目的 分析老年女性H型高血压患者与冠心病严重程度的关系.方法 选取2014年12月-2016年3月解放军第187中心医院干部病房收治的疑似合并冠心病的老年女性原发性高血压患者200例作为研究对象,根据患者血液半胱氨酸水平异常与否分为H型高血压组(Hcy≥10 μmol/L)128例和非H型高血压组(Hcy<10 μmol/L)72例.观察2组患者冠心病患病率以及Gensini积分情况.比较不同类型冠心病患者H型高血压比例及Hcy水平.结果 (1)H型高血压CHD发生率及Gensini积分均高于非H型高血压患者[82.03% vs.63.89%,χ2=8.200, P =0.004;(53.08±21.27)分 vs.(42.38±9.52)分, t =3.601, P =0.000];(2)稳定性心绞痛患者H型高血压发生率及Hcy均低于不稳定心绞痛和急性心肌梗死者,但差异无统计学意义[75.6% vs.82.6% vs.87.0%,χ2=1.817, P=0.403;(47.52±18.17)μmol/L vs.(53.92±21.05)μmol/L vs.(53.28±21.22)μmol/L, F =1.884, P =0.156];(3)同型半胱氨酸水平与Gensini积分呈正相关( r =0.551, P <0.01).结论 H型高血压与老年女性冠心病密切相关,但与血管病变范围以及狭窄程度无关.%Objective To explore the vulnerability characteristics of atheromatous plaque in elderly women patients with H type high blood pressure and its relationship with Gensini score.Methods From December 2014 to March 2016, 200 cases of elderly female patients with primary hypertension in the PLA 187 center hospital VIP wards were enrolled as the research objects, according to the level of homocysteine were abnormal or not, patients were classified as follows, there were 128 cases in H type hypertension group with Hcy>10 μmol/L, while there were 72 cases in non H type group with Hcy<10 μmol/L.The prevalence rate of coronary heart disease and Gensini score of the two groups were observed.Results The proportion of CHD in H type hypertension group was obviously higher than that of non H type hypertension group, the difference was statistically significant (82.03% vs.63.89%,χ2=8.200, P =0.004).The Gensini score of the H type hypertension group was also higher than the non H type hypertension group, the difference was statistically significant[(53.08±21.27) vs.(42.38±9.52), t =3.601, P =0.000].The proportion of patients with stable angina pectoris in H type hypertension group was lower than the proportion of unstable angina and acute myocardial infarction,but there was no significant difference(75.6% vs.82.6% vs.87.0%,χ2=1.817, P =0.403).The levels of homocysteine in patients with stable angina pectoris were lower than unstable angina and acute myocardial infarction[(47.52±18.17)μmol/L vs.(53.92±21.05)μmol/L vs.(53.28±21.22)μmol/L, F =1.884, P =0.156].Homocysteine levels were positively correlated with Gensini scores (r =0.551, P <0.01).Conclusion H type hypertension is closely related to coronary heart disease in elderly women, and it is related to the instability of coronary plaque, but it has nothing to do with the extent of vascular lesions and the degree of stenosis.
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