【作者】 王娜；

【导师】 李刚；

【作者基本信息】 河北医科大学 ， 内科学（专业学位）， 2018， 硕士

【摘要】 目的:老年患者大多合并多种基础疾病,高血压是老年常见疾病之一,且常伴有高血脂、高尿酸等现象,严重影响老年患者的生活质量。高尿酸血症是体内嘌呤代谢障碍及紊乱的结果,其高发年龄为中老年男性和绝经后妇女。高尿酸水平与高脂血症、高血压、高血糖、肥胖等心血管危险因素密切相关,同时也是急性心肌梗死、心力衰竭、脑卒中的重要危险因素之一。许多相关研究表明血清尿酸水平与高血压、冠状动脉粥样硬化的发生发展相关联,是老年患者高血压发病的危险因素之一,二者互为因果关系,相互影响。硫脑苷脂作为人体广泛存在的脂类,分布于神经系统、消化系统、心血管系统及内分泌系统等各个脏器中,在冠状动脉粥样硬化的发病机制中发挥重要作用,本研究通过分析老年高血压患者血尿酸水平与血清流脑苷脂的关系,探讨血清硫脑苷脂的临床意义。方法:选择2016年1月至2017年4月在河北省人民医院老年科住院期间的高血压患者69名,年龄均≥75岁,通过知情同意后,采集禁食12小时以上的空腹外周静脉血,血清尿酸、总胆固醇、高密度脂蛋白、空腹血糖等生化指标应用我院全自动生化分析仪进行检测;应用高效基质辅助激光解析电离飞行时间质谱法(MALDI-TOF MS)检测血清硫脑苷脂水平。根据血清尿酸水平,按照四分位法,将所有入选者血清尿酸水平分为≤280umol/L分位18例、281~319umol/L分位18例、320~419umol/L分位15例、≥420umol/L分位18例,应用SPSS21.0统计软件进行数据分析。结果:1.高尿酸血症组与尿酸正常组各指标的比较(1)与尿酸正常组相比,高尿酸血症组血清硫脑苷脂水平明显升高,差异有统计学意义(P<0.01)。(2)高尿酸血症组TG、肌酐虽高于尿酸正常组,但差异无统计学意义(P>0.05)。2.血清硫脑苷脂与四分位法血尿酸水平的关联分析(1)应用方差分析,结果所示:与≤280umol/L分位比较,281~319umol/L分位组血清硫脑苷脂明显升高(P<0.05),320~419umol/L分位组显著升高(P<0.01),≥420umol/L分位组明显升高(P<0.01);(2)与281~319umol/L分位比较,320~419umol/L分位组显著升高(P<0.05),≥420umol/L分位组显著升高(P<0.05);(3)与320~419umol/L分位相比,≥420umol/L分位组显著升高(P<0.05)。(4)简单线性回归分析结果提示,血尿酸水平与血清硫脑苷脂之间存在显著线性关系r=0.662,P<0.01。结论:血清尿酸水平与血清硫脑苷脂具有相关性,高尿酸血症是高血压发病的独立危险因素,血清硫脑苷脂可能作为高血压发病的重要危险因素之一,作为新的血清标记物,定期监测上述指标并采取相应的治疗有助于提高老年患者的生活质量,延缓疾病的进展,改善预后。更多还原

【Abstract】 Objective:Elderly patients are mostly combined with a variety of basic diseases.Hypertension is one of the common diseases of the elderly,and often accompanied by high blood lipids,high uric acid and so on,which seriously affect the quality of life of elderly patients.Hyperuricemia is caused by purine metabolism disorder,its high incidence in middle-aged men and postmenopausal women.Hyperuricemia is closely related to cardiovascular risk factors such as hyperlipidemia,hypertension,hyperglycemia and obesity,and it is also one of the important risk factors for acute myocardial infarction,heart failure and stroke.Many related studies showed that serum uric acid levels are associated with the occurrence and development of hypertension and coronary atherosclerosis,which is one of the risk factors of hypertension in elderly patients.Uric acid and hypertension are causality and influence each other.Sulfatide is the lipid of human body,which is distributed in nervous system,digestive system,cardiovascular system and endocrine system.It plays an important role in the pathogenesis of coronary atherosclerosis.In this study,the relationship between serum uric acid and serum sulfatide in elderly hypertensive patients was analyzed to explore whether serum sulfatide can be used as one of the predictors of hypertension and its clinical significance.Methods:69 old Patients with hypertension were selected from the geriatic department of Hebei Provincial People’s Hospital from January 2016 to April2017,all of whom were ≥75 years old.After informed consent,fasting peripheral venous blood was collected.Serum uric acid,total cholesterol,high density lipoprotein,fasting blood glucose and other biochemical indicators were detected by automatic biochemical analyzer in our hospital and sulfatideby matrix-assisted laser desorption ionisation time of flight mass spectrometry(MALDI-TOF MS).According to the levels of uric acid,by four points,all selected were divided into ≤280umol/L 18 cases,281~319umol/L18 cases,320 ~ 419umol/L 15 cases,≥420umol/L 18 cases.Data were analyzed using SPSS 21.0 software.Results:1.Comparison between hyperuricemia group and control group(1)Compared with the control group,the level of serum sulfatide in hyperuricemia group was significantly higher,the difference was ststistically significant(P<0.01).(2)Triglyceride and creatinine in hyperuricamia group were higher than those in control group,but the difference was not ststistically significant(P>0.05).2.Correlation analysis of serum sulfatide and serum uric acid levels(1)Correlation analysis showed that the serum sulfatide in 281 ~ 319umol/L(P<0.05)、320~419 umol/L(P<0.01)、≥420 umol/L groups(P<0.01)were significantly higher than those in ≤280 umol/L groups.(2)Compared with 281~319 umol/L,320~419 umol/L(P<0.05)、≥420umol/L groups(P<0.05)increased significantly.(3)Compared with 320 ~ 419 umol/L,the group ≥420 umol/L was significantly higher(P<0.05).(4)Simple linear regression analysis showed that there was a significant linear relationship between surum uric acid level and serum sulfatide r=0.662,P<0.01.Conclusion:Serum uric acid is correlated with serum sulfatide.Hyperuricemia is an independent risk factor of hypertension.As a new rerum marker,regular monitoring of these indicators and corresponding treatment can improve the quality of life of elderly patients,delay the progress of disease and improve prognosis.更多还原