中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2015年
4期
297-303
,共7页
李泽浦%唐丽萍%徐兵%袁录%刘云庆%姜蓉%赵勤华%孙宝贵%荆志成
李澤浦%唐麗萍%徐兵%袁錄%劉雲慶%薑蓉%趙勤華%孫寶貴%荊誌成
리택포%당려평%서병%원록%류운경%강용%조근화%손보귀%형지성
高血压%血栓栓塞
高血壓%血栓栓塞
고혈압%혈전전새
Hypertension%Thromboembolish
目的 探讨伴高同型半胱氨酸血症的高血压(H型高血压)患者血栓前状态的特点以及高同型半胱氨酸对高血压患者远期血栓事件的影响.方法 研究纳入2003年10月至2009年11月华山医院宝山分院门诊或住院的高血压2级患者220例,其中H型高血压患者110例即为H型高血压组,单纯型高血压患者110例即为单纯型高血压组.检测两组患者血栓前状态的实验室指标,包括纤维蛋白原定量(FIB)、血浆黏度、血栓调节蛋白(TM)、血小板颗粒膜糖蛋白(GMP-140)、凝血酶原片段1 +2(F1+2)、D-二聚体(D-Dimer)、抗凝血酶原Ⅲ(AT-Ⅲ).多元线性逐步回归分析高同型半胱氨酸与血栓前状态实验室指标的相关性.对所有患者进行长期随访,终点包括动脉血栓事件和静脉血栓事件.采用Cox比例风险模型对可能影响血栓事件的指标进行多因素回归分析,采用Kaplan-Meier生存曲线计算无血栓事件生存率,生存分析采用Log-rank检验.结果 H型高血压组患者TM、GMP-140和F1+2均明显高于单纯型高血压组[分别为(4.8±1.2) μg/L比(4.5±1.0)μg/L(P=0.045)、(18.8±3.2) μg/L比(17.1 ±4.3) μg/L(P=0.001)和(1.2±0.4)nmol/L比(1.0±0.6)nmol/L(P =0.004)],而AT-Ⅲ则明显低于单纯型高血压组[(95.3±10.4)％比(98.6±10.6)％,P =0.021].两组间FIB、血浆黏度、D-Dimer差异无统计学意义.多元线性逐步回归分析显示血浆同型半胱氨酸水平与年龄、女性、TM呈正相关(分别为β=0.217、P=0.04,β=5.667、P=0.001,β=2.341、P=0.003),与AT-Ⅲ呈负相关(β=-0.199、P=0.011).经远期随访(中位随访时间为85个月),多因素Cox比例风险分析显示高龄、高同型半胱氨酸是高血压患者发生血栓事件的独立危险因素(分别为OR 1.046、95％CI1.013 ～ 1.082,OR 1.052、95％CI1.027 ～1.078).Log-rank检验H型高血压组和单纯型高血压组间无血栓事件生存率差异有统计学意义(P=0.027).结论 H型高血压患者促凝标记物水平增高,而抗凝标记物水平降低.高龄及高同型半胱氨酸是高血压患者发生血栓事件的独立危险因素.
目的 探討伴高同型半胱氨痠血癥的高血壓(H型高血壓)患者血栓前狀態的特點以及高同型半胱氨痠對高血壓患者遠期血栓事件的影響.方法 研究納入2003年10月至2009年11月華山醫院寶山分院門診或住院的高血壓2級患者220例,其中H型高血壓患者110例即為H型高血壓組,單純型高血壓患者110例即為單純型高血壓組.檢測兩組患者血栓前狀態的實驗室指標,包括纖維蛋白原定量(FIB)、血漿黏度、血栓調節蛋白(TM)、血小闆顆粒膜糖蛋白(GMP-140)、凝血酶原片段1 +2(F1+2)、D-二聚體(D-Dimer)、抗凝血酶原Ⅲ(AT-Ⅲ).多元線性逐步迴歸分析高同型半胱氨痠與血栓前狀態實驗室指標的相關性.對所有患者進行長期隨訪,終點包括動脈血栓事件和靜脈血栓事件.採用Cox比例風險模型對可能影響血栓事件的指標進行多因素迴歸分析,採用Kaplan-Meier生存麯線計算無血栓事件生存率,生存分析採用Log-rank檢驗.結果 H型高血壓組患者TM、GMP-140和F1+2均明顯高于單純型高血壓組[分彆為(4.8±1.2) μg/L比(4.5±1.0)μg/L(P=0.045)、(18.8±3.2) μg/L比(17.1 ±4.3) μg/L(P=0.001)和(1.2±0.4)nmol/L比(1.0±0.6)nmol/L(P =0.004)],而AT-Ⅲ則明顯低于單純型高血壓組[(95.3±10.4)％比(98.6±10.6)％,P =0.021].兩組間FIB、血漿黏度、D-Dimer差異無統計學意義.多元線性逐步迴歸分析顯示血漿同型半胱氨痠水平與年齡、女性、TM呈正相關(分彆為β=0.217、P=0.04,β=5.667、P=0.001,β=2.341、P=0.003),與AT-Ⅲ呈負相關(β=-0.199、P=0.011).經遠期隨訪(中位隨訪時間為85箇月),多因素Cox比例風險分析顯示高齡、高同型半胱氨痠是高血壓患者髮生血栓事件的獨立危險因素(分彆為OR 1.046、95％CI1.013 ～ 1.082,OR 1.052、95％CI1.027 ～1.078).Log-rank檢驗H型高血壓組和單純型高血壓組間無血栓事件生存率差異有統計學意義(P=0.027).結論 H型高血壓患者促凝標記物水平增高,而抗凝標記物水平降低.高齡及高同型半胱氨痠是高血壓患者髮生血栓事件的獨立危險因素.
