同型半胱氨酸、血脂、肾功能指标及颈动脉超声在H型高血压中的临床应用价值

摘要

目的 评估同型半胱氨酸(Hcy)、血脂、肾功能指标及颈动脉超声在H型高血压诊治中的临床应用价值.方法 检测346例高血压患者和50名体检健康者(正常对照组)血压、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白(apo)A1、apo B100、apo E、脂蛋白(a)[Lp(a)]、游离脂肪酸(FFA)、尿素、肌酐(Cr)、尿酸(UA)、胱抑素C(Cys C)水平并行颈动脉超声检查.将高血压患者根据Hcy水平分为H型高血压组(Hcy≥10μmol/L,168例)和非H型高血压组(Hcy<10μmol/L,178例).结果 H型高血压组、非H型高血压组Hcy、TG、apo B100、Lp(a)、UA、Cys C水平均明显高于正常对照组(P<0.01),而apo A1水平低于正常对照组(P<0.01);H型高血压组Cr、尿素水平明显高于正常对照组(P<0.01),而apo A1水平明显低于非H型高血压组(P<0.01);H型高血压组年龄、男性比例、Hcy、apo B100、FFA、Cr、UA、尿素、Cys C水平明显高于非H型高血压组(P<0.01);其他指标3组之间差异均无统计学意义(P>0.05).在H型高血压组中,Hcy与HDL-C、apo A1呈负相关(r值分别为-0.127、-0.214,P<0.05),与尿素、Cr、UA、Cys C均呈正相关(r值分别为0.337、0.446、0.240、0.438,P<0.05).H型高血压组Hcy与颈动脉超声分组及血压分级呈正相关(r值均为0.383,P<0.05).结论 H型高血压患者发生肾功能损伤及动脉粥样硬化风险更高,定期监测高血压患者的Hcy水平对于H型高血压的诊断、治疗及改善预后具有重要意义.%Objective To evaluate the roles of homocysteine(Hcy),blood lipid,renal function and carotid ultrasound in the diagnosis and treatment of H-type hypertension. Methods Atotal of 346 patients with hypertension and 50 healthy subjects(healthy control group) were enrolled. The levels of blood pressure,total cholesterol (TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol (LDL-C),apolipoprotein(apo) A1,apo B100,apo E,lipoprotein(a)[Lp(a)],free fatty acid(FFA), urea,creatinine(Cr),uric acid(UA) and cystatin C(Cys C) were determined,and carotid ultrasound was performed. According to Hcy levels,the patients were classified into H-type hypertension group(Hcy≥10μmol/L, 168 cases) and non-H-type hypertension group(Hcy<10μmol/L,178 cases).Results Compared with healthy control group,the levels of Hcy,TG,apo B100,Lp(a),UA and Cys C were higher in hypertension group (P<0.01),while the level of apo A1 was lower(P<0.01). The levels of Cr and urea in H-type hypertension group were higher than those in healthy control group(P<0.01). Compared with non-H-type hypertension group,the levels of age,male proportion,Hcy,apo B100,FFA,Cr,UA,urea and Cys C were higher in H-type hypertension group(P<0.01),and the level of apo A1 was lower(P<0.01). There was no statistical significance for the other parameters among the 3 groups(P>0.05). In H-type hypertension group,the level of Hcy was negatively correlated with the levels of HDL-C and apo A1(r=-0.127 and-0.214,P<0.05),and it was positively correlated with urea,Cr,UA and Cys C(r=0.337,0.446,0.240 and 0.438,P<0.05). Hcy level was positively correlated with carotid ultrasound grading and blood pressure classification in H-type hypertension group(r=0.383,P<0.05). Conclusions H-type hypertension patients have a high risk of renal function impairment and atherosclerosis,and the periodic monitoring of Hcy levels is important for the diagnosis,treatment and prognosis of H-type hypertension.