血浆神经肽Y神经降压肽水平与高血压患者血压昼夜变化和靶器官损害的研究

Effect of neuropeptide Y and neurotensin on diurnal rhythm of blood pressure and target organ damage for essential hypertension

目的通过观察血浆中神经肽Y(NPY)、神经降压肽(NT)水平的变化,探讨其对原发性高血压(EH)患者24H血压昼夜变化和靶器官损害影响的临床意义。方法对EH患者90例,对照组30例行24H动态血压监测,采用放射免疫分析法(RIA)在不同时间点(2:00,8:00,16:00)分别测定血浆NPY、NT含量;同时检测其心、脑、肾靶器官功能。结果(1)根据动态血压监测的结果将EH者分为杓型组与非杓型组。(2)EH患者各时间点血浆NPY水平均明显高于对照组(P<0·01),而NT水平低于对照组(P<0·05)。(3)与杓型组相比,非杓型组NPY水平在各时间点升高和NT水平降低更为明显,尤其在夜间2:00时更为显著,差异均有统计学意义(P<0·01)。(4)与无靶器官受损组相比,EH伴心、脑、肾靶器官损害的患者血浆NPY升高,而血浆NT水平明显降低(P<0·01);血浆NPY、NT在各靶器官损害患者之间差异无统计学意义。结论血浆NPY、NT水平昼夜变化可能是导致EH患者血压昼夜节律紊乱的原因之一。EH患者伴靶器官损害时,血浆NPY水平明显升高和NT水平降低不仅参与了EH的发生、发展,也参与了靶器官受损的过程。

Objective To investigate the effect of plasma neuropeptide Y （ NPY）, neurotensin （NT） and their relationships on the diurnal rhythm of BP and target organ damage for essential hypertension. Methods Ambulatory BP monitoring （ABPM） for 24 hours was performed in ninety patients with essential hypertension and thirty healthy subjects. The patients were divided into two groups： 55 dippers and 35 non-dippers according to the ABPM results. Plasma NPY and NT levels in subjects were measured at 8： 00, 16：00 and 2：00 o＇ clock by using radioimmunoassay method. Target organ functions were measured. Results The plasma NPY level was higher and NT was lower in patients with hypertension those in normal controls （ P 〈 0. 001 ）. Compared with dippers, non-dippers had a higher NPY and a lower NT plasma levels, especially appearing at 2：00 o＇clock. The patients with left ventricular hypertrophy, stroke or kidney damage had a higher NPY and a lower NT levels compares with those without target organ damage. Conclusion The changes in plasma NPY and NT may contribute to disturbance of the diurnal rhythm of blood pressure in patients with essential hypertension, especially in those with target organ damages, which may serve as a pathophysiologic mechanism for target organ damages in hypertension.