【摘要】：目的探討血漿同型半胱氨酸濃度對女性高血壓患者冠狀動脈粥樣硬化病變及左心室功能的影響。方法選擇2015年1月至2016年6月在我院心血管內科住院的確診為原發(fā)性高血壓的女性患者354例,根據(jù)其血漿同型半胱氨酸的濃度分成2組,血漿同型半胱氨酸濃度10umol/l為H型高血壓組(240例),10umol/l為非H型高血壓組(114例),對兩組患者的年齡,體重指數(shù),血壓,糖尿病史等基礎資料,以及空腹血糖,糖化血紅蛋白,甘油三酯、總膽固醇、低密度脂蛋白膽固醇等主要生化指標進行比較,并對兩組患者行冠狀動脈造影檢查及心臟彩超檢查,根據(jù)冠狀動脈造影和心臟彩超結果對其冠狀動脈病變特點及左心室收縮及舒張功能進行分析比較。結果H型高血壓組和非H型高血壓組相比,兩組患者的年齡[(65.58±12.64)歲vs(63.08±9.94)歲,P0.05]、BMI[(25.10±3.65)kg/m~2vs(24.79±3.52)kg/m~2,P0.05]、糖尿病發(fā)病率(25.42%vs21.93%)、收縮壓[(142.3±19.82)mmHg vs(138.2±17.89)mmHg、P0.05]、舒張壓[(85.3±13.51)mmHg vs(83.7±11.7)mmHg],P0.05]、空腹血糖[(6.48±2.24)mmol/l vs(6.35±1.87)mmol/l,P0.05]、糖化血紅蛋白[(6.34±0.72)%vs(6.35±0.78)%,P0.05]、甘油三酯[(1.708±1.0)mmol/l vs(1.635±0.828)mmol/l,P0.05]、總膽固醇[(4.668±1.043)mmol/lvs(4.671±0.811)mmol/l,P0.05]、低密度脂蛋白膽固醇[(2.609±0.727)mmol/lvs(2.589±0.57)mmol/l,P0.05]均無顯著性差異。冠狀動脈造影結果顯示H型高血壓組患者冠狀動脈重度狹窄病變比例(55.8%vs14.9%,p0.05)高于非H型高血壓組,而輕度狹窄病變(1.7%vs 8.8%,p0.05)和中度狹窄病變比例(41.4%vs65.8%,p0.0001)低于非H型高血壓組;H型高血壓組患者三支血管病變比例(33.8%vs6.1%,p0.05)高于非H型高血壓組,兩支血管病變比例(14.6%vs8.8%,p0.05)無明顯統(tǒng)計學差異,而單支冠狀動脈病變比例(56.7%vs74.6%,p0.05)低于非H型高血壓組;H型高血壓組患者前降支病變比例(70%vs49.1%,p0.05)、回旋支病變比例(51.7%vs19.3%,p0.05)和右冠病變比例(62.5%vs23.7%,p0.05)均高于非H型高血壓組,兩組患者冠狀動脈左主干病變比例(1.7%vs0%,p0.05)無明顯統(tǒng)計學差異。H型高血壓組患者冠狀動脈病變積分[(23.96± 12.71vs(10.055±7.46),p0.05]明顯大于非H型高血壓組。心臟彩超結果顯示H型高血壓組反映左心室收縮功能的左心室射血分數(shù)[(63.66±4.878)%vs(65.13±3.468)%,p0.05]低于非H型高血壓組,而左心室質量指數(shù)[(141.89±2.73)g/m~2 vs(117.78±2.12)g/m~2,P0.01]和左心室室壁張力[(0.3944±0.0003)vs(0.3867±0.0062),P0.01]均高于非 H 型高血組。在反映左心室舒張功能的指標方面,H型高血壓組患者的左室等容舒張時間[(72.475±3.526)msvs(74.851 ±2.749)ms,P0.05]、舒張早期最大血流速度E峰和舒張晚期最大血流速度A峰的比值E/A[(0.946±0.254)vs(0.984±0.325),P0.05]都低于非H型高血壓組。H型高血壓組的舒張早期最大血流速度E峰[(73.84± 13.92)ms vs(67.63±8.21)ms,P0.05]高于非H型高血壓組。兩組患者的舒張晚期最大血流速度A峰值[(82.91 ± 15.73)msvs(76.15 ± 18.12)ms,P0.05]、二尖瓣環(huán)舒張早期e~'峰值[(5.721 ±0.842)ms vs(5.799± 1.035)ms,P0.05]、二尖瓣環(huán)舒張早期a'峰值[(9.115±1.298)ms vs(8.999±1.158)ms,P0.05]、二尖瓣環(huán)舒張早期e~'峰和a~'峰比值e~'/a~'[(0.645±0.124)vs(0.652±0.097),P0.05]、舒張早期最大血流速度E峰和二尖瓣環(huán)舒張早期e'峰比值E/e'[(13.181 ±2.854)vs(11.403±2.382),P0.05]相比較無明顯統(tǒng)計學差異。結論女性H型高血壓組患者和非H型高血壓患者在冠狀動脈病變,左心室收縮功能及部分左心室舒張功能上存在差異,女性H型高血壓患者的冠狀動脈粥樣硬化病變嚴重程度和左心室收縮及舒張功能減退程度均大于非H型高血壓組。在排除了年齡,吸煙史,血脂,血糖等因素后,血漿同型半胱氨酸濃度增高可能是女性高血壓患者冠狀動脈粥樣硬化病變及左心室功能減退的危險因素。
[Abstract]:Objective To investigate the effect of plasma homocysteine on coronary atherosclerosis and left ventricular function in female patients with hypertension.Methods 354 female patients with essential hypertension admitted to our cardiovascular department from January 2015 to June 2016 were divided into two groups according to their plasma homocysteine concentration. Plasma homocysteine concentration was 10 umol/l in H-type hypertension group (240 cases) and 10 umol/l in non-H-type hypertension group (114 cases). The age, body mass index, blood pressure, diabetes history, fasting blood glucose, glycosylated hemoglobin, triglyceride, total cholesterol, low density lipoprotein cholesterol and other major biochemical indicators were compared between the two groups. The coronary artery lesions and left ventricular systolic and diastolic function were analyzed and compared according to the results of coronary angiography and color Doppler echocardiography. BMI [(25.10 [(3.65) kg/m~2vs (24.79 [(24.79 [(3.52) kg/m~2 vs (24.79 [(3.52) kg/m~2, P 0.05], incidence of diabet (25.42% vs 21.93%),, systostolicblood pressure [(142.3 [(142.3 [19.82) mmHg vs (142.19.82) mmHvs (138.2 [(138.2 [17.2 [17.89) mmHg, P 0.05], diastostostostostostolicblood pressure [(85.3 [(85.3 [13.51) mmHvs (83.3 [83.7 [11./ l vs (6.35 + 1.87) mmol / l, P 0.05], HbA1c [(6.34 + 0. 