慢性心力衰竭患者血压变异性与血栓前状态的关系

Correlation between blood pressure variability and prothrombotic state in patients with chronic heart failure

目的:观察慢性心力衰竭(心衰)患者血压变异性和血栓前状态指标的情况,探讨血压波动与血栓前状态的关系。方法:入选对象分为心衰组(158例)和对照组(142例),分别对比2组24h、白天、夜间收缩压和舒张压变异性,以及血浆血管性假性血友病因子(vWF)、血小板α颗粒膜蛋白-140(GMP-140)、纤维蛋白原、D-二聚体、纤溶酶原激活物抑制物-1(PAI-1)和组织纤溶酶原激活物(t-PA)等血栓前状态指标的差异,并对各组血压变异性与血栓前状态的指标进行相关性分析。结果:①心衰组白天、夜间和全天24h收缩压变异性均显著高于对照组。②心衰组vWF、D-二聚体和PAI-1均显著高于对照组,其余血栓前状态指标2组无显著差异。③心衰组24h收缩压变异性与vWF和GMP-140有显著正相关(r=0.475,P<0.05和r=0.416,P<0.05);24h以及夜间的舒张压变异性与GMP-140均呈显著正相关(r=0.425,P<0.05和r=0.423,P<0.05)。心衰组其他各时段,以及对照组的血压变异性与各血栓前状态指标均无显著相关性。结论:慢性心衰患者的血压变异性显著增高,并伴有内皮损害、血小板和凝血纤溶系统的激活,而且血压变异性越大,则内皮损害和血小板激活越显著。

Objective：The study was designed to investigate the indexes of prothrombotic state（PTS）and blood pressure variability（BPV）in patients with chronic heart failure,and to explore the correlation between BPV and PTS.Method：Enrolled subjects were divided into heart failure group（158 patients）and control contrast group （142 patients）.Plasma von willebrand factor（vWF）,platelet alpha-granule membrane protein-140（GMP-140）,fibrinogen and D-dimer,plasminogen activator inhibitor-1（PAI-1）,tissue plasminogen activator（t-PA）in heart failure group were compared with control contrast group.Correlation between the PTS and the BPV were evalua-ted in each group,respectively.Result：①The systolic BPV in periods of daytime,nighttime and 24-hours of heart failure group were significant higher than those of the control contrast group.②The vWF,D-dimer and PAI-1in heart failure group were all significantly higher than those in compared with contrast group.Other indexes of PTS did not have significant difference between heart failure group and control contrast group no significant differences exist.③The systolic BPV of 24-hours time period in heart failure group had positive correlation with vWF（r=0. 475,P〈0.05）and GMP-140（r=0.416,P〈0.05）.The diastolic BPV of both 24-hours and nighttime periods in heart failure group present positive correlations with GMP-140（r=0.425,P〈0.05and r=0.423,P〈0.05）. The BPV of the other time periods of heart failure group and the BPV of all time periods of contrast group had no significant correlations with the indexes of PTS.Conclusion：The BPV of chronic heart failure increased significantly,which also accompanied with endothelial impairment and activation of platelet,coagulation and fibrinolysis. Furthermore the endothelial impairment and platelet activation positively correlated with the BPV.It suggests that the more BPV increasing,the more endothelial impairment and platelet activation.