关键词: 高血压, 同型半胱氨酸, 动脉粥样硬化, 卒中, 冠心病, 中风, 腔隙性

Abstract: Background　Hyperhomocysteinemia is a new risk factor for atherosclerosis，but its detailed association with atherosclerosis is still controversial in China．This study investigated the associations of hyperhomocysteinemia level with the severity of cardio-cerebral atherosclerosis as well as stroke and coronary heart disease prevalence in hypertension.Objective　To explore the associations of different hyperhomocysteinemia levels〔homocysteine（Hcy）≥10μmol/L or ≥15μmol/L 〕 with the severity of cardio-cerebral atherosclerosis in hypertension.Methods　One hundred and sixty-eight patients with newly diagnosed mild-to-moderate hypertension from Department of General Practice and Health Center，the Affiliated Hospital of Xuzhou Medical University from October to November 2019 were enrolled，and assigned to three groups according to Hcy level：group A（Hcy<10 μmol/L，n=50），group B （10 μmol/L≤Hcy<15 μmol/L，n=52） and group C（Hcy≥15 μmol/L，n=66）．Clinical data〔BMI，systolic and diastolic blood pressure，plasma lipid profile （total cholesterol，triglyceride，high-density lipoprotein，low-density lipoprotein），fasting plasma glucose，glycosylated hemoglobin，uric acid，folic acid，Hcy〕，ultrasound-assessed endothelium-dependent vasodilation of brachial artery（UEVBA）and carotid intima-media thickness，carotid intima-media thickness and lacunar infarction and coronary heart disease prevalence were compared among the groups．Multivariate Logistic regression was used to analyze the factors associated with lacunar infarction and coronary heart disease．Results　The average plasma folic acid level decreased successively across groups A，B，C（P<0.05）．Group C showed higher lacunar infarction prevalence than group A（P<0.001） and group B（P=0.045）．Group B had higher lacunar infarction prevalence than group A（P=0.035）．Coronary heart disease prevalence in group C was higher than that in group A（P=0.021） and group B（P=0.035）．There was no significant difference in coronary heart disease prevalence between groups A and B（P=0.802）．Multivariate Logistic regression analysis showed that systolic blood pressure，diastolic blood pressure，total cholesterol，high-density lipoprotein，Hcy≥10 μmol/L and carotid intima-media thickness were associated with lacunar infarction （P<0.05），and systolic blood pressure，diastolic blood pressure，total cholesterol，low-density lipoprotein，Hcy ≥15 μmol/L and UEVBA were associated with coronary heart disease（P<0.05）．Conclusion　Hyperhomocysteinemia may aggravate atherosclerosis in patients with hypertension．Our study suggests that Hcy≥10 μmol/L is an influencing factor of lacunar infarction，and Hcy≥15 μ mol/L is an influencing factor of coronary heart disease in hypertension.

Key words: Hypertension；Homocysteine；Atherosclerosis；Stroke；Coronary disease；Stroke, lacunar