CAJ | 학술논문

目的：观察24小时平均动脉血压正常、血压负荷增高对伴有血浆同型半胱氨酸增高（hyperhomocysteine-mia，HHcy）且行经皮冠状动脉介入治疗（PCI）的冠心病患者预后的影响。方法选取我院2009．10至2011．10期间经冠脉造影证实冠心病并行 PCI 治疗的患者共300例，均满足 HHcy 基本条件（大于10umol／L），根据24小时动态血压监测分为 H 型高血压组（100例）和平均动脉血压正常组（200例），根据血压负荷将平均血压正常组分为血压负荷增高组（104例）和负荷正常组（96例），H 型高血压组常规服用降压药物，观察1年及3年 MACE 事件（心源性死亡、非致死性心梗、血运重建）发生率。结果与负荷正常组相比，负荷增高组及 H 型高血压组在观察1年及3年非致死心梗及血运重建、观察3年心源性死亡方面均有统计学差异（P ＜0．05）。与 H 型高血压组相比，负荷增高组观察1年心源性死亡、非致死心梗均无统计学差异（P ＞0．05），血运重建方面存在统计学差异（P ＜0．05）；3年心源性死亡、非致死心梗及血运重建均有统计学差异（P ＜0．05）。结论在 PCI 人群中，伴有 HHcy 的血压负荷增高有不良预后，与药物干预的 H 型高血压相比，“H 型高血压负荷”更值得关注。
목적：관찰24소시평균동맥혈압정상、혈압부하증고대반유혈장동형반광안산증고（hyperhomocysteine-mia，HHcy）차행경피관상동맥개입치료（PCI）적관심병환자예후적영향。방법선취아원2009．10지2011．10기간경관맥조영증실관심병병행 PCI 치료적환자공300례，균만족 HHcy 기본조건（대우10umol／L），근거24소시동태혈압감측분위 H 형고혈압조（100례）화평균동맥혈압정상조（200례），근거혈압부하장평균혈압정상조분위혈압부하증고조（104례）화부하정상조（96례），H 형고혈압조상규복용강압약물，관찰1년급3년 MACE 사건（심원성사망、비치사성심경、혈운중건）발생솔。결과여부하정상조상비，부하증고조급 H 형고혈압조재관찰1년급3년비치사심경급혈운중건、관찰3년심원성사망방면균유통계학차이（P ＜0．05）。여 H 형고혈압조상비，부하증고조관찰1년심원성사망、비치사심경균무통계학차이（P ＞0．05），혈운중건방면존재통계학차이（P ＜0．05）；3년심원성사망、비치사심경급혈운중건균유통계학차이（P ＜0．05）。결론재 PCI 인군중，반유 HHcy 적혈압부하증고유불량예후，여약물간예적 H 형고혈압상비，“H 형고혈압부하”경치득관주。
Objective To observe the influence on the prognosis of percutaneous coronary intervention(PCI)pa-tients with the 24 hours mean arterial blood pressure normal,high blood pressure load and increased plasma homocys-teine (hyperhomocysteinemia,HHcy).Methods A total of 300 patients with coronary heart disease (CHD)who suffer PCI therapy during 2009.10 to 2011.10 in our hospital,meet the basic conditions of increased plasma homocysteine (greater than 10 umol/L),according to the 24-hour ambulatory blood pressure monitoring is divided into H - hyper-tension group (100 cases)and mean arterial blood pressure normal group (200 cases),according to the blood pressure load average blood pressure normal group can be divided into the blood pressure load increased group (104 cases)and normal load (96 cases),H-hypertension group of conventional antihypertensive drugs,observation 1 year and 3 years MACE events (cardiacdeath,nonfatal myocardial infarction,reascularization)rates.Results Compared with normal load group,higher load and H-hypertension group looking at 1 year,3 years of death and myocardial infarction reascu-larization,observe cardiac death in 3 years were statistically significant (P < 0.05).Compared with H-hypertension group,higher load group observation 1 year cardiac death,nonfatal myocardial infarction had no statistical difference (P> 0.05),reascularization were statistically significant (P <0.05);3 years,nonfatal myocardial infarction,cardiac death and reascularization were statistically significant (P <0.05).Conclusion In PCI group,high blood pressure load com-bined with HHcy have a poor prognosis,compared with H-hypertension drug intervention,the 〝H-style high blood pressure load”deserves more attention.