H型高血压危险因素流行病学研究

Patients with hypertension and plasma homocysteine rise are considered to have the hypertension of high HCY. Hypertension is the primary risk factor which causes heart brain and vessel diseases .Plasma homocysteine injure vascular endothelial cell through many ways, disrupt the normal blood coagulation mechanism, cause blood clots ,heart attack and stroke ,and it has clinically been considered as independent risk factors of heart brain and vessel diseases such as atherosclerosis , thrombosis and so on. The hypertension of high HCY means that patients suffer from double hazards of hypertension and high homocysteine. At present, the mechanism of homocysteine in the body has been basically clarified, but there are not enough researches to tell us what the risk factors that lead to hypertension patients plasma homocysteine levels rise are. This study conducted the questionnaire survey to the whole group of extraction by random of large population-based, with physical testing, laboratory testing and genetic testing to manage to obtain basic imformation of the related risk factors, analysised the distribution characteristic of people who suffer from the hypertension of high HCY and the present distribution of related risk factors, used methods of 1:1 case control study to analysis potential risk factors which possibly cause the hypertension of high HCY and the interactions among them ,and analyse the relationships among serum homocysteine levels ,hypertension grades and the risk stratification, which provides the basis of evidence-based medicine and new mentality to prophylaxis and treatments of the hypertension of high HCY.

高血压患者同时伴有血浆同型半胱氨酸升高称为高H型高血压。高血压是引起心脑血管疾病的首要危险因子；血浆同型半胱氨酸通过多种途径损伤血管内皮细胞，破坏正常凝血机制，引起血栓、心脏病发作和中风，在临床上作为动脉粥样硬化和血栓形成等心脑血管疾病发病的独立危险因素。H型高血压对心脑血管的危害意味着高血压和高同型半胱氨酸的双重危害。目前，同型半胱氨酸的体内作用机制已基本明确，但是有哪些危险因素引起高血压患者血浆同型半胱氨酸水平升高，还没有足够的研究来证明。本研究通过对随机整群抽取的大样本人群进行问卷调查、体格检测和实验室检测、基因检测获得相关危险因素的基本资料，分析H型高血压的人群分布特点和危险因素分布现状，采取1：1病例对照研究方法分析可能引起高H型高血压的危险因素和危险因素间的交互作用，分析血浆同型半胱氨酸水平和高血压分级以及危险分层的关系，为防治H型高血压提供循证医学依据和新思路。

高血压是引起心脑血管疾病的首要危险因子。伴有血浆同型半胱氨酸（HCY）升高的高血压称为H型高血压。高血压合并血浆同型半胱氨酸水平升高引发心脑血管疾病的危害更大，引发脑卒中、心肌梗死、致残、致死的危险性更高。同型半胱氨酸的体内作用机制已基本明确，但是有哪些危险因素引起高血压患者血浆同型半胱氨酸水平升高，还没有足够的研究来证明。所以，了解H型高血压的三间分布，掌握产生H型高血压的危险因素，分析血浆同型半胱氨酸（HCY）与高血压以及高血压分级的相关性，对防治H型高血压以及控制它的并发症的发生具有重要的意义。.本研究采用横断面研究方法，对湖南省30岁及以上人群进行H型高血压流行病学调查。了解湖南地区H型高血压的患病率；了解H型高血压的人群分布特点和发病现状；探索影响H型高血压病的危险因素；探索影响血浆同型半胱氨酸（HCY）水平升高的危险因素；分析HCY水平和高血压以及高血压分级的相关性。.研究结果显示：（1）湖南省30岁及以上人群H型高血压患病率为19.74%；其中男性为27.19%，女性为14.57%。H型高血压男性患病率高于女性。.（2）血浆同型半胱氨酸血症的患病率为35.07%,其中男性为44.95%%，女性为28.21%。血浆同型半胱氨酸血症的患病率男性高于女性。 .（3）H型高血压在高血压人群中占56.61%,其中男性62.87%,女性50.15%；HCY血症有56.29%人群患有高血压，其中男性HCY血症60.49%伴有高血压，女性51.65%HCY血症伴有高血压。.（4）以10岁为一个年龄段，H型高血压患病率随着年龄的增长患病率增高。.（5）多因素logistic回归分析显示：男性、高龄、吸烟、高吸烟指数、经常吃牛肉、黄豆和酸菜、经常嚼槟榔、肥胖、临床生化指标Cr、TG、FBG值高于正常值是H型高血压的危险因素；经常吃水果、蘑菇、坚果是H型高血压的保护因素。男性、吸烟、饮酒、高血压、临床指标A/G、BUN、UA、TG、TC、CRP指标值异常是HCY血症的危险因素。.（6）调整年龄、性别后，临床相关指标中只有ALT、TG指标值异常是H型高血压的独立危险因素。.（7）高血压患病率随着HCY水平升高明显升高， H型高血压与收缩压和舒张压都存在直接效应。.（8）MTHFR677T基因TT 突变可能是HCY水平升高和H型高血压发病的重要遗传因子。.研