高血压病患者血清Ⅰ型和Ⅲ型前胶原浓度变化及其临床意义探讨

Changes of serum concentrations of procollagen type Ⅰ and Ⅲ in essential hypertensive patients and their clinical significance

目的 探讨高血压病 (EH)患者心肌纤维化的无创性检测指标。方法 采用放免法测定 30例正常人和 6 0例EH患者 (伴心肌肥厚者 35例和不伴心肌肥厚者 2 5例 )血清Ⅰ型前胶原 (PCⅠ )和Ⅲ型前胶原 (PCⅢ )的浓度 ,用M型超声测算左室重量指数 (LVMI) ,用多普勒超声测定二尖瓣口舒张早期和晚期最大血流速度 (VE 和VA)。结果 ①EH患者血清PCⅠ和PCⅢ均明显高于正常对照组 [(4 6 6 5± 11 0 1)μg/Lvs (34 31± 5 91) μg/L ,P <0 0 5和 (146 0 0± 2 9 35 ) μg/Lvs (96 2 4± 2 1 18) μg/L ,P <0 0 1]。②EH非左室肥厚组血清PCⅢ浓度明显高于正常对照组 [(12 0 6 2± 16 2 3) μg/Lvs(96 2 4± 2 1 18) μg/L ,P <0 0 1],而血清PCⅠ与正常对照组无差别 [(33 73± 6 83) μg/Lvs (34 31± 5 91) μg/L ,P >0 5 ];EH左室肥厚组血清PCⅢ高于非肥厚组 [(16 4 14±2 2 2 8) μg/Lvs (12 0 6 2± 16 2 3) μg/L ,P <0 0 1]和正常对照组 [(16 4 14± 2 2 2 8) μg/Lvs (96 2 4± 2 1 18) μg/L ,P <0 0 1];血清PCⅠ亦高于非肥厚组 [(5 5 88± 12 86 ) μg/Lvs(33 73± 6 83) μg/L ,P <0 0 1]和正常对照组 [(5 5 88±12 86 ) μg/Lvs (34 31± 5 91) μg/L ,P <0 0 1]。

Objective To investigate of the non-invasive indices of myocardial interstitial fibrosis in patients with essential hypertenison. Methods 60 essential hypertensive patients(35 patients with left ventricular hypertrophy and 25 patients without left ventricular hypertrophy) and 30 normotensive control subjects were enrolled. The serum concentrations of procollagen type Ⅰ(PCI) and procollagen type Ⅲ(PCⅢ) were measured by specific radioimmunoassays . Two dimensional, M-mode and Doppler ultrasound recordings were abtained to determine left ventricular mass index (LVMI) and maximal early transmitral flow velocity in diastole (V E) and maximal late transmitral flow velocity in diastole (V A).Results ①Baseline serum PCⅠ and PCⅢ were increased in hypertensive patients as compared with normotensive subjectis (NT) [(46 65±11 01) μg/L vs (34 31±5 91)μg/L, P <0 05 and (146.00±29 35) μg/L vs (96 24±21 18) μg/L, P <0 01]. ② The serum concentration of PCⅢ was significantly higher in the patients without left ventricular hypertrophy (NLVH) than NT[(120 62±16 23) μg/L vs (96 24±21 18) μg/L, P <0 01]. No significant difference was noted between the serum PCⅠ of the NLVH and NT [(33 73±6 83) μg/L vs (34 31±5 91) μg/L, P >0 5]. The serum concentration of PCⅢ was significant increased in the patients with left ventricular hypertrophy (LVH) as compared with those of NLVH [(164 14±22 28) μg/L vs (120 62±16 23) μg/L, P <0 01] and NT [(164.14±22 28) μg/L vs (96 24±21 18) μg/L, P <0 01]. The serum concentration of PCⅠ was also significant higher in the patients with LVH as compared with those NLVN[(55 88±12 86) μg/L vs (33 37±6 83) μg/L, P <0 01] and NT[(55 88±12 86) μg/L vs (34 31±5 91) μg/L, P <0 01]. ③ Serum concentration of PCⅢ negatively correlated with V E/V A ( r =-0 661, P <0 01) and positively correlated with LVMI( r =0 823, P <0 01).④ Serum concentration of PCI negatively correlated with V E/V A( r =-0 479, P <0 01) and positively correlated with LVMI( r =0.710, P <0 01).Conclusions Elevated serum PCⅢ and PCⅠ may be markers of increased myocardial collagen type Ⅲ and typeⅠ synthesis in essential hypertensive patients. Measurement of serum PCⅢ and PCⅠ may provide indirect diagnostic information on diastolic function of left ventricle.