| Objectives In this study,through biochemical detector using the colour Doppler ultrasonograph in patients with hypertension,carotid artery, and evaluate the degree of carotid artery atherosclerosis. To clear high homocysteine is risk factor for atherosclerosis,and to explore the relationship between homocysteine and atherosclerosis and high homocysteine hyperlipidemia and hypertension the synergistic effect of different. In order to atherosclerosis H type hypertension patients to take early and effective, reasonable treatment measures, reduce the incidence of cardiovascular and cerebrovascular disease and provide a theoretical basis.Methods 1 The object of study: from 2014 January to December, North China University of And Techology,Tangshan City people’s hospital outpatient or hospitalized patients with hypertension 245 cases, carry on the detailed history of all subjects, with the subject of the study wererecorded: age, sex, systolic blood pressure and diastolic blood pressure were recorded, no history of diabetes, with or without coronary heart disease history, smoking history, drinking history, there is NO. 2 All of the subjects of venous blood, and blood biochemical examination:total cholesterol(TC), triglyceride(TG), low density lipoprotein cholesterol(LDL-C), fasting blood glucose(Glu), homocysteine(Hcy), homocysteine(Hcy),the results of biochemical examination records. 3 All of the subjects of neck vascular color Dopper ultrasound examination:(1) the anatomic characteristics of evaluation subjects carotid artery, blood flow velocity was recorded inpatients with bilateral neck vessls,observation of caroid artery dilatation and stenosis, carotid artery without occlusion.(2)measurement of neck vascular IMT.(3)with observation ofall the subjects with and without formation of carotid artery atherosclerotic plaque, such as found in the bilateral carotid atherosclerotic plaque formation, it should be a detailed record of carotid atherosclerosis plaque location, number and size of plaque echo characteristics, record according to the number of plaque or the largest patch for the vessel lumen ratio were evaluated plaque. 4 All of the subjects according to their blood levels of homocysteine were divided into three groups: A group(15μmol/L <Hcy≤ 30μmol/L), group B(Hcy>30μmol/L) and C grouph(Hcy≤15μmol/L). The research object of A group were 60 case,including 60 cases,including 40 cases of male, female 20 cases, average age(74.8±8.5). B group of 100 cases, including 70 case of male, female 30 case, average age(70.6±6.5). C group of 85 cases, including 55 cases male, 30 female, mean age(74.4±5.9) years old.Results 1 A, B, C between the three groups in age, gender differences, there are no history of diabetes,history of coronary heart disease, the proportion of the proportion of smoking and drinking history,blood pressure level,the proportion of TC, TG, LDL-C, Glu,the difference was not statistically significant(P>0.05). 2 The results of carotid ultrasongraphy(1)In group A, a total of 35 patients were detected in the plaque, the plaque detection rate was 58.3%(35/60). group B, a total of 95 patients were detected in the plaque, plaque detection rate was 95%(95/100). group C, a total of 15 patients were detected in the plaque, plaque detection rate was 17.6%(15/85).In A group, 25 case were detected in the unstable plaque(soft plaque and mixed plaque), the plaque detection rate was41.7%(25/60), 80 patients in group B were unstable plaque(soft plaque and mixed plaque), the plaque detection rate was 80%(80/100). C group of 5 patients was not stable paaque(soft plaque and mixed plaque),plaque detection rate was 5.88%(5/85). the three group between the plaque detection rate, unstable plaque proportion. The difference was statistically significant(P<0.05).(2) Three groups of patients with IMTmeasurement value:there IMT of groups A is 1.41±0.61 mm, there IMT of groups B is 1.96±0.71 mm, and there IMT of groups C is 0.99±0.22 mm. Three groups plaque detection rate plaque detection rate difference between with a statistical significance(P<0.05).(3) Three groups of patients with plaque score comparison: there plaque score of groups A is 2.00±2.13,there plaque score of groups B is 3.90±1.52, and there plaque score of groups C is0.59±1.33, Three groups plaque detection rate plaque detection rate difference between with a statistical significance(P<0.05). 3. Correlation analysis between the three groups of patients with carotid IMT and plaque score,carotid artery blood flow velocity and blood homocysteine in 245 patients :(1) 245 cases of carotid artery IMT and serum homocysteine levels of patients with Spearman rank test,the tesults showed that the correlation coefficient(r=0.410, P=0.000),the results show that the IMT of carotid artery and the blood homocysteine levels correlated positively, withelevated levels of homocysteine in the blood, the carotid artery IMT value is more and more higher.(2) The Spearman rank test in 245 cases of carotid plaques in patients with integral and bloodlevels of homocysteine, results showed that the correlation coefficient(r=0.401, P=0.004),indicating a positive carotid artery plaque score and serum homocysteine levels, along with the elevation of blood homocysteine, carotid artery block integral is more and more higher.(3) The Spearman rank test in 245 cases of carotid artery blood flow velocity and blood homocysteine levels, results showed that the correlation coefficient(r=-0.484, P=0.000),that is negatively related to carotid artery blood flow velocity and blood levels of homocysteine, with blood homocysteine level increased,carotid artery blood flow velocity is lower and lower. 4 Through the Logistic regression analysis model is established, with carotid atherosclerotic plaque as the dependent variable, according to age,gender, smoking, alcohol consumption, blood pressure, total cholesterol, triglyceride,consumption, blood pressure, total cholesterol, triglyceride, low density lipoprotein cholesterol, IMT and homocysteine as independent variables, the results show that high homocysteine can be used as an independent risk factor of carotid atherosclerosis(Hcy≥15μmol/L, OR=1.461, 95%CI=1.121-1.802,P=0.009).Conclusions 1 Hhyperhomocysteinemia is a risk factor of atherosclerosis,and the plasma Hcy was positively correlated with the atherosclerosis. 2 Hhyperhomocysteinemia and hypertension have synergistic effect in promoting arterial atherosclerosis. The main features of the carotid structure and function are change. |
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