超敏C反应蛋白与老年高血压患者合并颈动脉斑块稳定性的关系及其性别差异

Relationship between high-sensitivity C-reactive protein and the stability of carotid atherosclerotic plaques and the gender differences in elderly hypertensive patients

目的观察血清超敏C反应蛋白(hsCRP)水平与老年高血压患者颈动脉斑块及其稳定性的相关性,以及是否有性别差异。方法 "老年高血压降压治疗长期随访研究"的研究对象中,172例70岁以上的高血压患者行颈动脉超声检查,以内膜中层厚度(IMT)>1.3mm诊断动脉粥样斑块形成;根据有无斑块及斑块回声的特点分为无斑块组、稳定斑块组(扁平斑块和硬斑块)和易损斑块组(软斑块和溃疡型斑块)。同时测定hsCRP、血脂、血清肌酐、尿酸。结果颈动脉斑块组(n=131)血清hsCRP为(3.2±2.5)mg/L,显著高于无斑块组〔(2.0±1.8)mg/L,n=41,P=0.005〕。对危险因素进行logistic回归分析显示,只有血清hsCRP水平是发生颈动脉斑块的危险因素(RR=1.299,95%CI=1.052～1.604,P=0.015)。进一步分析显示易损斑块组血清hsCRP为(4.2±2.5)mg/L,显著高于稳定斑块组〔(2.5±2.2)mg/L〕和无斑块组(P<0.001)。后两组之间血清hsCRP则无显著差异(P=0.278)。分别分析男性和女性血清hsCRP与颈动脉斑块的关系,易损斑块组的血清hsCRP均显著高于稳定斑块组和无斑块组(P<0.05)。结论血清hsCRP水平与老年高血压患者颈动脉斑块的发生及其稳定性相关,易损斑块者的血清hsCRP显著高于无斑块者和稳定斑块者;并且这种相关性在70岁以上的男性和女性老年高血压患者中都存在,未观察到性别差异。

Objective To investigate the correlation between the levels of high sensitivity C-reactive protein （hsCRP） and the stability of carotid atherosclerotic plaques and the gender-associated differences in elderly hypertensive patients. Methods A total of 172 hypertensive patients aged over 70 years underwent ultrasound examination to measure intima media thickness （IMT）. Carotid atherosclerotic plaques were identified with IMT 〉1.3 mm. Serum hsCRP and serum lipids, creatinine and uric acid were tested. Then the patients were divided into three groups according to result of B-mode ultrasound examination： non-plaque group, stable plaque group and unstable plaque group. Results Serum hsCRP was significantly higher in plaque group（n=131） than in non-plaque group [n=41, （3.2±2.5） vs（2. 0±1. 8） mg/L, P=0. 005]. Logistic regression analysis showed that the serum hsCRP was the on ly risk factor of carotid atherosclerosis plaque （RR= 1. 299, 95%CI= 1. 052-1. 604, P= 0. 015）. Further analysis showed that the serum hsCRP was significantly higher in unstable plaque group [（4.2 ± 2.5） mg/L] than in stable plaque group [（2. 5±2. 2） mg/L, P〈0. 001] or non-plaque group （P〈0. 001）, but there was no difference between the latter two groups （P=0. 278）. Serum hsCRP was higher in both female and male elderly patients with unstable carotid atherosclerosis plaques than in patients with stable plaques or without plaques. Conclusion Serum hsCRP is associated with the stability of carotid atherosclerotic plaques in elderly hypertensive patients. Serum hsCRP is higher in patients with unstable carotid atherosclerosis plaques than in patients with stable plaques or without plaques. This correlation exists in both female and male elderly hypertensive patients, with no gender-associated difference.