内科

目的探讨同型半胱氨酸（Hcy）、高血压、颈内动脉粥样硬化易损斑块及T淋巴细胞亚群的关系。方法选取在我科住院治疗的高血压合并颈动脉粥样硬化斑块患者243例为研究对象，根据Hcy水平，将患者分为H型高血压组（162例，Hcy＞15 mmol/L）和非H型高血压组（81例，Hcy≤15 mmol/L）。根据患者Hcy水平以及颈动脉斑块类型，将患者分为H型高血压+易损斑块组（HHT+易损组，36例）、H型高血压+稳定斑块组（HHT+稳定组，126例）、非H型高血压+易损斑块组（HT+易损组，5例）、非H型高血压+稳定斑块组（HT+稳定组，76例）。对H型和非H型高血压组患者颈动脉易损斑块的发生率，四组（HHT+易损组、HHT+稳定组、HT+易损组、HT+稳定组）患者的Hcy水平及T淋巴细胞亚群进行比较分析；对高血压并颈动脉粥样硬化患者的Hcy水平与T细胞亚群的关系进行Spearman相关分析。结果HHT组患者颈动脉易损斑块的发生率（22.2%）显著高于HT组患者（6.2%），差异有统计学意义（P＜0.05）。HHT+易损组患者的Hcy水平、外周血CD3+T细胞比例、CD3+CD4+T细胞比例、CD3+CD4+/CD3+CD8+比值均显著高于其余三组，CD3+CD8+ T细胞比例明显低于其他三组，差异有统计学意义（P＜0.05）。HHT+稳定组患者的Hcy水平、CD3+T细胞比例、CD3+CD4+T细胞比例、CD3+CD4+/CD3+CD8+比值均显著高于HT+易损组及HT+稳定组，CD3+CD8+T细胞比例明显低于HT+易损组及HT+稳定组患者，差异有统计学意义（P＜0.05）。HT+易损组、HT+稳定组患者的Hcy水平及T淋巴细胞亚群比较，差异无统计学意义（P＞0.05）。高血压合并颈动脉粥样硬化斑块患者的血Hcy浓度水平与其CD3+CD4+T细胞比例呈正相关（r=0.397，P＜0.05），与CD3+CD8+T细胞比例呈负相关（r=-0.411，P＜0.05），与CD3+CD4+/CD3+CD8+比值呈正相关（r=0.465，P＜0.001）。结论在高血压并颈动脉粥样硬化患者中，H型高血压患者颈动脉易损斑块的发生率较高，随着Hcy浓度升高，CD4+T细胞比例升高，CD8+T细胞比例下降，CD3+CD4+/CD3+CD8+比值增高，免疫紊乱趋向严重，有可能会促进颈动脉易损斑块的形成。

ObjectiveTo investigate the relationship among homocysteine（Hcy）, hypertension, vulnerable plaque of carotid atherosclerosis and T lymphocyte subsets. MethodsA total of 243 patients with hypertension and carotid atherosclerotic plaque who were hospitalized in our hospital were selected. According to the level of Hcy, the patients were divided into H-type hypertension group (162 cases, Hcy＞15 mmol/L) and non-H type hypertension group (81 cases, Hcy ≤15 mmol/L). According to the Hcy level and carotid plaque type, the patients were divided into H-type hypertension plus vulnerable plaque group (HHT plus vulnerable group, 36 cases), H-type hypertension plus stable plaque group (HHT plus stable group, 126 cases), non-H type hypertension plus vulnerable plaque group (HT plus vulnerable group, 5 cases) and non-H type hypertension plus stable plaque group (HT plus stable group, 76 cases). The incidence of carotid vulnerable plaque on patients with H-type and non-H type hypertension, Hcy levels and T lymphocyte subsets in the four groups (HHT plus vulnerable group, HHT plus stable group, HT plus vulnerable group, HT plus stable group) were compared and analyzed. Spearman correlation analysis was performed on the relationship between Hcy level and T lymphocyte subsets on patients with hypertension and carotid atherosclerosis. ResultsThe incidence of carotid vulnerable plaque in the HHT group (22.2%) was significantly higher than that in the HT group (6.2%), and the difference was statistically significant (P＜0.05). The HHT plus vulnerable group had significantly higher Hcy level, peripheral blood CD3+ T cell ratio, CD3+CD4+ T cell ratio and CD3+CD4+/CD3+CD8+ ratio in comparison with the other three groups; while CD3+CD8+ T cell ratio was lower than the other three groups, and the difference was statistically significant (P＜0.05). HHT plus stable group had significantly higher Hcy levels, CD3+ T cell ratio, CD3+CD4+ T cell ratio and CD3+CD4+/CD3+CD8+ ratio in comparison with the other three groups; while CD3+CD8+ T cell ratio was lower than HT plus vulnerable group and HT plus stable group, and the difference was statistically significant (P＜0.05). There were no statistically significant differences in Hcy levels and T lymphocyte subsets between the HT plus vulnerable group and the HT plus stable group (P＞0.05). There was a positive correlation between serum Hcy level and CD3+CD4+ T cell ratio in patients with hypertension and carotid atherosclerotic plaque (r=0.397, P＜0.05), a negative correlation with CD3+CD8+ T cell ratio (r=-0.411, P＜0.05) and a positive correlation with CD3+CD4+/CD3+CD8+ ratio (r=0.465, P＜0.001). ConclusionIn patients with hypertension and carotid atherosclerosis, the incidence of carotid vulnerable plaque is higher on patients with type H hypertension. With the increase of Hcy concentration, the proportion of CD4+ T cells increases, the proportion of CD8+ T cells decreases, the ratio of CD3+CD4+/CD3+CD8+ increases, and the immune disorder tends to be serious, which may promote the formation of carotid vulnerable plaque.