内皮损伤标志物水平检测在原发性醛固酮增多症患者早期靶器官损害程度判定中的应用

Application of endothelial markers detection in early target organ damage degree determination for patients with primary aldosteronism

目的：比较原发性醛固酮增多症（ PA）与原发性高血压（ EH）患者内皮损伤标志物的水平，并探讨其对早期靶器官损害的预测价值。方法选择确诊的56例PA患者（观察组）与同期确诊且资料相匹配的56例EH患者（对照组）为研究对象，检测两组患者内皮损伤标志物包括血浆血管性假血友病因子（vWF）、可溶性细胞间黏附分子-1（sICAM-1）和氧化型低密度脂蛋白（ox-LDL），同时以左心室质量指数（LVMI）、24 h尿蛋白及尿白蛋白排泄率（ UAER ）评估早期靶器官损害。结果（1）观察组内皮损伤标志物血浆 vWF （133．4±54．9）％、sICAM-1（412．1±75．2）μg/L和ox-LDL（13．7±9．0）U/L水平均较对照组高（t＝4．642、3.955、2．843，均P＜0．05），且具有更高的24 h尿蛋白（t＝2．042，P＜0．05）和LVMI（t＝7．235，P＜0．05）。（2）相关性分析显示LVMI 与PAC、ox-LDL、vWF 均呈正相关（r ＝0．447、0．385、0．393，P ＝0．020、0．046、0.029），与入院时血K＋呈负相关（r＝-0．294，P＜0．05）；UAER与PAC、vWF和sICAM-1均呈正相关（r＝0.622、0．389、0．499，均P＜0．05），与入院时血K＋呈负相关（r＝-0．314，P＜0．05）。结论 PA患者较EH患者具有更明显的内皮功能障碍及早期靶器官损害，PAC和多种内皮损伤标志物是早期靶器官损害独立的预测因子。

Objective To compare plasma concentrations of biomarkers of endothelial dysfunction between patients with primary aldosteronism （PA） and essential hypertension （EH）,and to determine whether elevated levels of these biomarkers could predict development of early organ damage .Methods 56 PA patients （ the observation group） and 56 EH patients（the control group） matched for age,sex,blood pressure and duration of hypertension were included in this study .The plasma levels of biomarkers reflecting endothelial dysfunction [ von Willebrand factor （vWF）,soluble intercellular adhesion molecule 1（sICAM-1）,oxidized low density lipoprotein（ox-LDL）]were detec-ted and compared between PA and EH patients .The left ventricular mass index （ LVMI） determined by echocardio-graphy,24-hour urinary protein quantitative determination and urinary albumin excretion rate （ UAER） were analyzed to evaluate early organ damage .Results （ 1 ） In the observation group , the plasma markers of endothelial damage vWF （133.4 ±54.9）%,sICAM-1 （412.1 ±75.2）μg/L and ox-LDL （13.7 ±9.0） U/L levels were higher than those in the control group（t=4.642,3.955,2.843,all P〈0.05）,and the observation group had a higher 24 h urina-ry protein（t=2.042,P〈0.05） and LVMI（t=7.235,P〈0.05）.（2）Correlation analysis showed that LVMI was positively correlated with PAC,ox-LDL,vWF （r=0.447,0.385,0.393,P=0.020,0.046,0.029）,and was nega-tively correlated with admission blood K ＋（r=-0.294,P〈0.05）.UAER was positively correlated with PAC,vWF and sICAM-1 （r=0.622,0.389,0.499,all P〈0.05）,and was negatively correlated with admission blood K ＋（r=-0.314,P〈0.05）.Conclusion Patients with PA have severer endothelial dysfunction reflected by multiple bio-markers and earlier organ damage than patients with EH ,and plasma aldosterone concentration and multiple endotheli-al dysfunction biomarkers could independently predict early organ damage .