促肾上腺皮质激素,皮质醇节律变化与原发性高血压的关系探讨

Relationship Receach on Adrenocorticotropic Hormone,Cortisol of Patients with Essential Hypertension about Rhythmic Variation

目的：探讨不同时间点血浆促肾上腺皮质激素（ACTH）与皮质醇（Cor）节律变化与原发性高血压的关系。方法选取焦作市第二人民医院2012年7月～2014年3月期间住院及门诊原发性高血压患者90例并进一步经冠状动脉造影术和头颅磁共振成像（MRI）或计算机断层扫描（CT）分为3组：（B组）单纯原发性高血压组（42例），（C组）原发性高血压伴冠心病组（17例）和（D组）原发性高血压并发缺血性脑卒中组（31例）及（A组）健康查体者60例作为对照组。均采用放射免疫法进行24h内血浆 ACTH 和血清 Cor 8∶00，16∶00，24∶00不同时点检测，结果进行统计学分析。结果血浆ACTH 8∶00，16∶00，24∶00水平，D组（18.23±6.36，11.29±7.35，5.69±3.02 pg／ml）低于 A组（24.83±8.98，15.56±8.56，9.45±2.22 pg／ml），差异有统计学显著性意义（t＝4.56，P＝0.012）。其余 B组，C组与 A组血浆 ACTH 8∶00，16∶00，24∶00比较差异无统计学意义（t＝1.021～1.766，P 值均＞0.05），血清 Cor 8∶00，16∶00，24∶00水平，D组（326.53±56.3，176.9±59.6，165.2±42.5 ng／ml）和 C组（310.03±45.01，167.6±55.0，161.9±49.6 ng／ml）均较 B组（227.6±65.2，127.9±29.7，121.6±15.4 ng／ml）的表达为高，差异有统计学显著性意义（t＝3.26，4.62，均P＝0.016）；三者与 A组（127.6±21.3，87.9±18.5，27.9±6.5 ng／ml）比较差异均有统计学显著性意义（t＝6.39，6.89和7.23，P＝0.001）。结论原发性高血压患者尤其有缺血性脑卒中时血浆 ACTH 水平更低。单纯原发性高血压患者血清 Cor水平升高；当并发冠心病或缺血性脑卒中时，血清Cor水平则更高。

Objective To explore rhythmic variation about the relationship of adrenocorticotropic hormone （ACTH）and cor-tisol（Cor）with the essential hypertension at different time.Methods Chose 90 cases of patients in hospital and outpatient who visited the Second People’s Hospital of Jiaozuo between July 2012 and March 2014 with essential hypertension（EH） and furthere by coranory angiograph and head MRI or CT,they was divided into three groups：B groups （n=42）,C groups （n=17）and D group （n=31）.60 cases of healthy physical examination was as a control group.Detected plasma ACTH and serum Cor at 8∶00,16∶00,24∶00 o’clock with the radioimmunoassay.Results The plasma ACTH at 8∶00,16∶00,24∶00 o’clock of D group （18.23±6.36,11.29±7.35,5.69±3.02 pg/ml）were lower than A group （24.83±8.98,15.56± 8.56,9.45±2.22 pg/ml）with significant diffences （t=4.56,P=0.012）.and other groups B,C,A showed no significant change （t=1.566,P〉0.05）.Serum cortisol levels,D group （326.53±56.3,176.9±59.6,165.2±42.5 ng/ml）and B groups （310.03±45.01,167.6±55.0,161.9±49.6 ng/ml）were higher than C groups （227.6±65.2,127.9±29.7,121.6 ±15.4 ng/ml）with significant difference （t=3.26,4.62,P=0.016）.Three groups compared with the B group （127.6± 21.3,87.9±18.5,27.9± 6.5 ng/ml）had very significant difference （t=6.39,6.89 and 7.23,P=0.001）.Conclusion ACTH levels were lower with cerebral ischemic stroke.There were elevated Cor in serum of pure essentian hypertension pa-tients,with amalgamative coronary heart disease （CHD）or ischemic stroke,serum cortisol levels were higher.