老年H型高血压与心-踝指数、颈动脉内膜中层厚度相关性研究(1)
【摘要】目的 探讨老年H型高血压与心-踝指数(CAVI)、颈动脉中层厚度等动脉硬化指标之间相关性。方法 选取2017年12月～2018年6月在我科就诊年龄>65岁的老年高血压患者120例作为研究对象，其中，男67例、女53例，根据血浆同型半胱氨酸水平将其分为高同型半胱氨酸组(H型高血压组)78例和正常同型半胱氨酸组(非H型高血压组)42例。检测身高、体质量、体质量指数、血压、TC、TG、IDL-C、HDL-C、空腹血糖、同型半胱氨酸、尿酸、肌酐等指标，分析老年H型高血压对CAVI和颈动脉内膜中层厚度(IMT)的影响。结果 老年H型高血压组CAVI较非H型高血压组显著升高，差异有统计学意义[(13.02±2.88)m/sVS(10.24±2.24)m/s，P<0.01];同时H型高血压组颈动脉中层内膜厚度(IMT)与非H型高血压组之间差异同样具有显著性[(1.06±0.12)mmVS(0.98±0.14)mm;P<0.01]。结论 H型高血压是动脉硬化的独立危险因素。在老年高血压人群中，H 型高血压对动脉硬化起到了重要作用，同型半胱氨酸升高在高血压对动脉硬化的进程中起到重要促进作用。对老年H型高血压的早期干预和治疗对老年脑卒中诊治提供理论依据，为临床提供指导意义。
【关键词】高血压;动脉硬化;高同型半胱氨酸;心-踝指数、颈动脉内膜中层厚度
【中图分类号】R541 【文献标识码】A 【文章编号】ISSN.2095-6681.2018.36..04
【Abstract】Objective To investigate the correlation between H-type hypertension and arteriosclerosis such as Cardio-ankle vascular index (CAVI) and carotid artery middle thickness in elderly patients.Methods From December 2017 to June 2018， 120 elderly patients with hypertension，67males and 53females，According to the level of plasma homocysteine，78 patients were divided into Hyperhomocysteine group (H-type hypertension group) and 42 patients were divided into normal homocysteine group (non-H-type hypertension group).Height，body mass，body mass index，blood pressure，TC，TG，IDL-C，HDL-C，fasting blood glucose，homocysteine，uric acid，creatinine and other indicators were measured to analyze the effect of H-type hypertension on PWV and carotid intima-media thickness (IMT).Results CAVI was significantly higher in elderly patients with H-type hypertension than in non-H-type hypertension， and the difference was statistically significant [(13.02+2.88)m/sVS(10.24+2.24)m/s，P<0.01]. Meanwhile， there was also a significant difference in carotid intima-media thickness (IMT) between H-type hypertension and non-H-type hypertension [(1.06+0.12) m m VS (0.98+0.14) m m，P<0.01]].Conclusion Type H hypertension is an independent risk factor for atherosclerosis.In the elderly hypertensive population，H-type hypertension plays an important role in atherosclerosis，and elevated homocysteine plays an important role in the process of hypertension on atherosclerosis.Early intervention and treatment of H-type hypertension in the elderly provide theoretical basis for the diagnosis and treatment of stroke in the elderly，and provide guidance for clinical practice.
