隐蔽性高血压患者血管活性物质的变化

Vascular Active Substances in Patients with Masked Hypertension

目的探讨隐蔽性高血压患者血浆中血栓素A2(TXA2)、前列环素(PGI2)、神经肽Y(NPY)、降钙素基因相关肽(CGRP)水平变化并评价其对隐蔽性高血压患者血压水平的影响。方法78例研究对象分为健康对照组(A组,n=30),隐蔽性高血压组(B组,n=18)及原发性高血压组(C组,n=30)。检测各组血浆中TXA2、PGI2、NPY、CGRP水平并作比较。结果B组患者血浆中TXA2(1151.0±144.0)ng/L和NPY(138.1±16.1)ng/L水平高于A组[TXA2:(940.5±172.5)ng/L;NPY:(99.6±19.7)ng/L;P均<0.01],但是低于C组患者[TXA2:(1416.6±145.2)ng/L;NPY(169.8±26.2)ng/L;P均<0.01];而B组患者血浆中PGI2和CGRP水平低于A组[PGI2:(171.4±44.0)vsA组:(244.4±51.2)ng/L;CGRP:(56.2±15.6)vsA组:(79.8±17.9)ng/L;P均<0.01],高于C组患者[PGI2:(171.4±44.0)vsC组:(108.3±41.9)ng/L;CGRP:(56.2±15.6)vsC组:(39.2±16.6)ng/L;P<0.05或P<0.01]。经多元线性回归分析:B组患者白昼SBP水平与TXA2、NPY水平直线相关(P均<0.01);白昼DBP水平与TXA2、CGRP水平直线相关(P<0.05～0.01)。结论隐蔽性高血压病人血管活性物质如TXA2、PGI2、NPY、CGRP较正常血压的人不同,表现为收缩性血管活性因子增多,舒张性血管因子减少,提示这些血管活性物质可能参与了隐蔽性高血压的发病。

Objective To study the alteration of vascular active substances in plasma in patients with masked hypertension. Methods Seventy eight subjects were classified into 3 groups： normotensive control（NC） group（group A, n=30）, masked hypertension（MH） group（group B, n=18） and essential hypertension（EH） group（group C, n=30）. The plasma concentration of TXA2 , PGI2, NPY, CGRP were determined. Results The plasma concentration of TXA2, NPY in patients with MH were higher than those in NC（TXA2：1151.0±144.0 vs NC： 940.5±172.5 ng/L;NPY：138. 1±16. 1 vs NC： 99.6±19.7 ng/L, all P〈0.01）, but were lower than those in patients with EH（TXA2：1151.0±144.0 vs EH： 1416.6±145.2 ng/L;NPY：138.1±16.1 vs EH： 169.8±26.2 ng/L, all P〈0, 01）. The plasma concentration of PGI2, CGRP in patients with MH were lower than those in NC（PGI2 ：171.4±44.0 vs NC： 244.4±51.2 ng/L;CGRP：56.2±15.6 vs NC： 79.8±17.9 ng/L, P〈0.01 ）, but higher than those in patients with EH （PGI2 ： 171.4±44.0 vs EH ： 108.3±41.9 ng/L; CGRP： 56.2±15.6 vs EH：39.2±16.6 ng/L, P〈0.05）. Multiple regression analysis showed the levels of SBP in patients with MH were linearlly related to TXA2, NPY（P〈0.01）. The levels of DBP in patients with MH were linearlly related to TXA2, CGRP（P〈0. 05-0. 01）. Conclusion Patients with masked hypertension had higher plasma concentration of vasoconstrictive factors TXA2 and NPY, with lower vasorelaxative factors PGI2 and CGRP, suggesting these vasoactive substances may involve into the pathogenesis of masked hypertension. TXA2, NPY, PGI2 , CGRP play important roles in patients with MH.