老年高血压患者晨峰变化对炎性因子及血管内皮功能的影响

Influence of morning blood pressure surge on inflammatory factor and vascular endothelial function in old patients

目的研究原发性高血压患者血压晨峰(MBPS)与高敏C反应蛋白(hs-CRP)、基质金属蛋白酶9(MMP-9)、血管内皮功能的关系。方法对入选的127例原发性高血压患者行24 h动态血压监测,根据监测结果,将患者分为MBPS组(70例)和无MBPS组(NMBPS组,57例),两组均采用胶乳比浊法测定hs CRP,ELISA法测定MMP-9,血管超声检测肱动脉血流介导的血管扩张功能(FMD),比较两组hs-CRP、MMP-9和血管内皮功能水平。结果与NMBPS组比较,MBPS组患者平均收缩压晨峰变异幅度显著升高,且hs-CRP和MMP-9显著升高(P<0.01),而FMD显著降低,差异有统计学意义(P<0.01);MBPS与年龄、高血压病程、24 h平均收缩压、LDL-C、hs-CRP及MMP-9呈正相关,与FMD呈负相关(r=-0.237,P<0.01);多元线性回归分析显示,24 h平均收缩压、LDL-C、hs-CRP、MMP-9和FMD 5个自变量进入回归方程。24 h平均收缩压对MBPS指标值影响最大。结论 MBPS可能与hs-CRP、MMP-9及血管内皮功能相关。

Objective To study the relationship of morning blood pressure surge（MBPS） with high sensitivity C-reactive protein（hs-CRP）, matrix metalloproteinase-9（MMP-9） and changes of endothelium-dependent vasodilatation（FMD） in patients with essential hypertension. Methods According to the results of 24 h ambulatory blood pressure monitoring for the selected 127 cases with essential hypertension, the patients were divided into morning blood pressure surge group （MBPS group, 70 cases） and morning blood pressure normal group（NMBPS group, 57 cases）, hs- CRP was measured with turbidimetry, MMP-9 with enzyme linked immunosorbent assay and FMD in the brachial artery by high-resolution ultrasound technique. The results were analyzed to see if there was any statistically significant difference between the two groups. Results Compared with N MBPS group, MBPS group .had not only significant increase in hs-CRP （P 〈 0.01）, but also in MMP-9 （P 〈 0.01） ,while decrease in FMD （P 〈 0.01）. Pearson relation analysis showed that MBPS level had significant positive correlation with age, course of disease, the average of 24 h SBP, LDL-C, hs-CRP, MMP-9 and negative correlation with FMD （r=-0. 237, P 〈 0.01）. Multivariate regression analysis showed that the average of 24 h SBP, LDL-C, hs-CRP, MMP-9 and FMD were predictors of MBPS levels,especically the average of 24 h SBP. Conclusion The morning blood pressure surge is related to hs-CRP,MMP-9 and endothelium-dependent vasodilatation in patients with essential hypertension.