【Key words】Hypertension;Atherosclerosis;Hyperhomocysteine;Cardio-ankle vascular index (CAVI);Carotid intima-media thickness
高血壓目前日益成为影响我国健康人群的最主要和最重要的危险因素之一，特别随着我国人口老龄化及生活方式改变，高血压发病率呈逐年增高趋势，研究发现在我国高血压人群中，约3/4左右的高血压患者同时伴有血浆同型半胱氨酸水平升高，此类高血压临床称为高同型半胱氨酸高血压(H型高血压)[1]。最近多项研究发现血浆同型半胱氨酸增高是临床心脑血管事件的独立危险因素，在冠状动脉硬化性心脏病、急性冠脉综合征、脑梗塞、老年性痴呆等心脑血管疾病发生发展中有重要作用，同时也是我国高血压患者脑血管事件发生的重要独立危险因素[2-3]。研究证实血管病变特别是血管僵硬度增加是动脉血管性疾病如心脑血管事件发生的病理基础，而血压增高是血管疾病发生发展的最重要的危险因素[4].随着我国老龄化社会不断进展及老龄人口不断增多，对老年脑卒中合并H型高血压的患者动脉血管形态及血管功能评估显得尤为重要;目前作为评估主动脉血管硬化程度及功能的金标准脉搏波传导速度指标--心-踝指数(Cardio-ankle vascular index，CAVI)被临床广泛应用。同时研究发现在脑卒中发病机制中颈动脉粥样硬化及不稳定斑块破裂、脱落是引发缺血性脑卒中最重要的危险因素[5]，动脉血管内膜中层增厚往往是其粥样硬化的早期病理表现[6]。研究发现同型半胱氨酸水平增高是颈动脉内膜中层增厚独立危险因素[7]。颈动脉内膜中层厚度 (inteima-media thickness，IMT)也常作为全身动脉早期粥样硬化衡量指标，反应全身动脉粥样硬化程度。, 百拇医药(余其贵 谢军 孙媛媛 杨琳琳 陈娟)
【关键词】高血压;动脉硬化;高同型半胱氨酸;心-踝指数、颈动脉内膜中层厚度
【中图分类号】R541 【文献标识码】A 【文章编号】ISSN.2095-6681.2018.36..04
【Abstract】Objective To investigate the correlation between H-type hypertension and arteriosclerosis such as Cardio-ankle vascular index (CAVI) and carotid artery middle thickness in elderly patients.Methods From December 2017 to June 2018， 120 elderly patients with hypertension，67males and 53females，According to the level of plasma homocysteine，78 patients were divided into Hyperhomocysteine group (H-type hypertension group) and 42 patients were divided into normal homocysteine group (non-H-type hypertension group).Height，body mass，body mass index，blood pressure，TC，TG，IDL-C，HDL-C，fasting blood glucose，homocysteine，uric acid，creatinine and other indicators were measured to analyze the effect of H-type hypertension on PWV and carotid intima-media thickness (IMT).Results CAVI was significantly higher in elderly patients with H-type hypertension than in non-H-type hypertension， and the difference was statistically significant [(13.02+2.88)m/sVS(10.24+2.24)m/s，P<0.01]. Meanwhile， there was also a significant difference in carotid intima-media thickness (IMT) between H-type hypertension and non-H-type hypertension [(1.06+0.12) m m VS (0.98+0.14) m m，P<0.01]].Conclusion Type H hypertension is an independent risk factor for atherosclerosis.In the elderly hypertensive population，H-type hypertension plays an important role in atherosclerosis，and elevated homocysteine plays an important role in the process of hypertension on atherosclerosis.Early intervention and treatment of H-type hypertension in the elderly provide theoretical basis for the diagnosis and treatment of stroke in the elderly，and provide guidance for clinical practice.
【Key words】Hypertension;Atherosclerosis;Hyperhomocysteine;Cardio-ankle vascular index (CAVI);Carotid intima-media thickness
高血壓目前日益成为影响我国健康人群的最主要和最重要的危险因素之一，特别随着我国人口老龄化及生活方式改变，高血压发病率呈逐年增高趋势，研究发现在我国高血压人群中，约3/4左右的高血压患者同时伴有血浆同型半胱氨酸水平升高，此类高血压临床称为高同型半胱氨酸高血压(H型高血压)[1]。最近多项研究发现血浆同型半胱氨酸增高是临床心脑血管事件的独立危险因素，在冠状动脉硬化性心脏病、急性冠脉综合征、脑梗塞、老年性痴呆等心脑血管疾病发生发展中有重要作用，同时也是我国高血压患者脑血管事件发生的重要独立危险因素[2-3]。研究证实血管病变特别是血管僵硬度增加是动脉血管性疾病如心脑血管事件发生的病理基础，而血压增高是血管疾病发生发展的最重要的危险因素[4].随着我国老龄化社会不断进展及老龄人口不断增多，对老年脑卒中合并H型高血压的患者动脉血管形态及血管功能评估显得尤为重要;目前作为评估主动脉血管硬化程度及功能的金标准脉搏波传导速度指标--心-踝指数(Cardio-ankle vascular index，CAVI)被临床广泛应用。同时研究发现在脑卒中发病机制中颈动脉粥样硬化及不稳定斑块破裂、脱落是引发缺血性脑卒中最重要的危险因素[5]，动脉血管内膜中层增厚往往是其粥样硬化的早期病理表现[6]。研究发现同型半胱氨酸水平增高是颈动脉内膜中层增厚独立危险因素[7]。颈动脉内膜中层厚度 (inteima-media thickness，IMT)也常作为全身动脉早期粥样硬化衡量指标，反应全身动脉粥样硬化程度。, 百拇医药(余其贵 谢军 孙媛媛 杨琳琳 陈娟)