Objective To investigate the relationship between serum homocysteine(Hcy)level and central arterial pressure,carotid femoral artery pulse conduction velocity(cfPWV),central artery enhancement index(AIx)and endothelial function index(RHI)in the patients with refractory hypertension(RH).Methods A total of 124 patients with RH admitted in the hospital from May 2013 to November 2016 were enrolled in this study.Serum Hcy and vascular function index were measured.With Hcy and cfPWV ＞ fPWV2 as boundary values,the relative indexes of the two groups were analyzed and compared.Results(1)There was no signifi-cant difference in sex,age,course of disease,complication,smoking history,history of drinking,and medication status in the two groups of patients with Hcy ≥10 μmol/L(P＞0.05),and cfPWV,RHI,systolic blood pres-sure(SBP),diastolic pressure(DBP),total cholesterol(TC),three acyl glycerol(TG)in the group of Hcy＞10 μmol/L.The level of low density lipoprotein cholesterol(LDL-C)was significantly higher than that of Hcy＜10 μmol/L group,and the level of high density lipoprotein cholesterol(HDL-C)was significantly lower than that of Hcy＜10 μmol/L group,and the differences were statistically significant(P＜0.05).(2)With cfPWV＞14 m/s as the boundary value,there was no significant difference in sex,course of disease,complica-tions,medication history,smoking history and drinking history in the two groups(P＞0.05).The level of age,Hcy,SBP,DBP,TC,TG and LDL-C in group cfPWV＞14 m/s was significantly higher than that in cfPWV ＜14 group.The difference was statistically significant(P＜0.05).(3)The correlation between serum level of Hcy and cfPWV,SBP/DBP,TC,TG,LDL-C and HDL-C showed that there was no correlation between serum Hcy and TC,TG,LDL-C,HDL-C levels(P＞0.05).However,serum Hcy was positively correlated with cfP-WV and SBP/DBP(r＝0.633,0.341,P＜0.05).(4)cfPWV correlated positively with age,Hcy,SBP/DBP,TC,TG,LDL-C,HDL-C(r＝0.251,0.622,0.347,0.427,0.288,0.339,P＜0.05),cfPWV correlated negative-ly with HDL-C(r＝ －0.479,P＜0.05).(5)The multiple regression analysis of patients with age ＞50 years,Hcy＞10 μmol/L,SBP＞130 mm Hg,LDL-C＞3.12 mmol/L and cfPWV showed that the age of 50 years old,Hcy＞10 μmol/L,SBP＞130 mm Hg,LDL-C＞3.12 mmol/L were all independent risk factors.Conclusion The high Hcy level of serum in young and middle RH patients is an independent risk factor for cfPWV,which can accelerate the progress of arteriosclerosis,and it is necessary for clinicians to pay attention to the treat-ment process.%目的 探讨中青年难治性高血压(RH)患者不同血清同型半胱氨酸(Hcy)水平与中心动脉压、颈-股动脉脉搏传导速度(cfPWV)、中心动脉增强指数(AIx)及内皮功能指数(RHI)的关系.方法 选取2013年5月至2016年11月该院收治的RH患者124例作为研究对象,测定患者血清Hcy水平及血管功能指数,分别以Hcy 、cfPWV≥fPWV2为临界值,对两组患者各项相关指标进行比较分析.结果(1)以 Hcy≥10 μmol/L为临界值时,两组患者性别、年龄、病程、并发症、吸烟史、饮酒史、用药情况等差异均无统计学意义(P＞0.05);Hcy≥10 μmol/L组患者cfPWV 、RHI 、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平明显高于 Hcy＜10 μmol/L组,高密度脂蛋白胆固醇(HDL-C)水平明显低于Hcy＜10 μmol/L组,差异均有统计学意义(P＜0.05).(2)以cfPWV ≥14 m/s为临界值时,两组患者性别、病程、并发症、用药史、吸烟史、饮酒史等比较,差异均无统计学意义(P＞ 0.05);cfPWV ≥14 m/s组患者年龄、Hcy 、SBP 、DBP 、TC 、TG 、LDL-C水平明显高于cfPWV＜14 m/s组,HDL-C水平明显低于cfPWV＜14 m/s组,差异均有统计学意义(P＜0.05).(3)分析血清 Hcy水平与cfPWV 、SBP/DBP 、TC 、TG 、LDL-C 、HDL-C的相关性得出,血清Hcy与TC 、TG 、LDL-C 、HDL-C水平不存在相关性(P＞0.05);但血清 Hcy 与cfPWV 、SBP/DBP呈正相关(r＝0.633 、0.341,P＜0.05).(4)分析cfPWV 与年龄、Hcy 、SBP/DBP 、TC 、TG 、LDL-C 、HDL-C的相关性得出,cfPWV 与年龄、Hcy 、SBP/DBP 、TC 、TG 、LDL-C呈正相关(r＝0.251 、0.622 、0.347 、0.427 、0.288 、0.339,P＜0.05),与HDL-C呈负相关(r＝ －0.479,P＜0.05).(5)对年龄≥50岁、Hcy≥10 μmol/L 、SBP＞130 mm Hg 、LDL-C＞ 3.12 mmol/L 与cfPWV 进行多因素 Logistic回归分析显示,年龄≥50岁、Hcy ≥ 10 μmol/L 、SBP＞130 mm Hg 、LDL-C ＞ 3.12 mmol/L 均是引起 cfPWV 升高的独立危险因素(P＜ 0.05).结论 中青年RH患者血清高 Hcy水平是引起cfPWV 的独立危险因素,可加速动脉硬化进展,需要临床医生在治疗过程中加以关注.
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