高龄老年原发性高血压患者同型半胱氨酸与心室重构的关系

目的了解同型半胱氨酸（Hcy）对高龄老年原发性高血压患者左心室肥厚的影响。方法378 例高龄老年原发性高血压患者按Hcy 水平分为非H 型高血压组142 例和H 型高血压组236 例，记录身高、体质量、用药情况及收缩压、舒张压、血浆Hcy、血脂、肾功能等，彩色多普勒超声诊断仪测定左心室形态结构，分析Hcy 与左心室重构的关系。结果H 型高血压患者左心室肥厚比例高于非H 型高血压患者（45.8% vs 24.6%，χ2=16.81，P < 0.001）。H 型高血压组收缩压、Hcy 水平、左心室后壁厚度（LVPWT）、室间隔厚度（IVST）及左心室质量指数（LVMI）均高于非H 型高血压组分别为（162.20±14.97）mmHg vs（149.70±5.06）mmHg，（19.76±5.83）μmol/L vs（9.53±0.72）μmol/L，（9.77± 2.35）mm vs（9.21±2.68）mm，（9.74±3.15）mm vs（8.51±2.42）mm，（118.64±39.38）g/m2 vs（101.85±41.71）g/m2]。单因素分析显示Hcy 与LVMI 呈正相关（r=0.381，P < 0.001），多变量Logistic 回归显示高Hcy 血症是LVMI 增高的独立危险因素。结论高Hcy 血症是高血压左心室肥厚的独立危险因素，与高血压协同促进心室重构。

Correlation between plasma homocysteine level and ventricular remodeling in elderly patients with essential hypertension

Objective To explore the correlation of serum homocysteine（Hcy）levels and hypertrophy of left ventricle in very elderly hypertensive patients．Methods According to plasma Hcy levels，patients with essential hypertension (n= 378) were divided into non H-type hypertension group (n=142) and H-type hypertension group (n=236). Height, weight, reg? ular medication, blood pressure, renal function, blood lipid profile and the concentration of plasma Hcy were recorded. Color Doppler ultrasonic equipment was used to determine the morphology and structure of left ventricle. The correlation between plasma Hcy and left ventricle remodeling was analyzed. Results The ratio of left ventricular hypertrophy was higher in Htype hypertension group than that in non H-type hypertension group（45.8% vs 24.6%，χ2=16.81，P < 0.001）. Patients in Htype hypertension group had higher systolic blood pressure, higher plasma level of Hcy and larger left ventricular posterior wall thickness（LVPWT), larger interventricular septal thickness (IVST) and increased left ventricular mass index (LVMI) compared to those in non H-type hypertension group（162.20±14.97）vs（149.70±5.06）mmHg，（19.76±5.83）μmol/L vs （9.53±0.72）μmol/L，（9.77±2.35）vs（9.21±2.68）mm,（9.74±3.15）vs（8.51±2.42）mm,（118.64±39.38）vs（101.85±41.71）g/m2 respectively, all P＜0.05）. There was a positive correlation between LVMI and Hcy（r=0.381，P < 0.001）. Multivariable Lo? gistic regression analysis showed that hyperhomocysteinemia was an independent risk factor of LVMI. Conclusion High plasma Hcy level is an independent risk factor of LVMI, which works together with hypertension to promote left ventricular re? molding.