血浆同型半胱氨酸浓度对女性高血压患者冠状动脉病变及左心室功能的影响

发布时间：2018-09-08 09:33

【摘要】：目的探讨血浆同型半胱氨酸浓度对女性高血压患者冠状动脉粥样硬化病变及左心室功能的影响。方法选择2015年1月至2016年6月在我院心血管内科住院的确诊为原发性高血压的女性患者354例,根据其血浆同型半胱氨酸的浓度分成2组,血浆同型半胱氨酸浓度10umol/l为H型高血压组(240例),10umol/l为非H型高血压组(114例),对两组患者的年龄,体重指数,血压,糖尿病史等基础资料,以及空腹血糖,糖化血红蛋白,甘油三酯、总胆固醇、低密度脂蛋白胆固醇等主要生化指标进行比较,并对两组患者行冠状动脉造影检查及心脏彩超检查,根据冠状动脉造影和心脏彩超结果对其冠状动脉病变特点及左心室收缩及舒张功能进行分析比较。结果H型高血压组和非H型高血压组相比,两组患者的年龄[(65.58±12.64)岁vs(63.08±9.94)岁,P0.05]、BMI[(25.10±3.65)kg/m~2vs(24.79±3.52)kg/m~2,P0.05]、糖尿病发病率(25.42%vs21.93%)、收缩压[(142.3±19.82)mmHg vs(138.2±17.89)mmHg、P0.05]、舒张压[(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]、糖化血红蛋白[(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]、总胆固醇[(4.668±1.043)mmol/lvs(4.671±0.811)mmol/l,P0.05]、低密度脂蛋白胆固醇[(2.609±0.727)mmol/lvs(2.589±0.57)mmol/l,P0.05]均无显著性差异。冠状动脉造影结果显示H型高血压组患者冠状动脉重度狭窄病变比例(55.8%vs14.9%,p0.05)高于非H型高血压组,而轻度狭窄病变(1.7%vs 8.8%,p0.05)和中度狭窄病变比例(41.4%vs65.8%,p0.0001)低于非H型高血压组;H型高血压组患者三支血管病变比例(33.8%vs6.1%,p0.05)高于非H型高血压组,两支血管病变比例(14.6%vs8.8%,p0.05)无明显统计学差异,而单支冠状动脉病变比例(56.7%vs74.6%,p0.05)低于非H型高血压组;H型高血压组患者前降支病变比例(70%vs49.1%,p0.05)、回旋支病变比例(51.7%vs19.3%,p0.05)和右冠病变比例(62.5%vs23.7%,p0.05)均高于非H型高血压组,两组患者冠状动脉左主干病变比例(1.7%vs0%,p0.05)无明显统计学差异。H型高血压组患者冠状动脉病变积分[(23.96± 12.71vs(10.055±7.46),p0.05]明显大于非H型高血压组。心脏彩超结果显示H型高血压组反映左心室收缩功能的左心室射血分数[(63.66±4.878)%vs(65.13±3.468)%,p0.05]低于非H型高血压组,而左心室质量指数[(141.89±2.73)g/m~2 vs(117.78±2.12)g/m~2,P0.01]和左心室室壁张力[(0.3944±0.0003)vs(0.3867±0.0062),P0.01]均高于非 H 型高血组。在反映左心室舒张功能的指标方面,H型高血压组患者的左室等容舒张时间[(72.475±3.526)msvs(74.851 ±2.749)ms,P0.05]、舒张早期最大血流速度E峰和舒张晚期最大血流速度A峰的比值E/A[(0.946±0.254)vs(0.984±0.325),P0.05]都低于非H型高血压组。H型高血压组的舒张早期最大血流速度E峰[(73.84± 13.92)ms vs(67.63±8.21)ms,P0.05]高于非H型高血压组。两组患者的舒张晚期最大血流速度A峰值[(82.91 ± 15.73)msvs(76.15 ± 18.12)ms,P0.05]、二尖瓣环舒张早期e~'峰值[(5.721 ±0.842)ms vs(5.799± 1.035)ms,P0.05]、二尖瓣环舒张早期a'峰值[(9.115±1.298)ms vs(8.999±1.158)ms,P0.05]、二尖瓣环舒张早期e~'峰和a~'峰比值e~'/a~'[(0.645±0.124)vs(0.652±0.097),P0.05]、舒张早期最大血流速度E峰和二尖瓣环舒张早期e'峰比值E/e'[(13.181 ±2.854)vs(11.403±2.382),P0.05]相比较无明显统计学差异。结论女性H型高血压组患者和非H型高血压患者在冠状动脉病变,左心室收缩功能及部分左心室舒张功能上存在差异,女性H型高血压患者的冠状动脉粥样硬化病变严重程度和左心室收缩及舒张功能减退程度均大于非H型高血压组。在排除了年龄,吸烟史,血脂,血糖等因素后,血浆同型半胱氨酸浓度增高可能是女性高血压患者冠状动脉粥样硬化病变及左心室功能减退的危险因素。
[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.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

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