| Part oneObjective: Analyze the carotid plaque characteristics of patients with H-type hypertension complicated with cerebral infarction and its correlation of Homocysteine concentration through retrospective research.Methods: Retrospective collection of general clinical data,biochemical indicators and carotid artery ultrasound information of 1032 patients who underwent carotid ultrasound in our hospital from January 2019 to September 2021 and were screened by inclusion and exclusion criteria,unordered Multivariate Logistic regression model is used to analyze the independent risk factors of cerebral infarction in H-type hypertension patients and their relationship with carotid plaque characteristics.Results: 1.Comparison of general clinical data,biochemical parameters,index model and hypertension-related indicators among normal control group,Primary hypertension group,H-type hypertension group and H-type hypertension combined with cerebral infarction group showed that:(1)Compared with the Primary hypertension group,there were statistically significant differences in gender,smoking,alcohol,serum UA,Cr,UREA,INR,WBC,N,NLR,MLR,Tgy index between the two groups(P<0.05).Through Multivariate Logistic regression analygendersis showed that male gender(OR=1.059,95%CI: 1.037~1.081);Alcohol(OR=4.057,95%CI: 1.123~14.663);Smoking(OR=2.235,95%CI: 1.189~4.200)is an independent risk factor for H-type hypertension.(2)H-type hypertension combined with cerebral infarction group compared with the Primary hypertension group,There were statistically significant differences between the two groups in age,male,smoking,drinking,TG,HDL,UA,Cr,UREA,INR,WBC,N,PLCR,NLR,MLR,Tgy index(P<0.05).Multivariate Logistic regression analysis showed that male gender(OR=2.044,95%CI: 1.230~3.399);Age(OR=1.079,95%CI: 1.056~1.102);Smoking(OR=4.545,95%CI: 2.315~8.921)is an independent risk factor for H-type hypertension complicated with cerebral infarction.(3)H-type hypertension group and H-type hypertension combined with cerebral infarction group,There were statistically significant differences between the two groups in age,male sex,smoking,alcohol,serum Hcy,TG,HDL,UA,Cr,UREA,INR,WBC,N,PLCR,NLR,MLR,Tgy index,IMT,Crouse score and admission systolic blood pressure(P<0.05).Multivariate Logistic regression analysis showed that male gender(OR=1.018,95%CI: 1.004~1.003);Smoking(OR=1.521,95%CI: 1.040~2.224);Carotid plaque Crouse score(OR=1.207,95%CI: 1.073~1.358)and serum Hcy level(OR=1.025,95%CI: 1.011~1.040)were independent risk factors for H-type hypertension complicated with cerebral infarction.2.The detection rates of carotid plaque among the four groups were as follows: H-type hypertension combined with cerebral infarction group(83.1%)> H-type hypertension group(75.1%)> simple essential hypertension group(44.7%)> normal control group(24.6%),and the differences among the four groups were statistically significant(P<0.05).Further comparative analysis of carotid plaque stability showed that: The unstable plaque of H-type hypertension combined with cerebral infarction group(58.8%)> H-type hypertension group(31.2%)> simple essential hypertension group(15.8%)> normal control group(8.0%),and the difference between the four groups is statistically significant(P<0.05).Comparison of echo properties of carotid plaques in the three groups showed that: H hypertension with cerebral infarction group plaque echo properties for uneven echo proportion(32.6%),the largest H plaque echo hypertension group properties for strong echo proportion(34.1%),the largest pure essential hypertension group plaque echo properties for endometrial thickening proportion(46.1%),the largest overall statistical differences mean three sets of data;The analysis of the number of carotid plaque in the three groups showed that the number of carotid plaque in the three groups accounted for the largest proportion,the proportions were H-type hypertension group(41.3%)> simple essential hypertension group(34.2%)>H-type hypertension with cerebral infarction group(29.5%).The analysis of the common sites of carotid plaques in the three groups showed that the three carotid plaques were prone to occur in the right subclavian artery,and the proportions were as follows: simple essential hypertension group(47.4%)> H hypertension group(38.4%)> H hypertension group with cerebral infarction(26.0%).3.The stability and nature of carotid plaque in H-type hypertension group and H-type hypertension with cerebral infarction group are divided into groups and compared with serum Hcy level,The results showed that:(1)There is a correlation between carotid plaque stability and Hcy concentration in H-type hypertension group and H-type hypertension with cerebral infarction group,The higher the Hcy level,the more unstable the carotid plaque;and there is statistical difference in the overall distribution of Hcy concentration between the groups(P<0.01).