冠心病合并高血压患者血浆同型半胱氨酸水平与血压变异性的相关性

张芳; 陈国藩; 王明伟; 任开涵

doi:10.16766/j.cnki.issn.1674-4152.002534

冠心病合并高血压患者血浆同型半胱氨酸水平与血压变异性的相关性

doi: 10.16766/j.cnki.issn.1674-4152.002534

杭州师范大学附属医院心血管科，浙江杭州 310015

基金项目:

浙江省卫生健康科技计划项目 2021KY890

详细信息

通讯作者:
张芳, E-mail: tuoluolia@163.com

中图分类号: R541.4 R544.1
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出版历程
- 收稿日期: 2021-11-12
- 网络出版日期: 2022-09-23

Correlation between plasma homocysteine and blood pressure variability in patients with coronary heart disease complicated with hypertension

Department of Cardiology, Hangzhou Normal University, Hangzhou, Zhejiang 310015, China

摘要

摘要: 目的探讨冠心病(CHD)合并高血压患者血浆同型半胱氨酸(Hcy)水平与血压变异性(BPV)的相关性。方法选取2019年2月—2020年6月在杭州师范大学附属医院住院治疗的冠心病合并高血压患者146例，根据Hcy是否升高分为观察组(Hcy水平≥10 mmol/L)78例和对照组(Hcy水平＜10 mmol/L)68例，比较2组的相关临床资料，分析血浆Hcy水平与BPV的相关性。结果观察组尿酸(UA)、总胆固醇(TC)、空腹血糖(FPG)、Hcy、24小时收缩压(24 h SBP)、24小时舒张压(24 h DBP)、24小时收缩压变异率(24 h SPV)、24小时舒张压变异率(24 h DPV)均明显高于对照组(t=23.379、4.233、2.632、111.075、4.254、9.452、20.989、8.631，均P＜0.01)；经Pearson相关性分析显示，UA、Hcy、TC分别与24 h SBP、24 h DBP、24 h SPV、24 h DPV呈正相关关系(r=0.349、0.286、0.413、0.351、0.507、0.512、0.518、0.568、0.326、0.198、0.348、0.192，均P＜0.05)；经多重线性回归分析，校正UA、TC对BPV各指标的影响，Hcy水平与24 h SBP(β=0.023，P=0.029)、24 h DBP(β=0.028，P=0.034)、24 h SPV(β=0.156，P=0.005)、24 h DPV(β=0.035，P=0.039)均呈正相关关系。结论 CHD合并高血压患者的Hcy与BPV呈正相关关系，二者可能在促进CHD的发生和发展中具有相互作用，临床应密切监测CHD合并高血压患者Hcy与BPV的变化，并积极控制Hcy与BPV水平，进而提高CHD的防治效果。
- 冠心病 /
- 高血压 /
- 血浆同型半胱氨酸 /
- 血压变异性
Abstract: Objective To investigate the correlation between plasma homocysteine (Hcy) and blood pressure variability (BPV) in patients with coronary heart disease (CHD) complicated with hypertension. Methods A total of 146 cases of patients with CHD with high blood pressure from February 2019 to June 2020 in the hospital treatment were selected. In accordance with high Hcy, they were divided into observation group (78 cases, Hcy≥10 mmol/L) and control group (68 cases, Hcy levels < 10 mmol/L). The related clinical data of the two groups were compared. The correlation between plasma Hcy levels and BPV was analysed. Results Uric acid (UA), total cholesterol (TC), fasting blood glucose, Hcy, 24-h systolic blood pressure (24-h SBP), 24-h diastolic blood pressure (24-h DBP), 24-h systolic blood pressure variation (24-h SPV) and 24-h diastolic blood pressure variation (24-h DPV) in the observation group were significantly higher than in the control group (t=23.379, 4.233, 2.632, 111.075, 4.254, 9.452, 20.989 and 8.631, respectively; all P < 0.01). Pearson correlation analysis showed that UA, Hcy and TC were correlated with 24 h SBP, 24 h DBP and 24-h SPV, respectively, whilst DPV was positively correlated (r=0.349, 0.286, 0.413, 0.351, 0.507, 0.512, 0.518, 0.568, 0.326, 0.198, 0.348, 0.192, all P < 0.05). The results of multiple linear regression analysis showed that the influence of UA and TC on BPV index was adjusted Hcy level was positively correlated with 24 h SBP (β=0.023, P=0.029), 24-h DBP (β=0.028, P=0.034), 24-h SPV (β=0.156, P=0.005) and 24-h DPV (β=0.035, P=0.039). Conclusion A positive correlation existed between Hcy and BPV in patients with CHD complicated with hypertension. Hcy and BPV may interact with each other in promoting the occurrence and development of CHD. The changes of Hcy and BPV in these patients should be closely monitored clinically and the levels of Hcy and BPV should be actively controlled to improve the prevention and treatment effect of CHD.
- Coronary heart disease /
- High blood pressure /
- Plasma homocysteine /
- Blood pressure variability

