原发性高血压患者颈动脉内膜中层厚度与同型半胱氨酸、高敏C反应蛋白及血压变异性的相关研究

发布时间：2018-05-12 19:04

本文选题：原发性高血压 + 同型半胱氨酸　；参考：《安徽医科大学》2016年硕士论文

【摘要】：目的：本课题主要观察原发性高血压(essential hypertension, EH)患者人群中血浆同型半胱氨酸(homocysteine, Hcy)、高敏C反应蛋白(high-sensitivity C-reactive protein, hsCRP)的含量,以及动态血压变异性(blood pressure variability, BPV),以探讨其与颈动脉内膜中层厚度(carotid intima-media thickness, cIMT)之间的相互关系。方法：选取2014年1月至2014年12月入住安徽省立医院心血管内科的确诊为EH患者215例。其中包括124例男性,91例女性。这些患者年龄分布在27岁到86岁,平均年龄62±11岁,依据颈动脉超声检查结果,将入选病例分为三组,IMT正常组、IMT增厚组、斑块组。纳入IMT正常组69名患者,其中.37名男性,32名女性,平均年龄61±11岁；纳入IMT增厚组74名患者,其中44名男性,30名女性,平均年龄61±11岁；纳入斑块组72名患者,其中43名男性,29名女性,平均年龄65±10岁。给予所有患者行血浆一般生化检查：血总胆固醇(total cholesterol, TC)、甘油三酯(triglyceride, TG)、高密度脂蛋白(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白(low-density lipoprotein cholesterol, LDL-C)、血肌酐(serum creatinine, SCr);并行血浆Hcy, hsCRP检查,使用动态血压监测(ambulatory blood pressure monitoring, ABPM)得反映BPV参数：24小时收缩压标准差(24hour systolic blood pressure standard deviation,24hSSD)、24小时舒张压标准差(24hour diastolic blood pressure standard deviation,24hDSD)、日间收缩压标准差(day systolic blood pressure s tandard dev i at i on, dSSD)、夜间收缩压标准差(night systolic blood pressure standard deviation, nSSD)、日间舒张压标准差(day diastolic blood pressurestandard deviation, dDSD)、夜间舒张压标准差(night diastolic blood pressure standard deviation, nDSD),进行统计学分析,以评价Hcy、hsCRP和BPV的相关指标与cIMT之间的相关性。结果：在年龄、性别、TC、TG、HDL-C、LDL-C、SCr指标的比较上,三组患者之间没有统计学差异(P0.05),提示三组之间具有可比性；三组间的hsCRP和Hcy水平存在统计学差异(P0.01),其中斑块组、IMT增厚组与IMT正常组比较hsCRP和Hcy水平明显增加,斑块组hsCRP和Hcy水平比IMT增厚组明显增高;三组间24hSSD、dSSD、nSSD水平有明显的统计学差异(P0.01),其中斑块组、IMT增厚组与IMT正常组比较24hSSD、dSSD、nSSD水平明显增加,斑块组24hSSD、dSSD、 nSSD水平比IMT增厚组明显增高；线性相关分析提示：IMT与hsCRP、Hey、24hSSD、 dSSD、nSSD、 nDSD之间存在显著正相关,r值分别为0.643、0.732、0.407、0.522、0.538、0.180(均P0.01)结论：1.在EH患者中,颈动脉粥样硬化(carotid atherosclerosis,CAS)的程度越重,hsCRP、Hcy水平以及收缩压的变异性(24hSSD、dSSD、nSSD)越高；2.在EH患者中,cIMT与hsCRP、Hcy、24hSSD、dSSD、nSSD、nDSD之间存在显著正相关。
[Abstract]:Objective: to observe the plasma homocysteine (Hcy), Gao Min C-reactive protein high-sensitivity C-reactive protein (hsCRP-) in patients with essential hypertension (EH). The relationship between blood pressure variability and carotid intima-media thickness carotid intima-media thicknesswas studied. Methods: 215 EH patients admitted to Anhui Provincial Hospital from January 2014 to December 2014 were selected. Among them, 124 cases were male and 91 cases were female. The age of these patients ranged from 27 to 86 years old, with an average age of 62 卤11 years. According to the results of carotid ultrasound, the patients were divided into three groups: IMT thickening group and plaque group. There were 69 patients in the normal IMT group, including .37 males and 32 females with an average age of 61 卤11 years, 74 patients in the IMT thickening group, including 44 males and 30 females with an average age of 61 卤11 years, and 72 patients in the plaque group. There were 43 males and 29 females with an average age of 65 卤10 years. All patients were given plasma general biochemical tests: total cholesterol, TCU, triglyceride, TGN, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, LDL-CU, serum creatinine, serum hcy, hsCRP. Using ambulatory blood pressure monitoring (ABPM) blood pressure monitoring, ABPM) to reflect the BPV parameters: 24 hour systolic blood pressure standard deviation and 24 hour systolic blood pressure standard deviation, 24 hour diastolic blood pressure standard deviation, day to day systolic blood pressure s tandard dev i at i on, dSSDD, nighttime DBP standard deviation, 24 hour DBP standard deviation and 24 hour DBP standard deviation, day to day systolic blood pressure standard deviation. The standard deviation of systolic blood pressure (night), day diastolic blood pressure (DBP), night diastolic blood pressure (DBP) and night diastolic blood pressure (DBP) were analyzed statistically. To evaluate the correlation between hsCRP and BPV and cIMT. Results: there was no statistical difference between the three groups in the age, sex and HDL-CU LDL-Cr, suggesting that there was comparability among the three groups. There were significant differences in hsCRP and Hcy levels among the three groups (P 0.01). The hsCRP and Hcy levels in the plaque group were significantly higher than those in the normal IMT group, and the hsCRP and Hcy levels in the plaque group were significantly higher than those in the IMT thickening group. There was significant statistical difference among the three groups in 24 h SSDD dSSDnSSD levels. The level of SSDD dSSDnSSD in the plaque group was significantly higher than that in the normal IMT group at 24 h, and the nSSD level in the plaque group was significantly higher than that in the IMT thickening group. The linear correlation analysis showed that there were significant positive correlation r values between nDSD and hsCRPnSSD24hSSD, dSSD-nSSDand nDSD, respectively. Conclusion: 1. In EH patients, the higher the degree of carotid atherosclerosis carotid atherosclysis (CAS) was, the higher the Hcy level of hsCRP and the variability of systolic blood pressure were 24 h SSDD SSDnSSDnSSD2. In EH patients, there was a significant positive correlation between cIMT and 24 h SSDN dSSDN nSSDnDSD.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R544.1

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