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目的观察中青年难治性高血压(RH)患者血清同型半胱氨酸水平与动脉僵硬度的关系。方法入选2014年5月至2016年2月于徐州市中心医院高血压门诊就诊的中青年RH患者62例,并入选血压控制达标的高血压(CH)患者84例和正常血压者67人,按血清同型半胱氨酸(Hcy)水平(<10和≥10μmol/L)进行分层分析。应用主动脉波形分析仪及内皮功能检测仪检测患者中心动脉压、颈股动脉脉搏波传导速度(cfPWV)、中心动脉增强指数(AIx)及内皮功能指数(RHI)。结果在RH患者中,高Hcy组cfPWV和RHI均高于正常Hcy组[(9.71±1.77)比(8.36±1.33)m/s,2.09±0.64比1.73±0.28;均P<0.05],两亚组的中心动脉压和AIx的差异无统计学意义(均P>0.05);而在CH患者及正常血压人群中,高Hcy组与正常Hcy组以上指标的差异无统计学意义(均P>0.05)。调整混杂因素后,RH患者中血清Hcy与cfPWV呈正相关(r=0.362,P=0.045)。多元线性回归分析显示,在RH患者中血清Hcy是cfPWV的独立危险因素(B=1.041,P=0.039)。结论在中青年RH患者中,血清Hcy升高可能与动脉僵硬度进展相关。
Objective To observe the relationship between serum homocysteine level and arterial stiffness in middle-aged and adolescent patients with refractory hypertension (RH). Methods Totally 62 middle-aged and young patients with RH were enrolled in the hypertensive outpatient department of Xuzhou Central Hospital from May 2014 to February 2016. 84 patients with hypertensive disorder (CH) and 67 normal blood pressure were enrolled in the study. Serum homocysteine (Hcy) levels (<10 and ≥ 10 μmol / L) were stratified. The aortic waveform analyzer and endothelial function detector were used to detect the patients’ central arterial pressure, carotid artery pulse wave velocity (cfPWV), central artery enhancement index (AIx) and endothelial function index (RHI). Results In RH patients, the levels of cfPWV and RHI in high Hcy group were significantly higher than those in normal Hcy group [(9.71 ± 1.77) vs (8.36 ± 1.33) m / s, 2.09 ± 0.64 vs 1.73 ± 0.28, P <0.05] There was no significant difference in the central arterial pressure and the AIx between the two groups (all P> 0.05), but there was no significant difference between the Hcy group and the normal Hcy group in CH patients and normal blood pressure group (all P> 0.05 ). After adjusting for confounding factors, serum Hcy was positively correlated with cfPWV in RH patients (r = 0.362, P = 0.045). Multivariate linear regression analysis showed that serum Hcy was an independent risk factor for cfPWV in RH patients (B = 1.041, P = 0.039). Conclusion In young and middle-aged patients with RH, elevated serum Hcy may be related to the progress of arterial stiffness.