血清胱抑素C和同型半胱氨酸在原发性高血压患者颈动脉粥样硬化早期诊断中的应用【摘耍】目的：探讨血清胱抑素c和同型半胱氨酸在原发性高血压患者颈动脉粥样硬化早期诊断中的应用价值。方法：回顾分析2012年1月-2014年1月227例于本院门诊确诊为原发性高血压患者的临床资料。绘制受试者工作特征曲线分析血清胱抑素C和同型半胱氨酸対原发性高血压患者颈动脉粥样硬化的预测价值；分析血清胱抑素C和同型半胱氨酸与原发性高血压患者临床指标的相关性。结果：227例原发性高血压患者中诊断颈动脉粥样硬化42例。颈动脉粥样硬化组平均动脉压为(116.4±14.3)mmIlg,与非颈动脉粥样硬化组(78・3±13・5)mm血比较，有升高趋势，但差异无统计学意义(P=0・056)o颈动脉粥样硬化组收缩压为(167.2±16.3)mmHg,显著高于非颈动脉粥样硬化组的(123.1±17.5)mmHg,差异有统计学意义(P二0.002)0颈动脉粥样硕化组舒张压为(93.6±12.3)mmHg,与非颈动脉粥样硬化组(76.2土&5)iimiHg比较，差异无统计学意义(P二0.084)。颈动脉粥样硬化组血清胱抑素C为(1.4±0.2)mg/L,同型半胱氨酸为(22.8±5.2)?mol/L,均高于非颈动脉粥样硬化组的(0.8±0.l)mg/L>(13.2±4.9)?mol/L,差异均冇统计学意义(P二0.016、0.028)0血清胱抑素C受试者工作特征曲线下面积为0.882(0.850-0.954)。当血清胱抑素C临界值为0.95mg/L时，敏感性和特异性分别为88.3%和90.8%。同型半胱氨酸受试者工作特征曲线下面积为0.872(0.842-0.917)。当同型半胱氨酸临界值为16.9mmol/L时，敏感性和特异性分别为87.1%和76.3%。血清胱抑素C、同型半胱氨酸与收缩压均呈正相关（“0.762.0.715,P<0.05)o为提高联合试验的敏感性，采用平行试验。当血清胱抑素C、同型半胱氨酸分别取临界值为0.95mg/L和16.9mmol/L时，联合敏感性为98.5%,联合特异性为69.3%o结论：血清胱抑素C与同型半胱氨酸可用于原发性高血压患者颈动脉粥样硬化早期诊断。当血清胱抑素C、同型半胱氨酸分别取临界值为0.95mg/L和16.9mmol/L时，联合敏感性为98.5%,联合特异性为69.3%o【关键词】血清胱抑素C；同型半胱氨酸；原发性高血压；颈动脉粥样硬化[Abstract]Objective：ToinvestigatevalueofserumcystatinCandhomocysteineonearlyevaluationofcarotidarteryatherosclerosis(CAA)inpatientswithprimaryhypertension.Method：The227patientswithprimaryhypertensionwereenrolledfromJan2012toJan2014retrospectively.ROCcurvewasdonetoanalyzepredictivevalueofserumcystatinCandhomocysteinetocarotidarteryatherosclerosisinpatientswithprimaryhypertension.CorrelationamongserumcystatinC,homocysteineandclinicaldatainpatientswithprimaryhypertensionwereanalyzed.Result：The42patientswerediagnosedascarotidarteryatherosclerosis・MeanarterialpressureoftheCAAgroupwas(116.4±14.3)mmHg,andthenoCAAgroupwas(78.3+13.5)mmHg,therewasnostatisticallysignificontdifference(P=0.056)・SBPintheCAAgroupwassignificantlyhigherthanthatinthenoCAAgroup[(167.2±16.3)mmHgvs.(123.1±17.5)mmHg](P=0.002).DBPintheCAAgroupwas(93.6+12.3)mmHg,therewasnodifferencecomparedwiththenoCAAgroup(P=0.084)・SerumcystatinCandhomocysteineintheCAAgroupwere(1.4±0.2)mg/L,(22・8±5.2)?mol/L,weresignificantlyhigherthanthoseinthenoCAAgroup](0.8±0.1)mg/L,(13.2±4.9)?mol/L](P=0.016,0.028).AreaunderROCofserumcystatinCwas0.882(95%CT:0.850-0.954).Withacut-offvalueof0.95mg/L,serumcystatinChadasensitivityof88.3%andaspecificityof90.8%.AreaunderROCofhomocysteinewas0.872(95%CI：0.842-0.917)・Withacut-offvalueof16.9mmol/L,homocysteinehadasensitivityof87.1%andaspecificityof76.3%.TherewasapositivecorrelationbetweenserumcystatinCandsystolicpressure(r=0.762,P【Keywords]SerumcystatinC；Homocysteine；Primaryhypertension；CarotidarteryatherosclerosisFirst-author"saddress：NanxiongPeople?sHospital,Nanxiong512400,Chinadoi：10.3969/j.issn.1674-4985.2016.26....
