老年高血压患者肝肾阴虚证的特征

Clinical Features of Elderly Hypertensive Patients with Deficiency Syndrome of Both Liver and Kidney Yin

目的观察老年高血压患者肝肾阴虚证临床特征及外周血标识基因表达,为中医辨证论治老年高血压提供依据。方法本研究首先分析老年高血压患者高血压分级和病程与肝肾阴虚证的相关性;再根据全基因组芯片在原发性肝癌患者的肝肾阴虚证与非肝肾阴虚证组中筛选的具有差异表达的17个基因mRNA的表达,基于异病同证原理,应用实时荧光定量PCR技术探索性观察老年高血压肝肾阴虚证患者的外周血单个核细胞中是否存在同样的17个差异基因mRNA的表达。并应用受试者特征性操作曲线(ROC曲线)构建肝肾阴虚证的诊断模型。结果研究共纳入老年高血压患者(>65岁)60名,其中肝肾阴虚证患者30名,非肝肾阴虚证患者30名,随着高血压病程延长,老年高血压肝肾阴虚证患者更多;与非肝肾阴虚证患者相比,老年高血压肝肾阴虚证患者外周血单个核细胞中MLH3表达减少,CD55表达增加,差异具有统计学意义,进一步采用ROC分析,AUCMLH3=0.783,AUCCD55=0.737,MLH3和CD55作为老年高血压肝肾阴虚证诊断模型的灵敏度分别为63.5%、57%,特异度分别为93%,90%。结论 MLH3和CD55可能是老年高血压肝肾阴虚证的标识基因。

Objective To observe the clinical features and expression of marker genes in peripheral blood in elderly hypertensive patients with deficiency syndrome of both liver and kidney yin. Methods The correlation of hypertension grades and the course of the disease to deficiency syndrome of both liver and kidney yin was first studied; 17 mRNA expressions with differentia were screened out from primary liver cancer patients with deficiency syndrome of both liver an kidney yin and from primary liver cancer patients with no deficiency syndrome of both liver and kidney yin by chromosomal microarray, and then the real-time fluorescence quantitative PCR technology was applied in observing if there existed the mRNA expressions same with the 17 in peripheral blood mononuclear cells of the elderly hypertensive patients with deficiency syndrome of both liver an kidney yin; the diagnostic model was set up based on the Receiver Operating Characteristic （ROC） curves. Results In total, the study enrolled 60 elderly hypertensive patients （〉 65 years old）, 30 patients with deficiency syndrome of both liver and kidney yin while 30 patients with no; more elderly hypertensive patients got deficiency syndrome of both liver and kidney yin with the course of hypertension lasting; the MLH3 expression in peripheral blood mononuclear cells of the elderly hyper-tensive patients with deficiency syndrome of both liver an kidney yin decreased much more than that in patients with no defi-ciency syndrome of both liver an kidney yin while CD55 expression was enhanced, the difference was of statistical significance; ROC analysis showed that AUCMLH3=0.783 and AUCCD55=0.737; the sensitivity of MLH3 and CD55 of the diagnostic model was 63.5% and 57% respectively. Conclusions MLH3 and CD55 may be the marker genes in elderly hypertensive pa-tients with deficiency syndrome of both liver an kidney yin.