高血压患者动态脉压相关指数及高敏C反应蛋白与颈动脉粥样硬化的关系

摘要

目的 探讨中老年原发性高血压(EH)患者动态脉压相关指数即24h平均脉压(24 hPP)、动态脉压指数(PPI)、动态动脉硬化指数(AASI)和高敏C反应蛋白(hsCRP)与颈动脉病变的相关性.方法 对126例中老年EH患者行24h动态血压监测和颈动脉超声检查,并应用免疫散射比浊法测定血清hsCRP水平.据颈动脉内膜中层厚度(IMT)分为IMT正常组、IMT增厚组和斑块形成组；据动态血压参数计算出24 hPP、PPI、AASI；进一步分析24 hPP、PPI、AASI及血清hsCRP水平与颈动脉IMT的相关性.结果 ①IMT增厚组与斑块形成组的24 h收缩压(SBP)、24 hPP、PPI、AASI及血清hsCRP、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平均高于IMT正常组,HDL-C低于IMT正常组(P＜0.05)；且随着颈动脉IMT增加,血清hsCRP水平明显升高(P＜0.01).上述指标在IMT增厚组与斑块形成组之间比较,差异亦有统计学意义(P＜0.05).②Pearson相关分析显示颈动脉IMT与24 hPP、PPI、AASI及血清hsCRP、TC、LDL-C呈正相关,与HDLC呈负相关(P＜0.05).结论 动态脉压相关指数是评价中老年EH患者颈动脉硬化的良好指标,其中PPI和AASI的价值更大.血清hsCRP可能是影响颈动脉粥样硬化(AS)进程的重要细胞因子.血清hsCRP水平与动态脉压相关指数关系密切,两者共同参与了AS的发生发展过程.%Objective To study the effects of ambulatory pulse pressure related indexes, derived from ambulatory blood pressure monitoring, and serum high sensitive C-reactive protein ( hsCRP) on carotid atherosclerosis in elderly patients with essential hypertension. Methods A total of 126 elderly patients with essential hypertension underwent 24-hour ambulatory blood pressure monitoring (ABPM) and carotid color Doppler ultra-sonography. According to carotid intima-media thickness (IMT), the patients were divided into the normal IMT group (n = 33), the thickened IMT group (n=49) and the plaque formation group (n = 44). Ambulatory blood pressure parameters (24 hPP, PPI and AASI) were calculated. The level of serum hsCRP in patients of the three groups was measured by immunoturbidimetry. The relationship of ambulatory pulse pressure related indexes (24 hPP, PPI and AASI) with serum hsCRP and carotid IMT was analyzed. Results ① In the thickened IMT group and the plaque formation group, 24 h systolic blood pressure (SBP), 24 hPP, PPI, AASI as well as levels of serum hsCRP, TC and LDL-C were higher than those in the IMT normal group, whereas HDL-C was lower (P<0.05). Level of serum hsCRP was significantly elevated with the increase of carotid IMT (P<0.01). The difference between the thickened IMT group and the plaque formation group was also significant (P<0.05). ② Pearson correlation analysis showed that carotid IMT was positively correlated with 24 hPP, PPI, AASI as well as serum hsCRP, TC and LDL-C, but negatively correlated with HDL-C (P<0.05). Conclusion Ambulatory pulse pressure related indexes are good indicators for evaluating carotid atherosclerosis in elderly patients with essential hypertensim, and PPI and AASI have a greater value. Serum hsCRP may be an important cytokine affecting the process of AS. The level of serum hsCRP is closely related to ambulatory pulse pressure related indexes, and the two play an important role in the initiation and development of AS.