高同型半胱氨酸血症不同诊断切点对高血压患者心脑动脉粥样硬化的影响

背景　高同型半胱氨酸血症已成为动脉粥样硬化新的危险因素，国内对高同型半胱氨酸血症诊断切点尚有争议，本研究观察高同型半胱氨酸血症对高血压患者心脑动脉粥样硬化的影响，比较不同切点引起脑卒中和冠心病的发生情况。目的　探讨高同型半胱氨酸血症不同诊断切点〔同型半胱氨酸（Hcy）≥10 μmol/L，Hcy≥15 μmol/L〕对高血压患者心脑动脉粥样硬化的影响。方法　选择2019年10-11月在徐州医科大学附属医院全科医学科及健康中心新诊断的轻中度高血压患者168例为研究对象，根据Hcy水平分为：A组50例（Hcy<10 μmol/L），B组52例（10 μmol/L≤Hcy<15 μmol/L），C组66例（Hcy≥15 μmol/L）。比较3组患者临床资料〔体质指数、收缩压、舒张压、血脂（总胆固醇、三酰甘油、低密度脂蛋白、高密度脂蛋白）、空腹血糖、糖化血红蛋白、尿酸、叶酸、Hcy〕、超声下肱动脉内皮依赖性舒张功能（EDD）、颈动脉内膜中层厚度（IMT），腔隙性脑梗死和冠心病的发生情况。应用多因素Logistic回归分析探讨腔隙性脑梗死和冠心病发生的影响因素。结果　A组叶酸高于B组、C组，B组叶酸高于C组（P<0.05）；A组Hcy低于B组、C组，B组Hcy低于C组（P<0.05）。C组腔隙性脑梗死发生率高于A组、B组（P<0.05），B组腔隙性脑梗死发生率高于A组（P<0.05）。C组冠心病发生率高于A组、B组（P<0.05），A组和B组冠心病的发生率比较，差异无统计学意义（P=0.802）。多因素Logistic回归分析，结果显示，收缩压、舒张压、总胆固醇、高密度脂蛋白、Hcy≥10 μmol/L、IMT为腔隙性脑梗死发生的影响因素（P<0.05）；收缩压、舒张压、总胆固醇、低密度脂蛋白、Hcy≥15 μmol/L、EDD为冠心病发生的影响因素（P<0.05）。结论　高同型半胱氨酸血症加重高血压患者动脉粥样硬化程度，Hcy≥10 μmol/L为腔隙性脑梗死发生的影响因素，Hcy≥15 μmol/L为冠心病发生的影响因素。

Association of Hyperhomocysteinemia with Cardio-cerebral Atherosclerosis in Patients with Hypertension

Background　Hyperhomocysteinemia is a new risk factor for atherosclerosis，but its detailed association with atherosclerosis is still controversial in China．This study investigated the associations of hyperhomocysteinemia level with the severity of cardio-cerebral atherosclerosis as well as stroke and coronary heart disease prevalence in hypertension.Objective　To explore the associations of different hyperhomocysteinemia levels〔homocysteine（Hcy）≥10μmol/L or ≥15μmol/L 〕 with the severity of cardio-cerebral atherosclerosis in hypertension.Methods　One hundred and sixty-eight patients with newly diagnosed mild-to-moderate hypertension from Department of General Practice and Health Center，the Affiliated Hospital of Xuzhou Medical University from October to November 2019 were enrolled，and assigned to three groups according to Hcy level：group A（Hcy<10 μmol/L，n=50），group B （10 μmol/L≤Hcy<15 μmol/L，n=52） and group C（Hcy≥15 μmol/L，n=66）．Clinical data〔BMI，systolic and diastolic blood pressure，plasma lipid profile （total cholesterol，triglyceride，high-density lipoprotein，low-density lipoprotein），fasting plasma glucose，glycosylated hemoglobin，uric acid，folic acid，Hcy〕，ultrasound-assessed endothelium-dependent vasodilation of brachial artery（UEVBA）and carotid intima-media thickness，carotid intima-media thickness and lacunar infarction and coronary heart disease prevalence were compared among the groups．Multivariate Logistic regression was used to analyze the factors associated with lacunar infarction and coronary heart disease．Results　The average plasma folic acid level decreased successively across groups A，B，C（P<0.05）．Group C showed higher lacunar infarction prevalence than group A（P<0.001） and group B（P=0.045）．Group B had higher lacunar infarction prevalence than group A（P=0.035）．Coronary heart disease prevalence in group C was higher than that in group A（P=0.021） and group B（P=0.035）．There was no significant difference in coronary heart disease prevalence between groups A and B（P=0.802）．Multivariate Logistic regression analysis showed that systolic blood pressure，diastolic blood pressure，total cholesterol，high-density lipoprotein，Hcy≥10 μmol/L and carotid intima-media thickness were associated with lacunar infarction （P<0.05），and systolic blood pressure，diastolic blood pressure，total cholesterol，low-density lipoprotein，Hcy ≥15 μmol/L and UEVBA were associated with coronary heart disease（P<0.05）．Conclusion　Hyperhomocysteinemia may aggravate atherosclerosis in patients with hypertension．Our study suggests that Hcy≥10 μmol/L is an influencing factor of lacunar infarction，and Hcy≥15 μ mol/L is an influencing factor of coronary heart disease in hypertension.