正常血压与高血压颈动脉血流剪切力、MMP-9和CRP表达的差异性分析

Difference Analysis of Carotid Blood Flow Shear Force and Expression of MMP-9 and CRP under Normal Blood Pressure and Hypertension

目的探讨正常血压、高血压前期(PHT)及高血压颈动脉不稳定斑块患者血流剪切力、基质金属蛋白酶-9(MMP-9)和C反应蛋白(CRP)表达的差异性。方法选取2017年1月至2019年1月在内蒙古自治区人民医院体检的40例高血压颈动脉不稳定斑块患者为高血压颈动脉不稳定斑块组,选取40例PHT患者为PHT组,另选取40例血压正常者为正常血压组,检测并比较三组空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和尿酸(UA),采用酶联免疫吸附测定法检测三组MMP-9、CRP水平。全自动血流变测试仪检测血液黏稠度。应用多普勒超声诊断仪测定颈动脉舒张末期内径、颈动脉收缩末期峰值血流速度,根据公式计算颈动脉血流剪切力。采用Pearson相关分析颈动脉血流剪切力、MMP-9、CRP之间的相关性。结果三组FPG、TC、TG、HDL-C、LDL-C、UA比较差异无统计学意义(P>0.05)。高血压颈动脉不稳定斑块组和PHT组血液黏稠度、颈动脉舒张末期内径高于正常血压组[(8.14±0.45)mPa?s、(6.05±0.41)mPa?s比(4.82±0.39)mPa?s,(0.83±0.07)cm、(0.72±0.08)cm比(0.61±0.11)cm],且高血压颈动脉不稳定斑块组高于PHT组(P<0.05);高血压颈动脉不稳定斑块组和PHT组颈动脉收缩末期峰值血流速度、颈动脉血流剪切力低于正常血压组[(38.4±15.6)cm/s、(50.6±14.2)cm/s比(74.5±12.8)cm/s,(11.2±4.4)dynes/cm^2、(17.1±4.6)dynes/cm^2比(25.4±5.2)dynes/cm^2],且高血压颈动脉不稳定斑块组低于PHT组(P<0.05)。Pearson相关性分析显示,PHT及高血压颈动脉不稳定斑块患者MMP-9与CRP呈正相关(r=0.852,P<0.001),颈动脉血流剪切力与MMP-9、CRP呈负相关(r=-0.962、-0.915,均P<0.001)。结论与正常血压相比,PHT及高血压颈动脉不稳定斑块患者颈动脉血流剪切力明显下降,MMP-9、CRP表达明显升高,且颈动脉血流剪切力与MMP-9、CRP表达呈负相关。颈动脉血流剪切力可作为PHT及高血压颈动脉不稳定斑块患者血管内皮损伤的标志物,对临床研究具有重要价值。

Objective To investigate the differences in blood flow shear force and matrix metalloproteinase-9(MMP-9)and C-reactive protein(CRP)expression in patients with normal blood pressure,prehypertension(PHT)and hypertensive carotid instability plaques.Methods A total of 40 cases of hypertension with unstable carotid plaque from medical examination population in Inner Mongolia Autonomous Region People′s Hospital from Jan.2017 to Jan.2019 were included as a hypertensive instable carotid plaque group,and 40 cases of PHT were included as a PHT group,and 40 cases with normal blood pressure ewere included as a normal blood pressure group.The fasting plasma glucose(FPG),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)and uric acid(UA)of the three groups were collected.MMP-9 and CRP were determined by enzyme-linked immunosorbent assay.Hemodynamic parameters blood viscosity was tested by automatic hemorheology tester,maximum blood flow velocity,carotid end diastolic diameter,carotid blood flow shear force.The blood viscosity was measured by automatic hemorheology tester.The end diastolic diameter and the peak velocity of the end systolic blood flow of the carotid artery were measured by the Doppler ultrasound diagnostic instrument.Pearson analysis was done to analyze the correlation among carotid blood flow shear force,MMP-9 and CRP.Results There was no significant difference in FPG,TC,TG,HDL-C,LDL-C,UA among the three groups(P>0.05).The blood viscosity and end diastolic diameter in the hypertensive instable carotid plaque group and PHT group were significantly higher than those in the normal blood pressure group[(8.14±0.45)mPa?s,(6.05±0.41)mPa?s vs(4.82±0.39)mPa?s;(0.83±0.07)cm,(0.72±0.08)cm vs(0.61±0.11)cm],and hypertensive instable carotid plaque group higher than PHT group(P<0.05).The maximum blood flow velocity in the hypertensive instable carotid plaquegroup and PHT group was lower than that of normal blood pressure group[(38.4±15.6)cm/s,(50.6±14.2)cm/s vs(74.5±12.8)cm/s;(11.2±4.4)dynes/cm^2,(17.1±4.6)dynes/cm^2 vs(25.4±5.2)dynes/cm^2],and hypertensive instable carotid plaque group lower than PHT group(P<0.05).Pearson correlation analysis showed that PHT and hypertensive carotid artery plaques were positively correlated with MMP-9 and CRP(r=0.852,P<0.001),and carotid blood flow shear force was negatively correlated with MMP-9 and CRP(r=-0.962,-0.915,all P<0.001).Conclusion Compared with normal blood pressure,in patients with PHT and hypertensive instable carotid plaques,carotid blood flow shearing force is significantly decreased,MMP-9 and CRP expression are significantly increased,and blood flow shear force and MMP-9,CRP expression are negatively correlated.Blood flow shear can be used as a marker of vascular endothelial injury in patients with PHT and hypertensive instable carotid plaques,which is of great value for the clinical research.