高血压患者血压节律与抗AT_1受体自身抗体及临床常见指标的相关性探讨

Relationship between blood pressure circadian rhythm and autoantibody against AT_1 adrenoceptor

目的:探讨高血压患者中血压节律与抗AT_1受体自身抗体、血同型半胱氨酸、心率、血尿酸以及超敏C反应蛋白等临床常见指标的相关性。方法:回顾性分析191例高血压病患者临床资料,根据其24h动态血压监测(ABPM)结果,将其分为非杓型组(71例)、杓型组(120例)。所有患者测定肝功能、肾功能、血脂、血糖、高敏C反应蛋白、血同型半胱氨酸及血尿酸等生化指标,采用酶联免疫吸附技术(ELISA)检测抗AT_1受体自身抗体,比较两组患者的一般资料、实验室检查及动态血压参数的差异并进行回归分析。结果:1非杓型组的心率、血清同型半胱氨酸水平、血清尿酸水平、血清超敏C反应蛋白水平以及夜间收缩压与舒张压均高于杓型组(P<0.05),非杓型组夜间收缩压、舒张压下降率均低于杓型组(P<0.05)。2非杓型患者抗AT_1受体自身抗体阳性率为(42.3%),高于杓型患者(25.8%),P<0.05。3二项非条件logistic回归分析提示:非杓型血压形态与血尿酸水平、心率、超敏C反应蛋白水平有关系(P<0.05)。结论:非杓型血压患者中抗AT_1受体自身抗体阳性者更多,非杓型血压形态与心率、超敏C反应蛋白、血尿酸水平之间具有正相关性。

Objective：To investigate the relationships between blood pressure circadian rhythm and AT_1 adrenoceptor,clinical common index such as heart rate,uric acid,high-sensitivity C-reactive protein,homocystiene.Method：The 191inpatients（nondipping circadian pattern and dipping circadian pattern）who were diagnosed essential hypertension were collected.The hypertensive patients were divided into non-dipper type group（n=71）and dipper group（n=120）according to the result of 24-hour ambulatory blood pressure monitoring（ABPM）.All patients were measured the biochemical indicators including liver function,renal function,serum lipids,glycemia,homocystiene,serum uric acid and high-sensitivity C-reactive protein.The epitopes of the second extracellular loop of AT_1 R were synthesized and used to screen the autoantibodies from patients by ELISA.Compared the two groups with general data,laboratory tests and ambulatory blood pressure parameters and analyzed the relationship with unconditional logistic regression analysis.Result：1.The levels of HS-CRP,homocystiene,uric acid and heart rate were significantly higher in non-dipper group than dipper group（P〈0.05）.Nighttime mean systolic and diastolic blood pressure（P〈0.05）were significantly higher in non-dipper group than dipper group,and the rates of decline in nocturnal systolic and diastolic blood pressure were significantly lower in non-dipper group than dipper group（P〈0.05）.2.In patients in non-dipper type group,the prevalence rate of AT_1R（42.3%）was significantly higher than that of dipper type group（25.8%）,P〈0.05.3.The binomial unconditional logistic regression analysis showed that serum uric acid,heart rate and HS-CRP had independent relationship with nondipping circadian pattern（P〈0.05）.Conclusion：Serum uric acid,heart rate and HS-CRP had independent positive correlation with nondipping circadian pattern in patients with hypertension,and the number of nondipping circadian pattern＇s patients with positive autoantibody against AT_1 adrenoceptor were more than those of dipping circadian pattern.