【摘要】：同型半胱氨酸(homocysteinemia Hcy)是體內(nèi)甲硫氨酸即蛋氨酸循環(huán)過(guò)程中所產(chǎn)生的中間物質(zhì),不能直接合成蛋白質(zhì),2010年中國(guó)高血壓防治指南將血漿Hcy濃度10μmol/L定義為高同型半胱氨酸血癥(hyperhomocysteinemia HHcy)。大量的流行病學(xué)調(diào)查以及臨床實(shí)驗(yàn)均顯示,輕度至中度的Hcy升高是血管缺血性疾病的重要因素之一,獨(dú)立于傳統(tǒng)的動(dòng)脈硬化風(fēng)險(xiǎn)因素。目的:研究血漿同型半胱氨酸水平與頸動(dòng)脈粥樣硬化及狹窄程度的相關(guān)性。方法:入選2015年12月至2016年11月之間于吉林大學(xué)第二醫(yī)院老年病科就診,且行頸動(dòng)脈彩色多普勒超聲檢查的495例患者作為研究對(duì)象。其中包括女性205例,男性290例,平均年齡為64.92±9.16歲。其中除外口服B族維生素、葉酸、避孕藥等影響同型半胱氨酸代謝藥物的患者,除外心源性及其他原因所致頸動(dòng)脈血栓的患者,排除心肺肝腎功能衰竭、甲狀腺功能障礙患者。所有入選患者均于入院后采集空腹肘靜脈血,測(cè)定血常規(guī)、肝功能、血脂、腎功能、血糖及同型半胱氨酸等指標(biāo),詳細(xì)詢問(wèn)既往有無(wú)糖尿病、高血壓病病史及吸煙飲酒史,并采用頸動(dòng)脈彩色多普勒超聲儀檢查患者頸動(dòng)脈內(nèi)中膜厚度(Inner medial thickness IMT)、有無(wú)斑塊形成以及斑塊性質(zhì),綜合評(píng)估患者頸動(dòng)脈粥樣硬化及狹窄程度,根據(jù)檢查結(jié)果將患者分為正常組、IMT增厚組、斑塊形成組、中重度狹窄組,將頸動(dòng)脈正常組定義為對(duì)照組,采用單因素方差分析比較四組之間血漿Hcy水平,研究血漿Hcy水平與頸動(dòng)脈粥樣硬化及狹窄程度之間的相關(guān)性,采用非參數(shù)檢驗(yàn)分析比較其他因素與頸動(dòng)脈粥樣硬化的相關(guān)性,最后采用多元線性回歸分析,排除其他因素影響后,確定哪幾種因素是預(yù)測(cè)頸動(dòng)脈粥樣硬化的獨(dú)立危險(xiǎn)因素。所有數(shù)據(jù)均應(yīng)用SPSS22.0軟件包進(jìn)行統(tǒng)計(jì)學(xué)處理,所有分析結(jié)果均以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1頸動(dòng)脈粥樣硬化組患者年齡及吸煙患者所占比例明顯高于對(duì)照組,兩組比較均有明顯統(tǒng)計(jì)學(xué)差異(P0.05)。2動(dòng)脈粥樣硬化組患者的血漿Hcy水平明顯高于對(duì)照組,兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05);頸動(dòng)脈粥樣硬化各組之間血漿Hcy水平比較發(fā)現(xiàn),IMT增厚組斑塊形成組中重度狹窄組,各組之間差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。3頸動(dòng)脈粥樣硬化組患者的超敏C反應(yīng)蛋白(Hypersensitive C reactive protein HSCRP)水平明顯高于對(duì)照組,兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05);頸動(dòng)脈粥樣硬化組患者的尿酸(Uric acid UA)水平明顯高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4男性患者的血漿Hcy水平明顯高于女性患者,且兩者存在顯著統(tǒng)計(jì)學(xué)差異(P0.05);吸煙患者的血漿Hcy水平高于非吸煙患者,兩者差異有統(tǒng)計(jì)學(xué)意義(P0.05)。5在校正了性別、年齡、高血壓、糖尿病、膽固醇(Cholesterol CHOL)、低密度脂蛋白(Low-density lipoprotein LDL)、同型半胱氨酸、尿酸、甘油三酯(Triglycerides TG)、超敏C反應(yīng)蛋白等因素的影響后,性別、年齡、同型半胱氨酸以及超敏C反應(yīng)蛋白均可以作為預(yù)測(cè)頸動(dòng)脈粥樣硬化及狹窄程度的獨(dú)立危險(xiǎn)因素。結(jié)論:1血漿同型半胱氨酸水平與頸動(dòng)脈粥樣硬化及狹窄程度呈明顯正相關(guān),血漿Hcy水平越高,患者頸動(dòng)脈粥樣硬化及狹窄程度越重。2在校正了性別、年齡、高血壓、糖尿病、CHOL、TG、LDL、Hcy、UA、HSCRP等因素的影響后,血漿同型半胱氨可以作為預(yù)測(cè)頸動(dòng)脈粥樣硬化及狹窄程度的獨(dú)立危險(xiǎn)因素。
[Abstract]:The same type of cysteine (Hcy) is the intermediate substance produced during the circulation of methionine in the body, which cannot be directly synthesized. In 2010, the Chinese hypertension prevention and control guideline defined plasma Hcy concentration of 10. m u.mol/ L as hyperhomocysteinemia HHcy. A large number of epidemiological investigations and clinical trials show that mild to moderate Hcy elevation is one of the important factors in vascular ischemic diseases, independent of traditional risk factors for arteriosclerosis. Objective: To study the correlation between plasma homocysteine level and carotid atherosclerosis and stenosis degree. Methods: 495 patients were enrolled in the geriatrics department of the Second Hospital of Jilin University from December 2015 to November 2016, and 495 patients with carotid color Doppler ultrasound were used as research subjects. Among them, 205 males and 290 males were females, with an average age of 64. 92 and 9. 16 years. The patients with carotid thrombosis associated with the same type of cysteine metabolism, except cardiogenic and other causes, excluded from the group B vitamins, folic acid, and contraceptives, excluded cardiopulmonary and renal function failure and thyroid dysfunction. All enrolled patients were admitted to the hospital to collect fasting cubitus venous blood, determine blood routine, liver function, blood lipid, renal function, blood glucose and homocysteine and so on. The carotid artery color Doppler ultrasound was used to examine the thickness of carotid artery (IMT), plaque formation and plaque properties, and the carotid atherosclerosis and stenosis degree of patients were evaluated. The correlation between plasma Hcy level and carotid atherosclerosis and stenosis degree was studied by using single factor analysis of variance to compare plasma Hcy level between the four groups. The correlation between other factors and carotid atherosclerosis was analyzed by non-linear regression analysis. Finally, multivariate linear regression analysis was used to determine which factors were the independent risk factors for predicting carotid atherosclerosis. All the data were treated with SPSS22. 0 software package. All the results were statistically significant with P0.05. Results: The proportion of patients with carotid atherosclerosis was significantly higher than that in control group (P <0.05). The plasma Hcy level in atherosclerotic group was significantly higher than that in control group (P <0.05). 棰堝姩鑴夌播鏍風(fēng)‖鍖栧悇緇勪箣闂磋嫻咹cy姘村鉤姣旇緝鍙戠幇,IMT澧炲帤緇勬枒鍧楀艦鎴愮粍涓噸搴︾嫮紿勭粍,鍚勭粍涔嬮棿宸紓鍧囨湁緇熻瀛︽剰涔，

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