72% vs (6.35 (0.78)%, P 0.05 [(1.708 (1.708 (1.708 1.0) mmol/L vs (1.635 (0.828) mmol/l, P 0.05], total cholesterostero [(4.668 1.043) mmol/l vs (4.668 1.043) mmol/l vs (4.671 1 (0.671 (0.671 0.811 0.811) mmol/L (4.671 (0.811) mmol/L (0.811) mmol/L, P 0.05, 0.05], low density lipolipoAngiography showed H-type hypertension The proportion of severe coronary stenosis (55.8% vs 14.9%, P 0.05) was higher in patients with H-type hypertension than that in patients with non-H-type hypertension, while the proportion of mild stenosis (1.7% vs 8.8%, P 0.05) and moderate stenosis (41.4% vs 65.8%, P 0.0001) was lower in patients with H-type hypertension than that in patients with non-H-type hypertension; the proportion of three vessel lesions (33.8% vs 6.1%, P 0.05) in patients with H-type hypertension was higher than that in patients with non-H-type hypertension, and the ratio of two vessel lesions ( The proportion of vascular lesions (14.6% vs 8.8%, p0.05) had no significant difference, but the proportion of single coronary artery lesions (56.7% vs 74.6%, p0.05) was lower than that of non-H-type hypertension group; the proportion of anterior descending artery lesions (70% vs 49.1%, p0.05), the ratio of circumflex artery lesions (51.7% vs 19.3%, p0.05) and the ratio of right coronary lesions (62.5% vs 23.7%, p0.05) in H-type hypertension group were higher than that of non-H-type hypertension group. There was no significant difference between the two groups in the proportion of left main coronary artery lesions (1.7% vs 0%, P 0.05). The score of coronary artery lesions [(23.96 + 12.71 vs 10.055 + 7.46), P 0.05] in the H-type hypertension group was significantly higher than that in the non-H-type hypertension group. Ejection fraction [(63.66 +4.878)% vs (65.13 +3.468)%, P 0.05] was lower than that of non-H hypertensive group, while left ventricular mass index [(141.89 +2.73) g/m~2 vs (117.78 +2.12) g/m~2, P 0.01] and left ventricular wall tension [(0.3944 +0.0003) vs (0.3867 +0.0062), P 0.01] were higher than those of non-H hypertensive group. Left ventricular isovolumic diastolic time [(72.475 (+3.526) MS vs (74.851 (+2.749) ms, P 0.05]) and the ratio of E/A [(0.946 (+0.254) vs (0.984 (+0.325), P 0.05] in early diastolic maximum velocity E [(73.84) in early diastolic phase and A peak in late diastolic phase] in hypertension group were lower than those in non-H hypertension group. [13.92] MS vs (67.63 + 8.21) ms, P 0.05] was higher than that in the non-H-type hypertension group. The peak value of late diastolic maximum blood flow velocity A [(82.91 + 15.73) MS vs (76.15 + 18.12) ms, P 0.05], the peak value of early diastolic e ~'in mitral annulus [(5.721 + 0.842) MS vs (5.799 + 1.035) ms, P 0.05], and the peak value of early diastolic a [(9.115 + 1.298) MS (8.999) ms, P 0.05]. There was no significant difference between the early diastolic e ~'/ a ~'[(0.645 + 0.124) vs (0.652 + 0.097), P 0.05], the early diastolic maximum blood flow rate E ~'/ (13.181 + 2.854) vs (11.403 + 2.382), P 0.05] and the early diastolic e ~'/ (11.403 + 2.382) vs (0.645 + 0.124) vs (0.652 + 0.097), P 0.05). The severity of coronary atherosclerosis and the degree of left ventricular systolic and diastolic dysfunction in female patients with H-type hypertension were greater than those in non-H-type hypertension. Age, smoking history, blood lipids, blood sugar were excluded. Increased plasma homocysteine concentration may be a risk factor for coronary atherosclerosis and left ventricular dysfunction in women with hypertension.
【學位授予單位】：南京醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R544.1

