| Objective:To explore the correlation between homocysteine level,MTHFR C677T gene polymorphism and ventricular remodeling in hypertension patients,and to provide more evidence for the combination of high Hcy and MTHFR C677T gene polymorphism to promote the occurrence of ventricular remodeling.Methods:A total of 286 patients diagnosed as essential hypertension with hyperhomocysteinemia in the first hospital of Shanxi Medical University from January2018 to January 2019 were selected.According to left ventricular mass index(LVMI)and relative left ventricular wall thickness(RWT),the patients were divided into two groups:ventricular remodeling group:LVMI increased and/or RWT increased;left ventricular normal configuration group:LVMI normal and RWT normal.Among 286 patients with hypertension,190 patients had ventricular remodeling(66.4%),including 97 males and 93females,with an average age of(65±12)years;96 patients had normal left ventricular configuration(33.6%),including 54 males and 42 females,with an average age of(62±11)years.The plasma homocysteine levels were measured by enzyme circulation method.The MTHFR C677T gene polymorphism was detected by polymerase chain reaction restriction fragment length polymorphism(PCR-RFLP).Chi square test was used to compare the distribution of genotypes and alleles.Rank sum test and Kruskal-Wallis test were used to compare the Hcy levels between the two groups.Multivariate logistic regression analysis was used to analyze the independent risk factors of ventricular remodeling.Interaction analysis was used to analyze the combined effect of Hcy level and MTHFR TT genotype on ventricular remodeling.Results:1.The differences in systolic blood pressure,diastolic blood pressure and Hcy levels between the ventricular remodeling group and the normal configuration group are statistically significant(P<0.05).There were no statistical differences in other general information,past medical history and biochemical tests(P>0.05).Compared with the normal configuration group,the left ventricular mass of patients in the ventricular remodeling group was significantly increased,the left atrium was significantly enlarged,and the thickness of the posterior wall of the left ventricle and the thickness of the ventricular septum were significantly increased,while the left ventricular end diastolic and terminal inner diameters were not Significant difference,LVEF and left ventricular function were significantly reduced(P≤0.001).2.Both normal configuration group and ventricular remodeling group were in accordance with Hardy Weinberg genetic balance by chi square goodness of fit test((?)~2:0.103,0.257,P>0.05).There was no significant difference in MTHFR genotype distribution between normal configuration group and ventricular remodeling group(P>0.05);there was significant difference in allele frequency distribution between the two groups((?)~2=4.491,P=0.039).3.There were statistical differences in Hcy levels between the two groups of genotypes(H=25.884,P<0.001).Intra group comparison:there was no significant difference in Hcy level among genotypes in normal configuration group(P>0.05);in ventricular remodeling group,Hcy level in TT group was significantly higher than that in CT group and CC group(P=0.002,0.001).There was no significant difference in Hcy level between the two groups(P>0.05).4.The analysis results of the multi-factor stepwise logistic regression model show that the risk of ventricular remodeling in patients with genotype CT was 1.282 times higher than that in patients with genotype CC(95%CI:0.649～2.534);the risk of ventricular remodeling in patients with genotype TT was 2.162 times higher than that in patients with genotype CC(95%CI:1.020～4.582).5.After adjusting for confounding factors,there was a multiplicative interaction between Hcy level and MTHFR genotype(OR=1.232,95%CI:1.046～1.451).When Hcy<20μmol/L/genotype CC was used as reference group,the risk of ventricular remodeling was increased by 1.852 times when Hcy>20μmol/L was combined with genotype TT(95%CI:1.113～7.307).Conclusion:1.The level of homocysteine in plasma was related to MTHFR C677T genotype.Hcy level of MTHFR TT genotype was significantly higher than that of CT genotype and CC genotype.2.The T allele carrying rate in the ventricular remodeling group was significantly higher than that of the normal configuration group,and the risk of ventricular remodeling in patients with TT genotype and CT genotype was significantly higher than that of CC genotype.This proved that the mutation of C→T of MTHFR C677T gene was an important genetic factor for the occurrence of ventricular remodeling.3.High Hcy level and MTHFR C677T gene polymorphism interact with each other in the risk of ventricular remodeling.Hcy>20μmol/L and genotype TT have a joint effect on the risk of ventricular remodeling. |
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