摘要
目的探讨血清同型半胱氨酸(Hcy)水平对高血压前期患者进展为高血压的预测价值。方法选取2013年6月—2014年6月于上海市嘉定区南翔镇社区卫生服务中心进行体检的高血压前期患者421例为研究对象。收集其基线资料及实验室检查结果,并采用酶循环速率法测定血清Hcy水平。随访期间每年对研究对象进行一次常规体检,重点关注其高血压的发生情况。根据随访期间高血压前期患者是否进展为高血压,将所有患者分为高血压组(n=128)和非高血压组(n=293)。采用四分位法,根据421例高血压前期患者的Hcy水平将其分为4组,分别为Q1组(n=105):Hcy<11.2μmol/L,Q2组(n=105):Hcy水平为11.2~13.7μmol/L,Q3组(n=105):Hcy水平为13.8~16.4μmol/L,Q4组(n=106):Hcy>16.4μmol/L。比较高血压组与非高血压组的Hcy水平,比较不同Hcy水平患者的高血压发生率,探讨高血压前期进展为高血压的影响因素。结果平均随访时间为(2.6±0.9)年,421例高血压前期患者中,共有128例(30.4%)发展为高血压。高血压组基线年龄、男性比例、体质指数、收缩压、舒张压、空腹血糖、Hcy水平高于非高血压组,规律运动锻炼比例低于非高血压组,差异具有统计学意义(P<0.05)。Q1、Q2、Q3、Q4组高血压发生率分别为16.2%(17/105)、23.8%(25/105)、33.3%(35/105)、48.1%(51/106)。4组高血压发生率随着Hcy水平的增高而升高,差异有统计学意义(χ2趋势=28.320,P<0.001)。多因素Logistic回归分析结果显示,年龄、是否规律运动锻炼、体质指数、收缩压、Hcy水平是高血压前期患者进展至高血压的影响因素(P<0.05)。结论血清高Hcy水平是高血压前期进展为高血压的危险因素,提示监测血清Hcy水平有助于此类患者的危险分层及早期干预。
Objective To examine the predictive value of serum homocysteine(Hcy)level for the progression of prehypertension to hypertension.Methods Between June 2013 and June 2014,we recruited 421 individuals with prehypertension who received health examination in Jiading District Nanxiang Town Community Health Center,Shanghai.Baseline data including laboratory testing results were collected.Enzymatic cycling assay was used to determine the serum Hcy level.Based on the level of serum Hcy,they were classified into Q1 group(quartile 1:Hcy<11.2μmol/L,n=105),Q2 group(quartile 2:Hcy 11.2-13.7μmol/L,n=105),Q3 group(quartile 3:Hcy 13.8-16.4μmol/L,n=105)and Q4 group(quartile 4:Hcy>16.4μmol/L,n=106).During the follow-up period,all the participants underwent physical examination once a year,in particular,the incidence of hypertension was evaluated,and 128 were found with hypertension and 293 without were assigned to hypertension group,non-hypertension group,respectively.Comparisons were made between hypertension and non-hypertension groups in terms of serum Hcy level and between Hcy groups in respect to the incidence of hypertension.Moreover,the associated factors for the progression of prehypertension to hypertension were explored.Results The mean follow-up duration was(2.6±0.9)years,during which the incidence of hypertension was 30.4%.Compared with the non-hypertension group,hypertension group had higher mean age,mean BMI,mean systolic blood pressure(SBP),mean diastolic blood pressure(DBP),mean fasting blood glucose(FBG)and mean Hcy levels,and a higher proportion of men,but a lower proportion of patients who had regular physical activity at baseline(P<0.05).The incidence of hypertension in Q1,Q2,Q3 and Q4 groups was 16.2%(17/105),23.8%(25/105),33.3%(35/105)and 48.1%(51/106),respectively,indicating that it increased along with the elevation of Hcy levels(χ2 trend=28.320,P<0.001).Multivariate Logistic analysis revealed that age,regular physical activity,BMI,SBP and Hcy level were the associated factors of the progression to hypertension for prehypertension patients(P<0.05).Conclusion Elevated serum Hcy level is an independent risk factor for progression of prehypertension to hypertension,suggesting that measurement of Hcy may be helpful for the risk stratification and early management of these patients.
作者
侯惠丽
陈瑛
吴萍
许薇
顾海莉
HOU Hui-li;CHEN Ying;WU Ping;XU Wei;GU Hai-li(Jiading District Nanxiang Town Community Health Center,Shanghai 201802,China)
出处
《中国全科医学》
CAS
北大核心
2018年第22期2702-2706,共5页
Chinese General Practice