【參考文獻】

相關期刊論文 前10條

1 趙旭;余靜;;絕經(jīng)后高血壓的研究進展[J];中國全科醫(yī)學;2016年26期

2 張?zhí)斐?白鋒;余靜;王瓊英;張小衛(wèi);孫守剛;;國人同型半胱氨酸、高敏C反應蛋白及脂蛋白(a)與冠心病關系的Meta分析[J];山東醫(yī)藥;2016年33期

3 王琦;周艷輝;王康鳴;;同型半胱氨酸、胱抑素C、C反應蛋白與冠心病的相關性研究[J];重慶醫(yī)學;2016年18期

4 韓建倫;高剛利;馬靜;;高同型半胱氨酸血癥與冠脈病變關系的相關性研究[J];中西醫(yī)結合心腦血管病雜志;2016年07期

5 陳彥芳;安偉華;李彩英;孫英惠;趙朋英;;冠狀動脈粥樣硬化性心臟病患者Hcy、hs-CPR及cIMT檢測的臨床意義[J];臨床和實驗醫(yī)學雜志;2016年01期

6 任志靜;張晶;叢洪良;;H型高血壓與左心室重構的關系探討[J];天津醫(yī)藥;2016年03期

7 周偉;;冠心病患者血尿酸、同型半胱氨酸與冠脈病變嚴重程度關系[J];現(xiàn)代儀器與醫(yī)療;2015年06期

8 趙海鷹;;高血壓患者靶器官評估的重要性[J];臨床薈萃;2015年11期

9 曹銳紅;李獻良;;高血壓患者同型半胱氨酸水平與左室舒張功能的相關性[J];心血管康復醫(yī)學雜志;2015年05期

10 惠汝太;;高血壓早期靶器官損害的研究進展[J];中國循環(huán)雜志;2015年10期

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