老年单纯收缩期高血压患者左心功能变化的可能机制

Possible mechanism on changes of left-ventricular function in elderly isolated systolic hypertension

目的探讨血CD34＋、Toll样受体2（TLR2）、Toll样受体4（TLR4）和高敏c反应蛋白（hs—CRP）的水平变化与老年人单纯收缩期高血压（EISH）患者左心功能的关系。方法2008年2月至2010年2月徐州医学院淮安附属医院老年病科入住EISH合并慢性左心衰竭患者98例和同期健康体检者30例（对照组）。根据美国纽约心脏病学会（NYHA）心功能分级、左心室射血分数（LVEF）和收缩压将EISH患者分I级组25例、Ⅱ级组29例、Ⅲ级组24例和Ⅳ级组20例。使用双标记单克隆抗体和相应的对照抗体（由美国Beckman Coulter公司提供）标记血液中的白细胞，测定外周血CD34＋，采用流式细胞仪检测对照组和EISH患者TLR2和TLR4的平均荧光强度（MFI），免疫散射比浊法测定hs—CRP的水平。结果I级组、Ⅱ级组、Ⅲ级组、Ⅳ级组LVEF分别为（40．5±3．6）％、（30．8±2．5）％、（28．5±1．9）％和（26．4±2．1）％，收缩压分别为（151．1±5．9）mmHg（1mmHg=0．133kPa）、（171．1±6．0）mmHg、（190．7±7．3）mmHg和（211．1±8．4）mmHg。IV级组和I级组比较，LVEF、收缩压、CD34＋[分别为（0．5±0．2）×10^9／L和（2．5±0．4）×10^9／L]、TLR2[（8．0±1．0）MFI与（3．2±1．1）MFI]、TLR4[（6．4±1．3）MFI与（2．4±1．1）MFI]、hs—CRP[（14．7±0．3）mg／L与（4．90±0．61）mg／L]差异有统计学意义（均P〈0．05）。结论TLR2、TLR4和hs—CRP水平增高及CD34＋水平的下降与收缩压升高、LVEF下降和NYHA心功能分级升高相关。

Objective To study the relationship of left-ventricular function change with circulation levels of CD34＋ cells, toll like receptor 2 （TLR2） , TLR4 and high-sensitivity C-reactive protein （hs-CRP）in elderly isolated systolic hypertension. Methods According to New York Heart Association （NYHA）class, left ventricular ejection fraction （LVEF） and systolic blood pressure （SBP） ,the healthy subjects and the patients were divided into 5 groups： control 30 cases, class I 25 cases, class II 29 cases, class III 24 cases and class IV 20 cases. The expressions of circulating CD34 ＋ cells, TLR2 and TLR4 in the patients and healthy subjects were measured by flow cytometry. The level of hs-CRP was measured by nephelometry immunoassay. Results In class IV versus class I , the levels of LVEF[（26.4±2.1）%vs. （40.5±3.6）%] and CD34＋ [（0.5±0.2）×10^9 vs. （2.5± 0. 4） ×10^9/L] were decreased, whileSBP[（211.1±8.4）mm Hg vs. （151.1±5.9）mm Hg], TLR2 [（8.0±1.0） vs. （3.2±1. 1）MFI], TLR4 [（6.4±1. 3）MFT vs. （2.4±1. 1）MFI] and hs-CRP [（14.7±0.3）mg/L vs. （4.9±0.6）mg/L] were increased （all P〈0.05）. Conclusions The lower levels of CD34＋ cells, higher TLR2, TLR4 and hs-CRP levels are correlated with increasing SBP, decreasing LVEF and higher NYHA class.