血清单核细胞趋化蛋白-1水平与高血压靶器官损害的临床研究

A clinic study on correlation between serum levels of monocyte chemotactic protein-1 and target organ damage in patients with mild-moderate hypertension

目的探讨轻中度高血压是否存在亚临床表现的靶器官损害以及与血清单核细胞趋化蛋白-1（MCP-I）的关系。方法无临床靶器官损害证据的轻中度高血压患者为高血压组（50例），对照组为健康查体者（30例），观察尿白蛋白／肌酐比值（UACR）、踝臂指数（ABI）和肱踝脉搏波速度（baPwv）、左室重量指数（LVMI）、左心室舒张早期峰值速度／舒张晚期峰值速度（E/A）比值、左室射血分数（LVEF）等指标，评价是否发生靶器官损害；用酶联免疫吸附法（ELISA）测定血清MCP-1水平，应用相关分析法分析MCP-1与靶器官损害的相关性。结果高血压组UACR（mg／g）、ABI、baPWV（cm／s）、LVMI（g．m2）、E／A比值较对照组明显异常（UACR：54．93±6．32比15．09±4．18，ABI：0．72±0．24比1．06±0．21，baPWV：1800．03±250．29比1025．59±212．37，LVMI：138．60±29．88比103．66±24．19，E／A比值：0．72±0．32比1．04±0．26，均P〈0．05），MCP-1与UACR、ABI、baPWV呈正相关（r分别为0．439、0．421、0．567，均P〈0．01），与LVMI、E/A比值、LVEF无相关性（，值分别为0．135、0．092和0．126，均P〉0．05）。结论轻中度高血压已出现亚临床症状的靶器官损害，MCP-1与动脉硬化及阻力增加、尿微量白蛋白（MAU）有关，与心脏结构功能异常无显著相关性。

Objective To confirm the correlation between serum levels of monocyte chemotactic protein-I （ MCP-1 ） and target organ damage and whether sub-clinic target organ damage exists in patients with mild-moderate hypertension. Methods Mild-moderate hypertensive patients without clinical evidence of target organ damage were selected as hypertension group （n=50）, and the control group consisted healthy subjects （n=30）. The urinary albumin/ creatinine ratio （UACR）, ankle-brachial index （ABI）, braehial-ankle pulse wave velocity （baPWV）, left ventricle mass index （LVMI）, peak mitral filling velocities during early and late diastole （E/A）and left ventricle ejection fraction （LVEF）were observed to evaluate whether sub-clinic target organ damage had occurred. MCP-1 serum levels were determined by using a sandwich-enzyme linked immunosorbent assay （ELISA）. Correlation analyses were employed to assess whether serum MCP-1 levels were associated with target organ damage. Results UACR （mg/g）, ABI, baPWV （cm/s）, LVMI （g. m2）, E/A ratio were markedly abnormal in patients of hypertension group compared with those of the control group （UACR： 54.93±6.32 vs. 15.09±4.18, ABh 0.72±0.24 vs. 1.06±0.21, baPWV：1800.03±250.29 vs. 1025.59±212.37, LVML 138.60±29.88 vs. 103.66±24.19, E/A ratio： 0.72±0.32 vs. 1.04±0.26, all P〈0.05）. There were positive correlations between MCP-1 and each of the following： UACR, ABI, baPWV （r=0.439, 0.421, 0.567 respectively, all P〈0.01 ）, and no correlation was present between MCP-1 and LVMI, E/A ratio, LVEF respectively （r=0.135, 0.092, 0.126, allP〉0.05）. Conclusion Sub-clinic target organ damage exists in patients with mild-moderate hypertension, MCP-1 is closely related to arteriosclerosis, vascular resistance and mieroalbuminuria （MAU）, and there is no significant correlation between MCP-1 and abnormality in cardiac structure or function.