artery plaque may be a good method.