H型高血压合并2型糖尿病患者血浆Hcy、Cyst-C水平与颈动脉内膜中层厚度的关系

目的 观察H型高血压合并2型糖尿病患者血浆同型半胱氨酸(Hcy)、胱抑素C(Cyst-C)水平与颈动脉内膜中层厚度(cIMT)的关系.方法 收集符合入选标准的H型高血压合并2型糖尿病患者120例,应用彩色多普勒超声检查仪测定cIMT,根据颈动脉粥样硬化的程度分为3组,cIMT正常(cIMT ＜0.9 rmm)组、cIMT增厚(0.9 mm≤clMT＜ 1.3 mm)组和颈动脉斑块(clMT≥1.3 mm)组;按血压水平分为高血压1级(140～ 159/90 ～ 99mmHg)组、高血压2级(160 ～ 179/100～ 109mmHg)组、高血压3级(≥180/110mmHg)组,检测并比较3组间患者血糖、血脂、尿素氮、血肌酐、糖化血红蛋白(HbA1c)、血清Hcy、Cyst-C水平,分析血清Hcy、Cyst-C与颈动脉cI-MT的关系.结果 (1)按cIMT分为3组,3组间血糖、血脂、尿素氮、血肌酐等比较差异无统计学意义(P＞0.05),血清Hcy、Cyst-C比较差异有统计学意义(P＜0.05),其水平随着cIMT增厚而增加;(2)按血压水平分为3组,高血压3级组血清Hcy、Cyst-C水平高于高血压1级、2级组,高血压2级组血清Hcy、Cyst-C水平高于高血压1级组(均P ＜0.05),其水平随着血压水平升高而升高;(3)clMT与Hcy、Cyst-C、HbA1c、收缩压、舒张压呈正相关(r =0.256、0.358、0.280、0.580、0.306,均P＜0.05),进一步行二分类logistic回归分析显示Hcy、Cyst-C、HbA1C、收缩压是cIMT增厚的独立危险因素(OR =55.257、1.545、3.121、1.154,均P＜0.05).结论 H型高血压合并2型糖尿病患者血清Hcy、Cyst-C水平与颈动脉粥样硬化具有密切相关性,是cIMT增厚的独立危险因素.

The correlation between the levels of plasma Hcy and Cyst-C,and carotid intima-media thickness in patients with H-hypertension complicated with type 2 diabetes

Objective To investigate the correlation between the levels of plasma homocysteine (Hcy) and Cyst-C,and carotid intima-media thickness in patients with H-hypertension complicated with type 2 diabetes.Methods A total of 120 patients with H-hypertension complicated with type 2 diabetes.The application of color Doppler ultrasography was applied for the assessment of carotid intima-media thickness (cIMT).According to the degree of carotid atherosclerosis,the subjects were divided into 3 groups,normal carotid IMT group (cIMT ＜ 0.9 mm),carotid IMT thickening group (0.9 mm≤cIMT ＜ 1.3 mm) and carotid artery plaque group (cIMT≥1.3 mm).According to the level of blood pressure,the subjects were divided into high blood pressure Level-1 (140-159/90-99 mmHg),high blood pressure Level-2 (160-179/100-109 mmHg),and high blood pressure Level-3 (over 180/110 mmHg).The blood sugar,blood fat,blood urea nitrogen,creatinine,serum Hcy,and serum Cyst-C levels were assessed and analyzed.The correlation between serum Hcy,Cyst-C and cIMT was analyzed.Results (1) according to the thickness of the carotid artery was divided into normal group,the thickening of the group,plaque formation,There was no significant difference in blood sugar,blood fat,urea nitrogen or serum creatinine among the 3 cIMT groups (P ＞ 0.05),though there were significant differences in serum Hcy and Cyst-C among them (P ＜ 0.05).(2) The serum Hcy and Cyst-C in high blood pressure Level-3 group was significantly higher than those of Level-1 and Level-2 groups;and they were also significantly higher in Level-2 group than Level-1 group (all P ＜ 0.05).(3) The cIMT was significantly positively correlated with and Hcy,Cyst-C,HbA1c,systolic pressure and diastolic blood pressure (P ＜ 0.05).And Hcy,Cyst-C,HbA1c,and systolic blood pressure were the independent risk factors for the development of cIMT (P ＜ 0.05).Conclusion The serum levels of Hcy and Cyst-C are closely related to the cIMT,suggesting independent risk factors of cIMT.