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高血压是指以体循环血压升高为主要特征的慢性疾病,可造成心、脑、肾等器官功能损伤,也是诱发心脑血管疾病的高危因素[1]。有研究[2]指出,预计到2025年,我国高血压病人占总人数比重将达到20%,且随着我国老年人口的增多,高血压的发生率也不断升高,成为我国社会的重要负担。高血压本身并不可怕,但是很多病人在发病之后未能及时采取有效的干预措施和治疗手段,会引起多种慢性并发症,例如高血压肾病、脑卒中等,对病人的健康造成了较大威胁[3]。同型半胱氨酸(Hcy)是一种含硫氨基酸,是蛋氨酸与半胱氨酸代谢的中间产物,本身不参与蛋白质的合成,近年来临床医学发现血清Hcy是动脉粥样硬化的独立危险因素[4]。血压变异性(BPV)升高是高血压病人出现靶器官损伤的高危因素[5],老年人由于压力感受器的敏感性降低,当BPV升高后,心血管风险事件也进一步提升。心脏作为高血压损伤的常见靶器官,以左心功能损伤的发生最早,从而影响病人的心功能。本研究对老年高血压病人和非高血压老年病人进行观察,分析老年高血压病人Hcy水平、动态BPV与左心室射血分数(LVEF)的关系。现作报道。
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观察组血清Hcy水平为(20.80±4.59)μmol/L,明显高于对照组的(11.21±2.50)μmol/L(t=18.35,P < 0.01)。
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收缩压方面,观察组24 h SSD、D-SSD、N-SSD均明显高于对照组(P < 0.01);舒张压方面,2组24 h DSD、D-DSD、N-DSD差异均无统计学意义(P>0.05)(见表 1)。
分组 24 h SSD D-SSD N-SSD 24 h DSD D-DSD N-DSD 观察组 15.13±3.40 15.68±1.69 14.58±4.45 9.85±4.01 9.68±2.36 10.02±5.16 对照组 12.14±2.73 14.22±1.31 10.06±2.13 9.88±3.90 9.81±2.52 9.94±4.92 t 6.86 6.83 9.16 0.05 0.38 0.11 P < 0.01 < 0.01 < 0.01 >0.05 >0.05 >0.05 表 1 2组病人动态BPV比较(n=100;x±s)
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观察组LVEF为(48.8±6.5)%,明显低于对照组的(53.6±7.3)%(t=4.91,P < 0.01)。
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Pearson相关分析显示,老年高血压病人血清Hcy与LVEF呈负相关关系(r=-0.263,P < 0.05),24 h SSD、D-SSD、N-SSD与LVEF均呈正相关关系(r=0.331、0.338、0.171,P < 0.05)。
老年高血压病人Hcy水平、动态血压变异性与左心室射血分数的关系分析
Analysis of the relationship between the Hcy level, ambulatory blood pressure variability and left ventricular ejection fraction in elderly patients with hypertension
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摘要:
目的探讨老年高血压病人同型半胱氨酸(Hcy)水平、动态血压变异性(BPV)与左心室射血分数(LVEF)的关系。 方法选取老年高血压病人100例作为观察组, 同期选取非高血压老年病人100例设为对照组, 比较2组病人血清Hcy水平、动态BPV指标和LVEF, 分析Hcy、BPV指标与LVEF的相关性。 结果观察组病人血清Hcy水平明显高于对照组(P < 0.01);24 h收缩压标准差、白天收缩压标准差、夜间收缩压标准差均明显高于对照组(P < 0.01), 2组舒张压相应指标差异均无统计学意义(P>0.05);观察组LVEF明显低于对照组(P < 0.01)。Pearson相关分析显示, 老年高血压病人血清Hcy与LVEF呈负相关关系(P < 0.05), 24 h收缩压标准差、白天收缩压标准差、夜间收缩压标准差与LVEF均呈正相关关系(P < 0.05)。 结论相较于血压正常老年群体, 老年高血压病人血清Hcy、动态收缩压标准差水平明显偏高, LVEF明显偏低, 且三者之间具有相关性。 Abstract:ObjectiveTo investigate the relationship between the homocysteine(Hcy) level, ambulatory blood pressure variability(BPV) and left ventricular ejection fraction(LVEF) in elderly patients with hypertension. MethodsA total of 100 elderly patients with hypertension and 100 elderly patients without hypertension were divided into the observation group and control group, respectively.The serum Hcy level, ambulatory BPV index and LVEF between two groups were compared, and the correlation between Hcy, BPV index and LVEF were analyzed. ResultsThe serum Hcy level in observation group was significantly higher than that in control group(P < 0.01), the standard deviation of 24 h systolic blood pressure, day systolic blood pressure and night systolic blood pressure in observation group were significantly higher than those in control group(P < 0.01), there was no statistical significance in the diastolic blood pressure index between two groups(P>0.05), and the LVEF in observation group was significantly lower than that in control group(P < 0.01).The results of Pearson correlation analysis showed that the serum Hcy level was negatively correlated with LVEF(P < 0.05), and the standard deviation of 24 h systolic blood pressure, day systolic blood pressure and night systolic blood pressure were positively correlated with LVEF in elderly patients with hypertension(P < 0.05). ConclusionsCompared with the elderly group with normal blood pressure, the level of standard deviation of serum Hcy and ambulatory systolic blood pressure are significantly high, the level of LVEF is significantly low, and there is a correlation among the three. -
表 1 2组病人动态BPV比较(n=100;x±s)
分组 24 h SSD D-SSD N-SSD 24 h DSD D-DSD N-DSD 观察组 15.13±3.40 15.68±1.69 14.58±4.45 9.85±4.01 9.68±2.36 10.02±5.16 对照组 12.14±2.73 14.22±1.31 10.06±2.13 9.88±3.90 9.81±2.52 9.94±4.92 t 6.86 6.83 9.16 0.05 0.38 0.11 P < 0.01 < 0.01 < 0.01 >0.05 >0.05 >0.05 -
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