摘要
目的 探讨老年高血压患者的同型半胱氨酸(Hcy)水平与颈动脉内膜中层厚度的关系,以及Hcy对颈动脉斑块形成的影响.方法 选取自2020年3月至2022年1月于衡水市人民医院就诊的老年高血压患者259例.根据血清Hcy水平四分位数将患者分为H1组(＜17.81 umol/L)64例,H2组(17.81～20.93 umol/L)65例,H3组(20.93～24.06 umol/L)65例,H4组(＞24.06 umol/L)65例;统计研究对象颈动脉斑块形成的情况并检测患者颈动脉内膜中层厚度(CIMT),按照斑块形成情况分为斑块组(n=149)和无斑块组(n=110).比较4组不同血清Hcy水平患者的CIMT、颈动脉斑块形成情况,比较斑块组和无斑块组血清Hcy水平,采用Pearson相关分析血清Hcy与CIMT的相关性,采用多元线性回归分析CIMT的危险因素,采用多因素logistic回归分析CIMT增加和颈动脉斑块形成的影响因素.结果 四组研究对象的吸烟史、饮酒史、总胆固醇、低密度脂蛋白、血清Hcy、CIMT、颈动脉斑块形成率比较差异有统计学意义(P＜0.05);H4组的总胆固醇、CIMT、颈动脉斑块形成率(78.46％)均明显高于其他三组(P＜0.05),低密度脂蛋白、血清Hcy均明显高于H1、H2组(P＜0.05);斑块组的总胆固醇、低密度脂蛋白、血清Hcy、CIMT均明显高于无斑块组(P＜0.05);Pearson相关分析显示,CIMT与年龄、吸烟史、总胆固醇、低密度脂蛋白、血清Hcy呈正相关(r=0.298、0.178、0.214、0.293、0.305,P＜0.05),与高密度脂蛋白呈负相关(r=-0.205,P＜0.05);多元线性逐步回归分析结果显示,年龄、高密度脂蛋白、低密度脂蛋白、血清Hcy是CIMT的影响因素(β=0.157、-0.211、0.204、0.269,P＜0.05);多因素logistic回归分析结果显示,年龄、吸烟史、总胆固醇、低密度脂蛋白、血清Hcy均是颈动脉斑块形成的独立危险因素(β=0.864、0.243、1.546、0.026、0.549,P＜0.05),高密度脂蛋白是颈动脉斑块形成的独立保护因素(β=-1.207,P＜0.05).结论 老年高血压患者血清Hcy水平是颈动脉斑块形成的独立危险因素,并且与CIMT呈正相关,可作为临床上辅助诊断动脉粥样硬化的检测方式.
Abstract
Objective To investigate the relationship between homocysteine(Hcy)level and carotid intima-media thickness in elderly patients with hypertension and the effect of Hcy on carotid plaque formation.Methods A total of 259 elderly patients with hypertension were selected from March 2020 to January 2022 in Hengshui People's Hospital.According to the quartile of serum Hcy level,the patients were divided into the Hl group(＜17.81 umol/L)64 cases,H2 group(17.81～20.93 umol/L)65 cases,H3 group(20.93～24.06 umol/L)65 cases and H4 group(＞24.06umol/L)65 cases.Carotid plaque formation was observed and carotid intium-media thickness(CIMT)was measured.Patients were divided into the plaque group(n=149)and no plaque group(n=110)according to plaque formation.Pearson correlation was used to analyze the correlation between serum Hcy and CIMT;multiple linear regression was used to analyze the risk factors of CIMT;and multiple logistic regression was used to analyze the influencing factors of CIMT increase and carotid plaque formation.Results There were statistically significant differences in smoking history,drinking history,total cholesterol,low density lipoprotein,serum Hcy,CIMT and carotid plaque formation rate among the four groups(P＜0.05).The total cholesterol,CIMT and carotid plaque formation rate(78.46％)in H4 group were significantly higher than those in the other three groups(P＜0.05),and the low density lipoprotein and serum Hcy were significantly higher than those in Hl and H2 groups(P＜0.05).The total cholesterol,low density lipoprotein,serum Hcy and CIMT in the plaque group were significantly higher than those in the non-plaque group(P＜0.05).Pearson correlation analysis showed that CIMT was positively correlated with age,smoking history,total cholesterol,low density lipoprotein and serum Hcy(r=0.298,0.178,0.214,0.293,0.305,P＜0.05)and negatively correlated with high density lipoprotein(r=-0.205,P＜0.05).The results of multiple linear regression analysis showed that age,high density lipoprotein,low density lipoprotein and serum Hcy were the influencing factors of CIMT(β=0.157,-0.211,0.204,0.269,P＜0.05).Multivariate logistic regression analysis showed that age,smoking history,total cholesterol,low density lipoprotein and serum Hcy were the independent risk factors for carotid artery plaque formation(β=0.864,0.243,1.546,0.026,0.549,P＜0.05)and high density lipoprotein was independent protective factor for carotid artery plaque formation(β=-1.207,P＜0.05).Conclusions Serum Hcy level in elderly hypertensive patients is an independent risk factor for carotid plaque formation,and is positively correlated with CIMT,which can be used as a clinical auxiliary diagnostic test for atherosclerosis.
基金项目
河北省医学科学研究课题(2019)(20190635)
NETL
NSTL
万方数据