2026 年第 10 期 第 21 卷

同型半胱氨酸和微小RNA-21与老年难治性高血压患者血压昼夜节律关系及预测心脑血管事件的价值

Relationship of homocysteine and microRNA-21 with circadian rhythm of blood pressure and their value in predicting cardiovascular and cerebrovascular events in elderly patients with resistant hypertension

作者：白小军1姚美婧2甄宁3张立娜4王延海5

英文作者：Bai Xiaojun1 Yao Meijing2 Zhen Ning3 Zhang Lina4 Wang Yanhai5

单位：1中国人民解放军联勤保障部队第九八〇医院（白求恩国际和平医院）干部病房二科，石家庄050082；2河北省军区石家庄第二离职干部休养所门诊部，石家庄050000；3中国人民解放军联勤保障部队第九八〇医院（白求恩国际和平医院）神经内科，石家庄050082；4中国人民解放军联勤保障部队第九八〇医院（白求恩国际和平医院）基础医学实验室，石家庄050082；5中国人民解放军联勤保障部队第九八〇医院（白求恩国际和平医院）第五派驻门诊部，石家庄050082

英文单位：1Second Department of Cadre Ward the 980th Hospital of Joint Logistics Support Force of the Chinese People′s Liberation Army (Bethune International Peace Hospital) Shijiazhuang 050082 China; 2Outpatient Department Shijiazhuang Second Sanatorium for Retired Cadres of Hebei Provincial Military Command Shijiazhuang 050000 China; 3Department of Neurology the 980th Hospital of Joint Logistics Support Force of the Chinese People′s Liberation Army (Bethune International Peace Hospital) Shijiazhuang 050082 China; 4Laboratory of Basic Medicine the 980th Hospital of Joint Logistics Support Force of the Chinese People′s Liberation Army (Bethune International Peace Hospital) Shijiazhuang 050082 China; 5Fifth Stationed Outpatient Department the 980th Hospital of Joint Logistics Support Force of the Chinese People′s Liberation Army (Bethune International Peace Hospital) Shijiazhuang 050082 China

关键词：难治性高血压；同型半胱氨酸；微小RNA-21；血压昼夜节律；心脑血管事件

英文关键词：Resistanthypertension;Homocysteine;MicroRNA-21;Circadianrhythmofbloodpressure;Cardiovascularandcerebrovascularevents

• 摘要：

• 目的  探讨同型半胱氨酸（Hcy）、微小RNA-21（miR-21）与老年难治性高血压（RH）患者血压昼夜节律关系及预测心脑血管事件价值。方法 前瞻性选取中国人民解放军联勤保障部队第九八〇医院（白求恩国际和平医院）2020年1月至2023年12月收治的238例老年RH患者，随访截至2025年4月30日，中位随访时间为25个月，根据心脑血管事件发生情况分为观察组和对照组，比较2组一般资料、血压昼夜节律及血清Hcy、miR-21水平，采用Spearman秩相关系数分析血清Hcy、miR-21与血压昼夜节律的相关性，分析老年RH患者心脑血管事件的影响因素，绘制受试者工作特征（ROC）曲线分析血清Hcy、miR-21预测心脑血管事件价值。结果 随访期间，238例老年RH患者共有2例失访，80例发生心脑血管事件（观察组），余156例纳入对照组。观察组24 h收缩压、24 h舒张压及非杓型血压昼夜节律发生率高于对照组，末次随访血压达标率低于对照组（均P＜0.05）。血清Hcy、miR-21水平与24 h收缩压、24 h舒张压及非杓型血压昼夜节律呈正相关（Hcy：r=0.780、0.711、0.737，miR-21：r=0.721、0.733、0.736，均P＜0.05）。校正24 h收缩压、24 h舒张压、非杓型血压昼夜节律后，血清Hcy（比值比=1.495）、miR-21（比值比=1.556）仍是老年RH患者心脑血管事件的影响因素（均P＜0.05）。Hcy、miR-21联合预测老年RH患者心脑血管事件的曲线下面积高于单一预测（0.868比0.732、0.748，均P＜0.05）。结论 Hcy、miR-21与老年RH患者非杓型血压昼夜节律呈正相关，且是心脑血管事件发生影响因素，两者联合有助于提高预测效能，指导临床诊治。

• Objective To explore the relationships of homocysteine (Hcy) and microRNA-21 (miR-21) with circadian rhythm of blood pressure and their value in predicting cardiovascular and cerebrovascular events in elderly patients with resistant hypertension (RH). Methods A total of 238 elderly RH patients admitted to the 980th Hospital of Joint Logistics Support Force of the Chinese People′s Liberation Army (Bethune International Peace Hospital) from January 2020 to December 2023 were prospectively enrolled. The follow-up ended on April 30, 2025 with a median follow-up duration of 25 months. Patients were divided into observation group and control group according to the occurrence of cardiovascular and cerebrovascular events. General data, circadian rhythm of blood pressure and serum levels of Hcy and miR-21 were compared between the two groups. Spearman rank correlation coefficient was used to analyze the correlations of serum Hcy and miR-21 with circadian rhythm of blood pressure. Influencing factors for cardiovascular and cerebrovascular events in elderly RH patients were analyzed, and receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of serum Hcy and miR-21 for cardiovascular and cerebrovascular events. Results During follow-up, 2 of the 238 elderly RH patients were lost to follow-up, 80 patients developed cardiovascular and cerebrovascular events (observation group), and the remaining 156 patients were included in the control group. The 24 h systolic blood pressure, 24 h diastolic blood pressure and incidence of non-dipper blood pressure circadian rhythm in the observation group were higher than those in the control group, while the blood pressure control rate at the last follow-up was lower than that in the control group (all P＜0.05). Serum Hcy and miR-21 levels were positively correlated with 24 h systolic blood pressure, 24 h diastolic blood pressure and non-dipper blood pressure circadian rhythm (Hcy: r=0.780, 0.711, 0.737; miR-21: r=0.721, 0.733, 0.736, all P＜0.05). After adjusting for 24 h systolic blood pressure, 24 h diastolic blood pressure and non-dipper blood pressure circadian rhythm, serum Hcy (odds ratio=1.495) and miR-21 (odds ratio=1.556) remained independent influencing factors for cardiovascular and cerebrovascular events in elderly RH patients (all P＜0.05). The area under the curve of combined detection of Hcy and miR-21 for predicting cardiovascular and cerebrovascular events in elderly RH patients was higher than that of single indicator prediction (0.868 vs 0.732, 0.748, both P＜0.05). Conclusions Hcy and miR-21 are positively correlated with non-dipper blood pressure circadian rhythm in elderly RH patients, and are influencing factors for the occurrence of cardiovascular and cerebrovascular events. Combined detection of the two indicators helps improve predictive efficacy and guide clinical diagnosis and treatment.