原发性高血压血瘀证患者活化血小板、胰岛素抵抗及动态血压变化特点

Characteristics of activating platelet, insulin resistance and changes of dynamic blood pressure in patients with primary hypertension and blood stasis syndrome

目的:观察原发性高血压血瘀证患者活化血小板、胰岛素抵抗、动态血压变化,并与非血瘀证及健康体检者相对照。方法:①选择2001-03/2002-12厦门市中山医院老年科住院或门诊就诊的原发性高血压患者60例,男38例,女22例,年龄60～80岁。均对检测项目知情同意。高血压血瘀证组22例,男13例,女9例;年龄63～80岁。高血压非血瘀证组38例,男25例,女13例,年龄63～80岁。选择同期本院体检健康人30名为对照组,男20名,女10名;年龄60～80岁。均对检测项目知情同意。②采用无创携带式全自动监测仪监测24h收缩压变异性。采用EPICX-XL型流式细胞仪测定外周血活化血小板的表面分子标志物血小板α-颗粒膜糖蛋白、血小板溶酶体膜糖蛋白的阳性表达率。分别用葡萄糖氧化酶法及放射免疫法测定空腹血糖和空腹胰岛素,胰岛素敏感指数=ln[1/(空腹血糖×空腹胰岛素)]。计算体质量指数[体质量(kg)/身高2(m2)]。③两组差异用成组数据t检验,采用多元逐步回归分析,并进行直线相关分析。结果:原发性高血压患者60例和健康人30名均进入结果分析。①高血压患者、高血压血瘀证组、高血压非血瘀证组患者空腹胰岛素、血小板α-颗粒膜糖蛋白阳性表达率及血小板溶酶体膜糖蛋白阳性表达率明显高于对照组(P<0.05～0.01)。高血压组和高血压血瘀证组患者胰岛素敏感指数明显低于对照组(P<0.05,0.01)。高血压血瘀证组患者血小板溶酶体膜糖蛋白阳性表达率明显高于高血压非血瘀证(P<0.05)。②原发性高血压患者血小板α-颗粒膜糖蛋白阳性表达率与胰岛素敏感指数呈显著正相关(r=0.440,P<0.05),血小板溶酶体膜糖蛋白阳性表达率与胰岛素敏感指数无明显相关性(r=-0.17,P>0.05)。③以24h动态收缩压变异性为应变量,以血小板溶酶体膜糖蛋白阳性表达率、血小板α-颗粒膜糖蛋白阳性表达率及体质量指数为自变量X建立逐步回归方程Y=-4.42+0.750×血小板α-颗粒膜糖蛋白阳性表达率+0.747×体质量指数。以24h动态收缩压变异性为应变量Y,Y=0.963+0.836×血小板溶酶体膜糖蛋白阳性表达率,表明动态收缩压变异性与活化血小板和体质量指数关系密切。结论:原发性高血压血瘀证患者存在着明显血小板活化及胰岛素抵抗的异常,血小板溶酶体膜糖蛋白、血小板α-颗粒膜糖蛋白、胰岛素敏感指数可能是血瘀证微观辨证的指标之一。

AIM： To investigate the relationship among activating platelet, insulin resistance （RI） and changes of dynamic blood pressure in patients with primary hypertension and blood stasis syndrome （BSS） so as to compare with non-BSS patients and healthy people. METHODS： ①Totally 60 patients, 38 males and 22 females, aged 60- 80 years, with primary hypertension were selected from Department of Geriatrics of Xiamen Zhongshan Hospital from March 2001 to December 2002. There were 22 patients including 13 males and 9 females aged 63- 80 years in hypertensive BSS group, 38 patients including 25 males and 13 females aged 63-80 years in hypertensive non-BSS group, and 30 healthy people including 20 males and 10 females aged 60-80 years in control group. All patients were told the fact. ②Variability of systolic pressure was assayed within 24 hours with non-invasive portable automatic monitor, Positive rates of platelet a-granule membrane protein and platelet membrane of lysosome glycoprotein were assayed with EPICX-XL flow cytometer. Fasting blood glucose and fasting insulin were measured with glucose oxidase and radio-immunity methods respectively. Sensitive index of insulin was In [l/（fasting blood glucose × fasting insulin）], and index of body mass was [body mass （kg）/height^2 （m^2）]. ③ Differences between two groups were compared with t test, and multiple stepwise regression analysis and liner correlation analysis were also used in this study. RESULTS： Totally 60 patients with primary hypertension and 30 normal subjects entered the final analysis. ① Content of fasting insulin and positive rates of platelet α-granule membrane protein and platelel membrane of lysosome glycoprotein were higher in hypertensive group, hypertensive BSS group and hypertensive non-BSS group than those in control group （P 〈 0.05-0.01）. Sensitive index of insulin was lower in hypertensive group and hypertensive BSS group than that in control group （P 〈 0.05, 0.01）. Positive rate of platelet membrane of lysosome glycoprotein was higher in hypertensive BSS group than that in hypertensive non-BSS group （P 〈 0.05）. ② Positive rate of platelet α- granule membrane protein was positively correlated with sensitive index of insulin （r=0.440, P 〈 0.05）, but there was not obvious correlation between positive rate of platelet membrane of lysosome glyeoprotein and sensitive index of insulin （r= -0.17, P 〉 0.05）. ③ Regarded variability of dynamic systolic pressure within 24 hours as dependent variable, and positive rates of platelet a-granule membrane protein and platdet membrane of lysosome glyeoprotein and index of body mass as independent variable X, the stepwise regression equation was determined as followed： Y = -4.42 ＋ 0.750 × positive rate of platelet α-granule membrane protein ＋ 0.747× index of body mass. Regarded variability of dynamic systolic pressure within 24 hours as dependent variable Y, Y = 0.963 ＋ 0.836 × positive rate of platelet membrane of lysosome glycoprotein, it manifested that variability of dynamic systolic pressure was closely correlated with activating platelet and index of body mass. CONCLUSION： Patients with primary hypertension and BSS has obvious abnormality of platelet activation and insulin resistance, and platelet membrane of lysosome glycoprotein, platelet α-granule membrane protein and sensitive index of insulin may be one of diagnostic standardization for BSS.