外周血HCY、PLR及hs-CRP预测原发性高血压患者颈动脉粥样硬化的诊断效能

摘要 目的：通过临床回顾性研究分析外周血同型半胱氨酸（HCY）、血小板淋巴细胞比值（PLR）及C反应蛋白（hs-CRP）预测原发性高血压（PH）患者颈动脉粥样硬化（AS）的诊断效能。方法：通过病历系统查询，收集2019年1月至2020年1月于我科收治的PH患者167例，根据患者IMT检查结果分为非AS组及AS组，同期选择于我院体检的健康人群40例为对照组，采集PH患者入院24h内的空腹静脉血5 mL，采集对照组于查体时的空腹静脉血5 mL，采用免疫荧光法检测受检者hs-CRP水平，采用循环酶法检测受检者HCY水平，采用血细胞检测仪检测受检者血小板及淋巴细胞水平，计算血小板与淋巴细胞比值(PLR)。比较各组受检者血清HCY、PLR及hs-CRP水平，采用Pearson线性相关分析各因子水平变化的相关性。采用多因素Logistics回归分析PH患者病发AS的影响因素，采用ROC曲线分析HCY、PLR及hs-CRP在预测PH患者病发AS中的价值。分析外周血HCY、PLR及hs-CRP预测原发性高血压患者颈动脉粥样硬化的诊断效能。结果：PH组患者血清HCY、PLR及hs-CRP水平明显高于对照组，AS组患者HCY、PLR及hs-CRP水平明显高于非AS组（P＜0.05）。采用Pearson线性相关分析得知，HCY、PLR及hs-CRP与IMT均呈明显正相关（r分别为0.451、0.519、0.615，P均＜0.05或＜0.01）。采用多因素Logistics回归分析得知，HCY、PLR及hs-CRP是影响PF患者病发AS的危险因素（P均＜0.05）。ROC曲线分析得出，hs-CRP诊断PH患者病发AS的AUC为0.764，HCY诊断PH患者病发AS的AUC为0.659，PLR诊断PH患者病发AS的AUC为0.704， 三者联合诊断PH患者病发AS的AUC为0.895。结论：PH病发AS的患者血清HCY、PLR及hs-CRP水平呈明显高表达状态，且与IMT水平呈明显正相关，是PH患者病发AS的危险因素，三者在诊断PH患者病发AS方面具有一定价值，其中三者联合价值最高，可在临床中广泛应用。

Diagnostic Efficacy of Peripheral Blood Hcy, PLR and hs-CRP in Predicting Carotid Atherosclerosis in Patients with Essential Hypertension

ABSTRACT Objective: To analyze the diagnostic efficacy of peripheral blood homocysteine (Hcy), platelet lymphocyte ratio (PLR) and C-reactive protein (hs CRP) in predicting carotid atherosclerosis (as) in patients with essential hypertension (PH). Methods: 167 patients with PH admitted to our hospital from January 2019 to January 2020 were collected and divided into non as group and as group according to the results of IMT examination. At the same time, 40 healthy people in our hospital were selected as the control group. 5 mL of fasting venous blood was collected from PH patients within 24 h after admission, and 5 mL of fasting venous blood was collected in the control group during physical examination The levels of Hcy were detected by circulating enzyme method, the levels of platelets and lymphocytes were detected by blood cell analyzer, and the platelet to lymphocyte ratio (PLR) was calculated. The serum levels of Hcy, PLR and hs CRP were compared among the three groups. Pearson linear correlation was used to analyze the correlation between the changes of the levels of each factor. Multivariate logistic regression was used to analyze the influencing factors of as in PH patients, and ROC curve was used to analyze the value of Hcy, PLR and hs CRP in predicting as in PH patients. Objective to analyze the diagnostic efficacy of peripheral blood Hcy, PLR and hs CRP in predicting carotid atherosclerosis in patients with essential hypertension. Results: the serum levels of Hcy, PLR and hs CRP in pH group were significantly higher than those in control group. The levels of Hcy, PLR and hs CRP in as group were significantly higher than those in non as group (P<0.05). Pearson linear correlation analysis showed that Hcy, PLR and hs CRP were significantly positively correlated with IMT (r = 0.451, 0.519, 0.615, P<0.05 or <0.01). Multivariate logistic regression analysis showed that Hcy, PLR and hs CRP were the risk factors of as in PF patients (all P<0.05). ROC curve analysis showed that the AUC of hs CRP in the diagnosis of as in PH patients was 0.764, that in Hcy was 0.659, that in PLR diagnosis was 0.704, and that in combined diagnosis of as in PH patients was 0.895. Conclusion: The serum Hcy, PLR and hs CRP levels in patients with PH disease with as are significantly high expression, and are significantly positively correlated with the level of IMT, which are the risk factors of as in PH patients. The three have certain value in the diagnosis of as in PH patients, and the combination of the three has the highest value, which can be widely used in clinical practice.