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表 1 2组CHD合并高血压患者一般资料比较

Table 1. Comparison of general data of CHD patients with hypertension between the two groups

组别	例数	性别[例(%)]		吸烟[例(%)]			糖尿病[例(%)]		年龄(x±s，岁)
组别	例数	男	女	是	否		是	否	年龄(x±s，岁)
观察组	78	46(58.97)	32(41.03)	31(42.31)	45(57.69)		23(29.49)	55(70.51)	62.91±2.82
对照组	68	37(54.41)	31(45.59)	27(39.71)	41(60.29)		21(30.88)	47(69.12)	62.79±2.83
统计量		0.308^a		0.018^a			0.034^a		0.256^b
P值		0.579		0.895			0.855		0.798

组别	例数	BMI(x±s)	FPG(x±s，mmol/L)	UA(x±s，μmol/L)		TG(x±s，mmol/L)		TC(x±s，mmol/L)	LDL(x±s，mmol/L)
观察组	78	24.17±2.48	7.23±0.75	418.23±13.48		1.52±0.36		4.67±0.72	2.38±0.37
对照组	68	23.96±2.63	6.82±0.81	365.27±13.85		1.59±0.21		4.12±0.85	2.49±0.63
统计量		0.496^b	2.632^b	23.379^b		-1.048^b		4.233^b	-1.306^b
P值		0.621	0.009	＜0.001		0.161		＜0.001	0.194

组别	例数	HDL(x±s，mmol/L)	Hcy(x±s，μmol/L)	24 h SBP(x±s，mm Hg)		24 h DBP(x±s，mm Hg)		24 h SPV(x±s)	24 h DPV(x±s)
观察组	78	1.12±0.15	12.13±0.25	11.35±1.81		8.82±0.85		0.16±0.03	0.15±0.05
对照组	68	1.08±0.32	7.85±0.21	10.13±1.63		7.53±0.79		0.08±0.01	0.09±0.03
统计量		0.987^b	111.075^b	4.254^b		9.452^b		20.989^b	8.631^b
P值		0.325	＜0.001	＜0.001		＜0.001		＜0.001	＜0.001
注：^a为χ²值，^b为t值。1 mm Hg=0.133 kPa。

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表 2 CHD合并高血压患者各临床指标与BPV各指标的Pearson相关分析

Table 2. Pearson correlation analysis of clinical indexes and BPV indexes in CHD patients with hypertension

项目	24 h SBP		24 h DBP		24 h SPV		24 h DPV
项目	r值	P值	r值	P值	r值	P值	r值	P值
年龄	0.152	0.108	-0.041	0.712	0.129	0.173	0.065	0.179
BMI	0.081	0.391	0.059	0.543	0.037	0.149	0.089	0.363
FPG	0.042	0.683	-0.053	0.538	0.087	0.365	-0.135	0.143
UA	0.349	＜0.001	0.286	0.002	0.413	＜0.001	0.351	＜0.001
TG	-0.145	0.126	-0.032	0.731	-0.158	0.087	-0.081	0.396
TC	0.326	＜0.001	0.198	0.032	0.348	＜0.001	0.192	0.041
LDL	-0.015	0.886	0.006	0.956	-0.108	0.253	-0.046	0.612
HDL	0.052	0.539	-0.056	0.536	0.087	0.366	-0.138	0.142
Hcy	0.507	＜0.001	0.512	＜0.001	0.518	＜0.001	0.568	＜0.001

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表 3 CHD合并高血压患者Hcy与BPV各指标的多重线性回归分析

Table 3. Multiple linear regression analysis of Hcy and BPV in CHD patients with hypertension

变量	β	SE	B	t值	P值
24 h SBP	0.023	0.019	0.677	1.986	0.029
24 h DBP	0.028	0.020	0.686	1.953	0.034
24 h SPV	0.156	0.132	1.459	2.865	0.005
24 h DPV	0.035	0.022	0.697	1.819	0.039

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