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目的研究高血压患者颈动脉粥样硬化与同型半胱氨酸相关性及其城乡差异。方法纳入2012年9月~2013年1月参加“东营市脑卒中筛查与防治项目”的高血压患者2 132人,进行问卷调查、体格检查、血生化检查和颈部血管超声检查。按Hcy水平的三分位数将患者分为3组,第1组(≤12.3μmol/L)716人,第2组(12.3~16.5μmol/L)703人,第3组(≥16.5μmol/L)713人。比较3组Hcy水平及其对颈动脉斑块的影响和城乡差异。结果 1第1、2、3组的颈动脉斑块的患病率分别为50.28%、60.03%、65.36%;第2组颈动脉斑块的发生率高于第1组,其差异有统计学意义[OR=1.485,95%CI(1.203,1.833),P=0.000];第3组的发生率高于第1组,其差异有统计学意义[OR=1.866,95%CI(1.508,2.308),P=0.000]。2农村高血压人群颈动脉斑块的现患率为62.24%,城市的现患率为52.39%,农村和城市差异有统计学意义[OR=1.500,95%CI(1.259,1.788),P=0.000]。3以颈动脉有无斑块为因变量,Hcy水平为协变量构建logistic回归模型发现,第2组斑块形成是第1组的1.491倍,第3组斑块形成是第1组的1.752倍。以第1组为参照,对危险因素(性别、年龄、BMI、TG、TC、LDL-C、HDL-C和血糖)进行校正后,第2组斑块形成是第1组的1.388倍,第3组斑块形成是第1组的1.452倍。结论高血压患者Hcy水平的增高与颈动脉斑块的发生率增加具有相关性;农村高血压人群颈动脉斑块的发生率高于城市;对高血压人群来说,高水平的Hcy是颈动脉斑块形成的独立危险因素。
Objective To study the association between carotid atherosclerosis and homocysteine in urban hypertensive patients and their differences between urban and rural areas. Methods A total of 2 132 hypertensive patients who participated in “Dongying Stroke Screening and Prevention Project” from September 2012 to January 2013 were investigated by questionnaires, physical examinations, blood biochemical tests and neck vascular ultrasonography. Patients were divided into 3 groups according to Hcy level: 716 in group 1 (12.3μmol / L), 703 in group 2 (12.3-16.5μmol / L), group 3 (≥16.5μmol / L) 713 people. The levels of Hcy in 3 groups and their effects on carotid plaque and urban-rural differences were compared. Results 1 The prevalence of carotid plaques in groups 1, 2 and 3 were 50.28%, 60.03% and 65.36%, respectively. The incidence of carotid plaque in group 2 was higher than that in group 1, and the difference was statistically significant (OR = 1.485,95% CI 1.203,1.833, P = 0.000). The incidence of the third group was higher than that of the first group (OR = 1.866,95% CI 1.508,2.308 ), P = 0.000]. The prevalence rate of carotid artery plaque was 62.24% in rural hypertensive population and 52.39% in urban area. There was significant difference between rural and urban areas (OR = 1.500, 95% CI 1.259,1.788, P = 0.000) . 3 With plaque-free carotid artery as the dependent variable and Hcy level as the covariate, we found that the plaque formation in group 2 was 1.491 times of that in group 1 and 1.752 times in group 3 . After adjusting for risk factors (gender, age, BMI, TG, TC, LDL-C, HDL-C and blood glucose) based on the first group, plaque formation in the second group was 1.388 times that of the first group, Three groups of plaque formation is 1.452 times of the first group. Conclusions The increase of Hcy in hypertensive patients is correlated with the increase of carotid artery plaque. The incidence of carotid plaque in rural hypertensive patients is higher than that in urban areas. For hypertensive patients, high Hcy is the risk of carotid Independent risk factors for plaque formation.