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目的 分析原发性高血压人群同型半胱氨酸(Hcy)与脑血管功能积分的相关性.方法 对2015年10月—2018年3月在重庆市人民医院健康管理(体检)中心同时进行血清Hcy和脑血管功能检测的2 767例原发性高血压人群进行横断面调查,了解高血压人群高同型半胱氨酸血症(HHcy)的检出情况,采用方差分析、χ2检验和秩和检验分析不同Hcy水平的脑血管功能积分值及其异常率的差异,采用Logistic回归分析Hcy水平与脑血管功能积分的相关性.结果 2 767例原发性高血压人群Hcy浓度为11.8(9.3～15.0)μmol/L,HHcy的检出率为25.15%(男性27.01%,女性19.80%),男性高于女性(χ2=14.576,P<0.001),男性和女性HHcy检出率随着年龄的增长均呈上升趋势(P均<0.001).脑血管功能积分异常组(<75分)在卒中病史比例、服用降压药比例、年龄、空腹血糖、收缩压、脉压和Hcy水平上均高于积分正常组(≥75分),差异有统计学意义(P均<0.001).原发性高血压人群脑血管功能积分为(86.99±16.10)分,其中Hcy最高四分位组的积分值为(77.91±23.77)分,明显低于其他四分位组(P均<0.001).脑血管功能积分总体异常率(<75分)为15.25%,异常率随着Hcy水平的升高呈上升趋势(χ2=13.986,P<0.001).Logistic回归结果显示,校正性别、年龄、卒中病史、服药史等混杂因素后,Hcy第二、第三和最高四分位组发生脑血管功能积分异常的风险分别是最低四分位组的1.913、2.045和7.497倍(P均<0.001).结论 原发性高血压人群中Hcy与脑血管功能积分异常相关.当Hcy≥15 μmol/L时,脑血管功能异常显著加重,需引起重视.

Objective To investigate the correlation between homocysteine (Hcy) and cerebrovascular hemodynamic accumulative scores in primary hypertension patients. Methods A cross-sectional survey was conducted in 2 767 patients with essential hypertension who were simultaneously tested for serum Hcy and cerebral vascular function in the health management/physical examination center in Chongqing General Hospital from October 2015 to March 2018. The prevalence of hyperhomocysteinemia (HHcy) was also explored. Differences between cerebrovascular hemodynamic accumulative scores and its abnormal rate among different Hcy levels were evaluated using the analysis of variance and χ2tests, and logistic regression was used to analyze the correlation between Hcy and cerebrovascular hemodynamic accumulative scores. Results The median level of Hcy in primary hypertension was 11.8 (9.3-15.0) μmol/L. HHcy prevalence was 25.15% (27.01% in men and 19.80% in women), which was higher in men than women (χ2=14.576, P<0.001) and was increasing with age (P<0.001). The proportion of stroke, proportion of taking hypotensive medications, age, fasting plasma glucose, systolic pressure, pulse pressure, and Hcy were significantly higher in the abnormal score (<75 points) group (P<0.001) than in the normal score (≥75 points) group. The average cerebrovascular hemodynamic accumulative score was 86.99±16.10 points. The score in the highest quartile of Hcy (77.91±16.10) was significantly lower than that in other quartiles. The abnormal score rate (<75 points) was 15.25% and was increasing with the Hcy level (χ2=13.986, P<0.001). Logistic regression showed that Hcy in the second, third, and highest quartiles observed in abnormal scores was, respectively, 1.913-fold, 2.045-fold, and 7.497-fold higher than that in the lowest quartile after adjusting the confounding factors. Conclusion Hcy may be an independent risk factor for abnormal cerebrovascular hemodynamic accumulative scores in primary hypertension. Cerebrovascular dysfunction should be closely monitored when Hcy was higher than 15 μmol/L.