목적 탐토반고동형반광안산혈증적고혈압(H형고혈압)환자혈전전상태적특점이급고동형반광안산대고혈압환자원기혈전사건적영향.방법 연구납입2003년10월지2009년11월화산의원보산분원문진혹주원적고혈압2급환자220례,기중H형고혈압환자110례즉위H형고혈압조,단순형고혈압환자110례즉위단순형고혈압조.검측량조환자혈전전상태적실험실지표,포괄섬유단백원정량(FIB)、혈장점도、혈전조절단백(TM)、혈소판과립막당단백(GMP-140)、응혈매원편단1 +2(F1+2)、D-이취체(D-Dimer)、항응혈매원Ⅲ(AT-Ⅲ).다원선성축보회귀분석고동형반광안산여혈전전상태실험실지표적상관성.대소유환자진행장기수방,종점포괄동맥혈전사건화정맥혈전사건.채용Cox비례풍험모형대가능영향혈전사건적지표진행다인소회귀분석,채용Kaplan-Meier생존곡선계산무혈전사건생존솔,생존분석채용Log-rank검험.결과 H형고혈압조환자TM、GMP-140화F1+2균명현고우단순형고혈압조[분별위(4.8±1.2) μg/L비(4.5±1.0)μg/L(P=0.045)、(18.8±3.2) μg/L비(17.1 ±4.3) μg/L(P=0.001)화(1.2±0.4)nmol/L비(1.0±0.6)nmol/L(P =0.004)],이AT-Ⅲ칙명현저우단순형고혈압조[(95.3±10.4)％비(98.6±10.6)％,P =0.021].량조간FIB、혈장점도、D-Dimer차이무통계학의의.다원선성축보회귀분석현시혈장동형반광안산수평여년령、녀성、TM정정상관(분별위β=0.217、P=0.04,β=5.667、P=0.001,β=2.341、P=0.003),여AT-Ⅲ정부상관(β=-0.199、P=0.011).경원기수방(중위수방시간위85개월),다인소Cox비례풍험분석현시고령、고동형반광안산시고혈압환자발생혈전사건적독립위험인소(분별위OR 1.046、95％CI1.013 ～ 1.082,OR 1.052、95％CI1.027 ～1.078).Log-rank검험H형고혈압조화단순형고혈압조간무혈전사건생존솔차이유통계학의의(P=0.027).결론 H형고혈압환자촉응표기물수평증고,이항응표기물수평강저.고령급고동형반광안산시고혈압환자발생혈전사건적독립위험인소.
Objective To evaluate the association between homocysteine level and prethrombotic status and long-term thromboembolic events in patients with primary hypertension.Methods Results between 110 hypertensive patients with elevated homocysteine (HCY) level were compared with 110 hypertensive patients with normal HCY level,which were enrolled from October 2003 to November 2009.Fibrinogen (FIB),viscosity,thrombomodulin (TM),granule membrane protein (GMP-140),prethrombin F1 +2 fragment (F1 +2),D-dimer fragment (D-Dimer) and antithrombin Ⅲ (AT-Ⅲ) were measured and correlated to HCY and prethrombotic state.The endpoints of the study were arterial and venous thromboembolic events.The variables linked with arterial and venous thromboembolic events were included in Cox proportional hazard models.The event-free survival was illustrated with Kaplan-Meier survival curves and compared by the Log-rank test.Results The patients were followed up for 8-122 months (median follow-up time was 85 months).Compared with hypertensive patients with normal HCY,the plasma level of TM ((4.8 ± 1.2) μg/L vs.(4.5 ± 1.0) μg/L,P =0.045),GMP-140((18.8 ±3.2) μg/L vs.(17.1 ±4.3) μg/L,P =0.001),F1+2 ((1.2 ±0.4) nmol/L vs.(1.0 ±0.6) nmol/L,P =0.004) were significantly higher while the plasma level of AT-Ⅲ ((95.3 ± 10.4) ％ vs.(98.6 ± 10.6) ％,P =0.021)was significantly lower in hypertensive patients with elevated HCY level.FIB,viscosity of plasma and D-dimer were similar between the two groups.Multiple regression analyses indicated that HCY level was negatively correlated with AT-Ⅲ(3 =-0.199,P =0.011) and positively correlated with age (3 =0.217,P =0.04),female gender (β =5.667,P =0.001) and TM (β =2.341,P =0.003).Cox multivariate analysis revealed that age and HCY level were independent prognostic risk factors of thromboembolic events (OR 1.046,95％ CI 1.013-1.082,OR 1.052,95％ CI 1.027-1.078,respectively) (all P ＜ 0.05).Kaplan-Meier curves showed that there was a significant difference in the event-free survival between the two groups (Log-rank test,P =0.027).Conclusions Compared with normal HCY hypertensive patients,the levels of plasma prothrombin activators such as TM,GMP-140 and F1+2 were significant increased and anti-thrombin factor such as AT-Ⅲ was significant decreased in hypertensive patients with elevated HCY.Old age and high HCY level were independent prognostic risk factors of thromboembolic events.The eventfree survival in hypertensive patients with elevated HCY is lower than in hypertensive patients with normal HCY level.