(2)There is a correlation between the echo property of carotid plaque and serum Hcy level in H-type hypertension group and H-type hypertension with cerebral infarction group,The higher the Hcy level,the more unstable the the echo property of carotid;and there is a statistical difference in the concentration distribution between groups(P<0.05).Conclusions: H-type hypertension complicated with cerebral infarction associated with male gender,smoking,high serum level of Hcy,increased Crouse score of carotid plaque.Part TwoMethods: After signing the informed consent form,The serum,clinical data,biochemical indicators and carotid artery ultrasound information of 114 patients who underwent carotid ultrasound in our hospital from August 2021 to December 2021 and exclusion criteria were collected.ELISA is used to detect serum MCP-1 and MCPIP1 level,and ROC Curve is used to analyze the diagnostic value of MCP-1 and MCPIP1 in H-type hypertension complicated with cerebral infarction.Results:1.The 114 patients were divided into normal control group,Primary hypertension group,H-type hypertension group and H-type hypertension complicated with cerebral infarction group,The results showed that: The levels of serum MCP-1,MCPIP1,Hcy and N in H-type hypertension combined with Primary hypertension group were significantly higher than those in control group,simple essential hypertension group and H-type hypertension group,and the differences were statistically significant(P<0.05).Compared with the Primary hypertension group,higher serum Hcy(OR=9.036,95%CI: 1.631~50.335)level and lower serum N(OR=0.214,95%CI: 0.047~0.969)level in H-type hypertension group increased the risk of H-type hypertension(P<0.05).The increase of serum MCP-1(OR=1.011,95%CI: 1.003~1.018)in H-type hypertension group with cerebral infarction increased the risk of H-type hypertension with cerebral infarction compared with H-type hypertension group(P<0.05).2.Spearman’s relevant analysis shows that:(1)There is a positive correlation between carotid plaque Crouse score and serum Hcy level in H-type hypertension group(rs=0.356;P<0.05).(2)There is a positive correlation between Crouse score and serum Hcy level in patients with H-type hypertension complicated with cerebral infarction(rs=0.486;P<0.05).3.ROC curve of H-type hypertension group and H-type hypertension combined with cerebral infarction group showed:(1)ROC curve of diagnostic value of H-type hypertension group showed: The area under the ROC curve of IMT and Crouse integral is greater than 0.7 but less than 0.9,which has certain diagnostic significance for H-type hypertension(P<0.05).The area under the ROC curve of IMT is 0.764.When the Youden index takes the maximum value of 0.503 and the cut-off value is 0.60,the diagnostic effect is the largest,and the sensitivity is 74.4%.The specificity is 75.9%.When the area under the ROC curve of Crouse integral is 0.788,When the Youden index takes the maximum value of 0.503,and the cut-off value is 0.60,the diagnostic effect is the largest,the sensitivity is 74.4%,the specificity is 75.9%.The area under the ROC curve of serum Hcy is greater than 0.9,which had definite diagnostic significance for H-type hypertension(P<0.001).Among them,The area under the ROC curve of Hcy is 0.975.When the Youden index takes the maximum value of 0.940 and the cut-off value is 10.05,its diagnostic effect is the largest,with a sensitivity of 97.4% and specificity of 96.6%.(2)ROC curve of diagnostic value of H-type hypertension combined with cerebral infarction showed: the area under the ROC curve of IMT,Crouse score,N and Cr is greater than 0.5 but less than 0.7,which have a low diagnostic value of H-type hypertension combined with cerebral infarction(P<0.05).The area under the ROC curve of serum Hcy,UA,MCP-1 and MCPIP1 is greater than 0.7 but less than 0.9,which have a certain diagnostic value for H-type hypertension complicated with cerebral infarction(P<0.05).Among them,The area under the ROC curve of Hcy is 0.823,and When the Youden index takes the maximum value of 0.545 and the cut-off value is 12.95,with a sensitivity of 91.3% and a specificity of 63.2%.When the MCP-1 area under the curve is 0.806,When the Youden index takes the maximum value of 0.593,and the cut-off value is 458.55,its diagnostic effect is the largest,with a sensitivity of 69.6% and specificity of 89.7%.When the MCPIP1 area under the curve is 0.800,When the Youden index takes the maximum value of 0.593,the diagnostic effect is the largest.When the cut-off value is 2.320,its diagnostic effect is the largest,with a sensitivity of 69.1% and specificity of 88.5%.Conclusions: Serum MCP-1,MCPIP1 may be have early diagnosis and warning indicators for H-type hypertension complicated with cerebral infarction. |
