老年原发性高血压患者颈动脉粥样硬化斑块与血清标志物之间的相关性分析

摘要

Objective To study the relationship between carotid atherosclerosis (CAS) and serum markers in elderly essential hypertension (EH) patients.Methods Three hundred and eightyeight elderly EH patients who underwent carotid colour ultrasonography and biochemical testing served as an EH group and 82 subjects undergoing physical examination served as a control group.The patients in EH group were divided into plaque-free group (n =142),stable plaque group (n=132),and unstable plaque group (n=114).The relationship between CAS and serum FPG,Hcy,TBIL,DBIL,IBIL,UA,ferritin,fibrinogen,CRP levels was analyzed.Results The incidence of CAS and serum Hcy level were significantly higher in EH group than in control group (63.40％ vs 31.71％,12.69±3.58 μmol/L vs 6.96±2.89 μmol/L,P＜0.01).The incidence of CAS was 63.40％ in EH patients.The serum levels of FPG,TC,TG,LDL-C,Hcy,UA,ferritin,fibrinogen,CRP were significantly higher while those of TBIL,DBIL,and IBIL were significantly lower in stable plaque group than in unstable plaque group (P＜0.05,P＜0.01).Logistic regression analysis showed that stable CAS was negatively related with serum levels of TBIL and IBIL and positively related with those of FPG,TC,LDL-C,Hcy,UA,ferritin,fibrinogen and CRP,history of smoking,incidence of DM and hypertension (P＜0.05).Conclusion Serum levels of TBIL and IBIL are the protective factor for CAS while those of FPG,Hcy,UA,ferritin,fibrinogen and CRP are the risk factors for CAS in elderly EH patients.%目的 探讨老年原发性高血压(EH)患者颈动脉粥样硬化(CAS)和血清标志物之间的关系.方法 选择住我院或门诊的老年EH患者388例(EH组),均行颈动脉彩色超声及血生化检查,根据有无颈动脉斑块分为3组:无斑块组142例;稳定斑块组132例;不稳定斑块组114例.另选择同期体检且健康者82例作为对照组.分析CAS与空腹血糖(FPG)、Hcy、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、尿酸、铁蛋白、纤维蛋白原(Fib)、C反应蛋白(CRP)之间的关系.结果 EH组患者的CAS和Hcy水平显著高于对照组[63.40％ vs 31.71％、(12.69±3.58)μmol/L vs (6.96±2.89) μmol/L,P＜0.01].EH患者CAS发生率为63.40％,与无斑块组比较,稳定斑块组和不稳定斑块组的FPG、TC、TG、LDL-C、Hcy、尿酸、铁蛋白、Fib、CRP显著升高,而TBIL、DBIL、IBIL等显著降低,差异有统计学意义(P＜0.05,P＜0.01).logistic回归分析显示,CAS斑块与血清TBIL、IBIL水平呈负相关,与FPG、TC、LDL-C、Hcy、尿酸、铁蛋白、Fib、CRP、吸烟、糖尿病、高血压呈正相关(P＜0.05).结论 老年EH患者血清TBIL、IBIL是CAS的保护因子,而FPG、Hcy、尿酸、铁蛋白、Fib和CRP则是不良因素.