高血压人群高同型半胱氨酸血症的影响因素分析
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摘要
目的分析高血压人群高同型半胱氨酸血症的患病情况及其影响因素。方法采用横断面流行病学调查的方法,将纳入的5814例高血压患者分为高血清同型半胱氨酸组(以下简称"高Hcy组")与正常血清同型半胱氨酸组(以下简称"正常Hcy组"),描述两组患者一般情况,比较两组疾病史、疾病家族史以及生化指标等因素的差异。结果5814例中高Hcy组1694例(29.1%),正常Hcy组4120例(70.9%)。高Hcy组有男性1331例(78. 57%),女性363例(21.43%),正常Hcy组有男性1768例(42.91%),女性2352例(57.09%)。两组患者的性别差异具有统计学意义。高Hcy组的年龄和体质指数(BMI)的中位数与吸烟、饮酒和睡眠不好的比例均高于正常Hcy组(P <0.05),高Hcy组的脑卒中、冠心病、房颤、慢性肾脏病的患病率以及高血压家族史和糖尿病家族史的比例均较高(P <0. 05)。高Hcy组的血肌酐、甘油三酯和高密度脂蛋白浓度的中位数显著高于正常Hcy组(P<0.05),而其低密度脂蛋白、维生素B_(12)和叶酸的水平显著低于正常Hcy组(P<0.05)。多因素Logistic回归显示男性、年龄和慢性肾病是高Hcy的危险因素;血肌酐与Hcy之间呈正相关,而低密度脂蛋白、维生素B_(12)和叶酸水平与Hcy呈相关。结论男性、年龄和慢性肾脏病是高血压人群高同型半胱氨酸血症的危险因素;血肌酐、低密度脂蛋白、维生素B_(12)和叶酸水平与Hcy存在关联。
Objective To analyze the prevalence and influence factors of hyperhomocysteinemia(HHcy)among hypertention patients. Methods 5814 hypertension patients were recruited in this cross-sectional study and divided into two groups: participants with or without HHcy. Demographic variables were described and the differences between the two groups were compared in the history of diseases, family history of diseases and biochemical assay results using one way and multivariable logistic analysis. Results Among the 5814 subjects in this study,there were 1694 subjects(29.1%)in the HHcy group and 4120 subjects(70.9%)in the normal Hcy group. There were 1331 men(78. 57%) and 363 women(21. 43%)in the HHcy group and 1768 men(42.91%)and 2352 women(57.09%)in the normal Hcy group,respectively. The difference of the gender was statistically significant. The prevalence rates of smoking,drinking and poor sleep,and the median of age and the BMI in the HHcy group were all significantly higher than the normal group(P < 0. 05). The prevalence rates of stroke, coronary heart disease, atrial fibrillation and chronic kidney disease in high Hcy group were also higher than that in the normal group(P < 0. 05). The proportions of family history of hypertension and diabetes in HHcy group were also higher than the normal group(P <0. 05). And the medians of the serum creatinine, triglyceride and high-density lipoprotein in HHcy group were significantly higher than the normal group(P<0.05),while the medians of low density lipoprotein,vitamins B_(12) and folic acid were significantly lower than the normal group(P <0. 05). Results of multivariable logistic analysis showed that male, age and chronic kidney disease were the risk factors of HHcy; there was a positive correlation between the serum creatinine and HHcy, and there were negative correlations between the low density lipoprotein,vitamin B_(12) and folic acid levels. Conclusion Male,age and chronic kidney disease are the risk factors of HHcy; there are associations between HHcy and the serum creatinine,low density lipoprotein,vitamin B_(12) and folic acid levels.
Objective To analyze the prevalence and influence factors of hyperhomocysteinemia(HHcy)among hypertention patients. Methods 5814 hypertension patients were recruited in this cross-sectional study and divided into two groups: participants with or without HHcy. Demographic variables were described and the differences between the two groups were compared in the history of diseases, family history of diseases and biochemical assay results using one way and multivariable logistic analysis. Results Among the 5814 subjects in this study,there were 1694 subjects(29.1%)in the HHcy group and 4120 subjects(70.9%)in the normal Hcy group. There were 1331 men(78. 57%) and 363 women(21. 43%)in the HHcy group and 1768 men(42.91%)and 2352 women(57.09%)in the normal Hcy group,respectively. The difference of the gender was statistically significant. The prevalence rates of smoking,drinking and poor sleep,and the median of age and the BMI in the HHcy group were all significantly higher than the normal group(P < 0. 05). The prevalence rates of stroke, coronary heart disease, atrial fibrillation and chronic kidney disease in high Hcy group were also higher than that in the normal group(P < 0. 05). The proportions of family history of hypertension and diabetes in HHcy group were also higher than the normal group(P <0. 05). And the medians of the serum creatinine, triglyceride and high-density lipoprotein in HHcy group were significantly higher than the normal group(P<0.05),while the medians of low density lipoprotein,vitamins B_(12) and folic acid were significantly lower than the normal group(P <0. 05). Results of multivariable logistic analysis showed that male, age and chronic kidney disease were the risk factors of HHcy; there was a positive correlation between the serum creatinine and HHcy, and there were negative correlations between the low density lipoprotein,vitamin B_(12) and folic acid levels. Conclusion Male,age and chronic kidney disease are the risk factors of HHcy; there are associations between HHcy and the serum creatinine,low density lipoprotein,vitamin B_(12) and folic acid levels.
