【作者】 刘慧；

【导师】 钟远； 苗雅；

【作者基本信息】 上海交通大学 ， 内科学， 2017， 硕士

【摘要】 目的:高血浆HCY(homocysteine,HCY)已被证实是心血管疾病的一个重要危险因素,但是针对易患血管疾病的老年高危人群的高血浆HCY水平和颈动脉粥样硬化早晚期进展之间相关性的研究结果仍存在着较大的争议性。此篇论文主要探讨高危老年患者体内高血浆HCY水平和颈动脉粥样硬化之间相关性及其临床意义。方法:我们收集了99名住院的老年患者(74±9岁),并由颈动脉超声专家应用7.5MHZ的线性B型超声探头的多普勒彩超检测双侧颈总动脉的颈动脉内膜中层厚度(IMT,the intima-media thickness)以及颈动脉分叉处的粥样硬化的斑块病变;收集空腹静脉血检测HCY及其他相关指标,并根据血浆HCY值分为小于15umol/l的低HCY组,以及大于等于15umol/l的高HCY组。结果:运用卡方检验得出两组之间斑块数存在显著差异(P<0.05),且运用Logistic回归分析平衡年龄和性别因素影响后高HCY对斑块的影响仍具有统计学意义,Spearma分析血浆HCY与斑块数之间相关系数为0.291,且两者相关性显著(P<0.05),偏相关平衡年龄和性别影响后,两者相关性仍具有统计学意义(r=0.133,P=0.049);同样地两组间斑块稳定性的差异性在平衡年龄和性别后仍然存在(回归系数为0.046,P=0.023),血浆HCY水平和斑块稳定性之间存在相关性(偏相关系数为0.076,P=0.045)。运用方差分析及协方差分析校正后得出组间斑块厚度存在显著差异(P<0.05),且血浆HCY与斑块厚度之间存在显著线性相关,相关系数为0.32(0.005—0.6)(P<0.05),同样在偏相关平衡了年龄和性别因素后两者相关性仍存在(偏相关系数为0.119,P=0.024);而两组间颈动脉IMT之间存在着一定的差异,但是两者之间差异的统计学意义并不显著(P=0.057,校正后P=0.509),并且血浆HCY与颈动脉IMT之间的并不存在显著的Pears on相关性(r=0.067,P=0.512)。结论:本研究表明高血浆HCY水平与斑块厚度、斑块数及斑块稳定性之间存在着显著相关性,这在一定程度上表明高血浆HCY水平是影响颈动脉粥样硬化斑块形成的重要因素之一。更多还原

【Abstract】 Objective Higher plasma total homocysteine(HCY)is an established risk factor for cardiovascular disease.The association between plasma total homocysteine concentration and the process of the carotid atherosclerosis in high-risk populations with vascular disease still be controversy.The essay is aimed to study the relation between HCY and carotid atherosclerosis and it’s clinic significance.Method we evaluated the intima-media thickness(IMT)of the common carotid arteries and the sclerotic lesions of the carotid arteries bulb by ultrasonography in high-risk 99 elderly in-patients(74±9 years)with vascular disease.An ultrasonograpy and 7.5MHZ linear type B-mode probe were used by a specialist to evaluate the sclerotic lesions of the carotid arteries.Boold was drawed from the patients while fasting for the determination of plasma total homocysteine and other factors.According to the plasma total homocysteine concentrations(15umol/l),we divided the patients into two groups.Results The significant difference are found in the numbers of plaque between two groups by ANOVA and Logistic regerssion,meanwhile,Spearma correlation beween the plasma total homocysteine concentrations and the numbers of plaque is significant(r=0.291,P<0.05),the correlation still has statistical significance even though we balance the effacts of age and sex by thepartial correlation analysis.As well,the difference of plaque stability also exists in the two groups(regression coefficient=0.046,P=0.023),and the partial correlation exists in plasma total homocysteine concentrations and plaque stability(partial correlation coefficient=0.076,P=0.045).We find the significant variations in the thickness of plaque between the two groups by ANOVA and analysis of covariance,furthermore,the linear correlation is showed significantly between plasma total homocysteine and plaque thickness(r=0.32,P<0.05,partial correlation coefficient=0.119,P=0.024),While the variations between the IMT of the carotid arteries and plasma total homocysteine is not significant(P=0.057,adjusted P=0.509),and the Pearson correlation of them is also unexsit.(r=0.067,P=0.512).Conclusion The findings of significant correlations beween the plasma total homocysteine concentrations and plaque numbers,plaque thickness show that total homocysteine would rather be one of important factors which affact the plque formation in the later process of cartoid artherosclerosis.更多还原