同型半胱氨酸水平对老年男性高血压患者血栓前状态及血栓事件的影响

摘要

Objective To study the effect of different homocysteine levels on prethrombotic state and thrombotic events in elderly male patients with hypertension .Methods 108 cases of elderly male hypertensive patients were collected and divided into high ( H group,44 cases)and low level of homocysteine groups (L group,64 cases).laboratory parameters were detected and multiple linear regression analysis was used to analyze the correlation between homocysteine and Laboratory parameters of prethrombotic state .All patients were followed up and Cox proportional hazard models were used for multivariate analysis to analyze laboratory parameters affecting thrombotic events .Kaplan-Meier survival curve was used to calculate thrombotic event-free survival .Log-rank test was used for survival analysis .Results The level of AT-Ⅲin H group was significantly lower than that of L group (P<0.01),and TM,GMP-140 and F1+2 were higher than those of L group (P<0.01, P<0.05).There were no significant differences in FIB,Hct,D-Dimer between the two groups(P>0.05).Partial correlation analysis and par-tial correlation analysis showed that the level of plasma homocysteine was negatively correlated with AT -Ⅲ(r=-0.201,P=0.040),while it was positively correlated with TM(t=0.236,P=0.032).Multivariate Cox proportional hazards analysis showed that advanced age (OR=1. 050,P=0.002),high homocysteine(OR=1.048,P<0.007) were independent risk factors for thrombotic events in hypertensive patients . Log-rank test showed that there was significant difference in thrombotic event-free survival between two groups .Conclusions Advanced age and high homocysteine are independent risk factors for thrombotic events in elderly male hypertensive patients .%目的：分析同型半胱氨酸（ Hcy）水平对老年男性高血压患者血栓前状态特点及发生血栓事件的影响。方法108例老年男性高血压患者，按照Hcy水平分为高Hcy水平组（ H组，44例）和低Hcy水平组（ L组，64例）。检测两组患者血栓前状态的实验室指标，多元线性逐步回归分析Hcy水平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，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组患者抗凝血酶Ⅲ（ AT－Ⅲ）水平明显低于L组（ P＜0．01），而血栓调节蛋白（TM）、血小板α颗粒膜蛋白（GMP）－140和凝血酶原片段（F）1＋2则均明显高于L组（P＜0．01，P＜0．05）。两组间 D－二聚体（D－Dimer）、纤维蛋白原（FIB）、血浆黏度无统计学差异（P＞0．05）。简单相关分析和偏相关分析显示血浆Hcy水平与AT－Ⅲ呈负相关（r＝－0．201，P＝0．040），与TM呈正相关（r＝0．236，P＝0．032）。多因素Cox比例风险分析结果显示高龄（OR＝1．050，P＝0．002）、高Hcy（OR＝1．048，P＜0．007）是高血压患者发生血栓事件的独立危险因素。 Log－rank检验H组和L组间无血栓事件生存率有统计学差异。结论高龄及高Hcy是老年男性高血压患者发生血栓事件的独立危险因素。