引文
[1]高艳玲,段淑荣.高同型半胱氨酸血症与脑梗死的相关性研究[J].神经疾病与精神卫生,2013,13(5):531-533.
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[4]李磊.脑梗死与高同型半胱氨酸的相关性研究[J].临床研究,2018,26(1):118-120.
[5]冯春宁,仲玲,王伟,等.高同型半胱氨酸血症的危险因素调查研究[J].中国实用医药,2012,7(29):109-110.
[6]王冬梅,张秋波.血清同型半胱氨酸测定在糖尿病肾病中的临床意义[J].分子影像学杂志,2017(2):190-193.
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[8] HAO L, MA J, ZHU J, et al. High prevalence of hyperhomocysteinemia in Chinese adults is associated with low folate,vitamin B12, and vitamin B6 status[J]. J Nutr, 2007,137(2):407-413.
[9] QIN X,LI J, CUI Y, et al. MTHFR C677T and MTR A2756G polymorphisms and the homocysteine lowering efficacy of differentdoses of folic acid in hypertensive Chinese adults[J]. Nutr J,2012,11:2.
[10] HOLMES M V, Newcombe P, Hubacek J A, et al. Effect modification by population dietary folate on the association between MTHFR genotype, homocysteine, and stroke risk:a meta-analysis of genetic studies and randomised trials[J]. Lancet, 2011,378(9791):584-594.
[11] WANG X,QIN X, DEMIRTAS H, et al. Efficacy of folic acid supplementation in stroke prevention:a meta-analysis[J]. Lancet.2007,369(9576):1876-1882.
[12] LI Y,HUANG T,ZHENG Y,et al. Folic Acid Supplementation and the Risk of Cardiovascular Diseases:A Meta-Analysis of Randomized Controlled Trials[J]. J Am Heart Assoc,2016,5(8).pit:e003768. doi:10. 1161/JAHA. 116.003768.
[13]肖昌亮.高血压前期患者血肌酐水平与血同型半胱氨酸的相关性研究[D].华中科技大学,2014.
[14]臧卫平,刘海涛,冯来会,等.脑卒中患者血浆同型半胱氨酸低密度脂蛋白与颈动脉斑块相关性研究[J].中国实用神经疾病杂志,2015(5):78-79.
[15]寇璐,秦勤.冠心病患者小而密低密度脂蛋白与血浆同型半胱氨酸水平的关系[J].天津医药,2010,38(9):774-776.
[2]王晶,刘家丰,郭兆慧,等.高同型半胱氮酸血症与老年急性脑梗死预后的关系研究[J]中华高血压杂志,2013(11):1100.
[3]张蓓,张红,罗秋华,等.青年脑梗死血清同型半胱氨酸和高敏C反应蛋白相关性的研究[A].中华医学会第十八次全国神经病学学术会议论文汇编[C].成都:中华医学会,2015:340-341.
[4]李磊.脑梗死与高同型半胱氨酸的相关性研究[J].临床研究,2018,26(1):118-120.
[5]冯春宁,仲玲,王伟,等.高同型半胱氨酸血症的危险因素调查研究[J].中国实用医药,2012,7(29):109-110.
[6]王冬梅,张秋波.血清同型半胱氨酸测定在糖尿病肾病中的临床意义[J].分子影像学杂志,2017(2):190-193.
[7]张彦,杨永长,范小明.血清同型半胱氨酸测定在糖尿病肾病中的临床意义[J].实验与检验医学,2011(1):53-54.
[8] HAO L, MA J, ZHU J, et al. High prevalence of hyperhomocysteinemia in Chinese adults is associated with low folate,vitamin B12, and vitamin B6 status[J]. J Nutr, 2007,137(2):407-413.
[9] QIN X,LI J, CUI Y, et al. MTHFR C677T and MTR A2756G polymorphisms and the homocysteine lowering efficacy of differentdoses of folic acid in hypertensive Chinese adults[J]. Nutr J,2012,11:2.
[10] HOLMES M V, Newcombe P, Hubacek J A, et al. Effect modification by population dietary folate on the association between MTHFR genotype, homocysteine, and stroke risk:a meta-analysis of genetic studies and randomised trials[J]. Lancet, 2011,378(9791):584-594.
[11] WANG X,QIN X, DEMIRTAS H, et al. Efficacy of folic acid supplementation in stroke prevention:a meta-analysis[J]. Lancet.2007,369(9576):1876-1882.
[12] LI Y,HUANG T,ZHENG Y,et al. Folic Acid Supplementation and the Risk of Cardiovascular Diseases:A Meta-Analysis of Randomized Controlled Trials[J]. J Am Heart Assoc,2016,5(8).pit:e003768. doi:10. 1161/JAHA. 116.003768.
[13]肖昌亮.高血压前期患者血肌酐水平与血同型半胱氨酸的相关性研究[D].华中科技大学,2014.
[14]臧卫平,刘海涛,冯来会,等.脑卒中患者血浆同型半胱氨酸低密度脂蛋白与颈动脉斑块相关性研究[J].中国实用神经疾病杂志,2015(5):78-79.
[15]寇璐,秦勤.冠心病患者小而密低密度脂蛋白与血浆同型半胱氨酸水平的关系[J].天津医药,2010,38(9):774-776.