The Study of Correlation between H Type Hypertension and the Structural Changes of Carotid Artery
|Course||Medical Imaging and Nuclear Medicine|
|Keywords||H type hypertension ultrasonography IMT carotid atheroscleroticplaque Hcy|
Objective：To investigate the correlation between the level of plasma homocysteine andthe severity of carotid artery atherosclerosis in essential hypertension patients, weevaluate the changes of carotid structures both in H type hypertension and simplehypertension by carotid ultrasonography. Simultaneously, we establish a BinaryLogistic analysis to analyse whether the elevated plasma homocysteine is the mainrisk factor for carotid plaques or not. In that case，we can take reasonable andeffective measures for controlling the plasma homocysteine levels and carotid arteryatherosclerosis as soon as possible in H type hypertension，to prevent from appearingof the cardiovascnlar and cerebrovascular diseases.Material and Methods：1.295hospitalized essential hypertension patients are selected in the SecondAffiliated Hospital of Nanchang University from August2012to January2013. Allpatients are received detailed medical history-taking. The basic informations ofpatients are recorded，including age，gender，course of hypertension，grade ofhypertension，height，weight， diabetes mellitus or not，smoking history anddrugtaking history.2. All patients are under going on carotid high-resolution ultrasonicexamination:(1) assess carotid normal anatomical structure and hemodynamicinformation, blood vessel lines are normal or not, blood lumens are expanding，narrowing，warping，oppressed or not;(2) measure IMT;(3) the position、number、size and echo of carotid artery plaques are observed and recorded, and calculatecarotid artery plaque score.3. The items of laboratorial biochemical examination: Hcy、FPG、TC、TG、HDL-C、LDL-C.4.295patients are divided into two groups based on the concentration ofplasma homocysteine: H type hypertension group(Hcy≥10μmol/L) and simplehypertension group(Hcy＜10μmol/L). There are217patients in H type hypertension group, including110males and107females, average age:67.39±10.70years old. And there are78patients in simple hypertension group, including38malesand40females, average age:65.56±8.94years old.Results：1.The level of plasma Hcy is18.25±8.37μmol/L in H type hypertension group,While the level of plasma Hcy is8.95±0.82μmol/L in simple hypertension group, andthere is a statistical difference between two groups in the level of plasmahomocysteine(P＜0.05).2. The results of carotid ultrasonography(1)42patients are detected66plaques in78cases of simple hypertension,with the plaque detection rate of53.84%(42/78).185patients are detected452plaques in217cases of H type hypertension, with the plaque detection rate of85.25%(185/217). There are22patients only with one plaque and20patients with≥2plaques in simple hypertension, with the single plaque detection rate of28.20%(22/78) and≥2plaques detection rate of25.64%(20/78). There are44patients only with one plaque and141patients with≥2plaques in H typehypertension, with the single plaque detection rate of20.28%(44/217) and≥2plaques detection rate of64.97%(141/217). There is a statistical difference betweentwo groups in plaque detection rate、single plaque detection rate and≥2plaquesdetection rate(P＜0.05).(2) The intima media thickness and plaque score(PS) of two groups: H typehypertension group> simple hypertension group； IMT:(1.00±0.16mm)vs(0.89±0.18mm); PS:(4.90±3.77mm) vs (1.88±2.28mm).(3) The differences between two groups have no statistical significance，whichin greater than carotid stenosis50%detection rate，the total constituent rate of plaquelocation distribution and plaque echo(P＞0.05). However, There is a statisticaldifference in plaque location distribution in295patients, and the highest plaquedetection rate of bifurcation, then common carotid artery and internal carotid artery,the lowest is external carotid artery. 3. The correlation of carotid IMT、PS and plasma homocysteine in295patients(1) The correlation analysis between carotid IMT and the level of plasmahomocysteine shows correlation coefficient r is0.371(P=0.000) in295patients,illustrating that carotid IMT and the level of plasma homocysteine is positivecorrelation.(2) The correlation analysis between carotid PS and the level of plasmahomocysteine shows correlation coefficient r is0.696(P=0.000) in295patients,demonstrating that carotid PS and the level of plasma homocysteine is obviouspositive correlation, which carotid PS become higher with elevated plasmahomocysteine.4. The Binary Logistic Regression analysis identify that age、IMT≥1.0mm andHcy≥10.0μmol/L are risk factors of carotid atherosclerotic plaque formation.(age:OR=1.067，95%CI=1.020-1.115，P=0.005；IMT≥1.0mm：OR=19.566，95%CI=2.528-151.413, P=0.004；Hcy≥10.0μmol/L：OR=1.380,95%CI=1.210-1.574，P=0.000).Conclusions:1. The structural damage of carotid artery in H type hypertension is more seriousthan simple hypertension, and maybe elevated plasma homocysteine and hypertensionhave a synergistic effect.2. Hcy≥10.0μmol/L、IMT≥1.0mm and age are important risk factors of carotidatherosclerotic plaque formation in essential hypertension. The level of plasmahomocysteine and carotid atherosclerotic plaque formation、the level of plasmahomocysteine and severity of carotid atherosclerosis are positive correlation, whichmaybe take part in development process of carotid atherosclerosis.3. The highest plaque detection of carotid artery is bifurcation, then commoncarotid artery and internal carotid artery, the lowest is external carotid artery.