餐后三酰甘油与炎症反应导致高血压患者高脂餐后纤溶功能紊乱

Fibrinolytic Dysfunction After A High-fat Meal Induced Postprandial Triglyceride and Inflammatory Responses in Normocholesterolemic Patients with Essential Hypertension

目的研究高血压患者高脂餐后血浆高敏C反应蛋白(hsCRP)、纤溶酶原激活物抑制剂1(PAI-1)和组织型纤溶酶原激活剂(t-PA)抗原的浓度变化。方法空腹胆固醇水平正常的高血压患者54例和健康对照者30例于禁食12h后接受高脂餐负荷试验,检测空腹(F)和餐后4h(P)血浆hsCRP、PAI-1、t-PA抗原以及三酰甘油(TG)、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇的浓度。结果餐后血浆TG浓度在两组受试者均高于空腹水平,但高血压患者餐后TG浓度较高[(高血压组:(3.4±1.5)比对照组:(1.7±0.8)mmol/L,P<0.01]。与空腹状态相比,高血压患者餐后log(hsCRP)升高[空腹:(0.32±0.21)比餐后:(0.56±0.31)、血浆PAI-1[空腹:(37.1±14.3)比餐后:(57.5±15.1)μg/L]和t-PA抗原[空腹:(9.0±6.1)比餐后:(15.9±10.0)μg/L]浓度升高(P均<0.01);而对照组无显著变化。将84例受试者作为一个整体,相关分析显示:餐后血浆TG浓度分别与餐后log(hsCRP)(r=0.565,P<0.01)、PAI-1抗原(r=0.332,P<0.05)浓度显著相关。回归分析显示:餐后血浆TG浓度的增长值(r=0.324,P<0.05)和log(hsCRP)的增长值(r=0.386,P<0.01)对餐后血浆PAI-1抗原浓度的增长值有独立和显著的预示价值。结论一次性高脂餐引起的餐后TG增高和炎症反应可促使高血压患者餐后纤溶功能异常。

Objective To explore the potential influence of a high-fat meal on systemic inflammation and fibrinolytic dysfunction in normocholesterolemic patients with essential hypertension（EH）.Methods Plasma concentrations of lipids profiles,high-sensitivity C-reactive protein（hsCRP）,plasminogen activator inhibitor type 1（PAI-1）and tissue plasminogen activator（t-PA）antigens in fasting state（F）and at 4 hours after a single high-fat meal（P）were measured in 54 EH patients and 30 healthy controls（Con）.Results Postprandial triglyceride concentrations increased significantly in both hypertensive patients and healthy controls（P〈0.01）.EH patients had significantly higher postprandial triglyceride concentrations（EH：3.4±1.5 vs Con：1.7±0.8 mmol/L,P〈0.01）than controls.A high-fat load produced significant increases in log（hsCRP）（F：0.32±0.21 vs P：0.56±0.31）,plasma PAI-1（F：37.1±14.3 vs P：57.5±15.1 μg/L）and t-PA（F：9.0±6.1 vs P：15.9±10.0 μg/L）antigens concentrations at 4 hours in hypertensive patients（all P〈0.01）but not in healthy controls.Taking all subjects as a whole（n=84）,postprandial plasma triglyceride concentration was correlated with log（hsCRP）（r=0.565,P〈0.01）and PAI-1 antigen（r=0.332,P〈0.05）concentrations,respectively.Postprandial increments of plasma triglyceride concentration（r=0.324,P〈0.05）and log（hsCRP）（r=0.386,P〈0.01）independently and significantly predicted the increases in PAI-1 antigen.Conclusion A high-fat meal induces fibrinolytic dysfunction,presenting as increased plasma t-PA and PAI-1 antigen concentrations in normocholesterolemic patients with essential hypertension,which may be mediated by postprandial triglyceride and inflammatory responses.