血清褪黑素水平及昼夜分泌节律的改变与老年高血压患者血压晨峰的关系

Relation between the serum level of melatonin,the circadian rhythm of melatonin secretion and morning blood pressure peak in elderly hypertensive patient

目的探讨血清褪黑素水平及昼夜分泌节律的改变与老年高血压患者血压晨峰的关系。方法将150例老年患者(大于65岁)按2010年高血压诊断与治疗指南标准,分为老年高血压(100例)及老年健康对照组(50例),100例高血压病患者分为晨峰血压增高组(56例)、非晨峰血压增高组(44例),分别测量各研究对象血清褪黑素水平及昼夜节律变化、动态血压。结果与对照组和非晨峰血增高组比较,晨峰血压增高组患者夜间血清MT水平明显下降,差异有统计学意义(P<0.01);晨峰血压增高组夜间/早晨血清MT的比值低于对照组和非晨峰血压增高组,差异有统计学意义(P<0.01),晨峰血压增高组存在MT昼夜分泌节律异常。血压晨峰值与夜间/早晨血清褪黑素的比值呈负相关(P<0.01)。结论晨峰血压增高组血清褪黑素水平为白昼分泌较少,夜间分泌也无明显增多,昼夜分泌节律异常,导致具有升高血压作用的神经-内分泌激素受抑制减少,引起晨峰血压增高。

Objective To explore the circadian rhythm of melatonin and morning blood pressure peak in elder- ly hypertensive patient. Methods According to the 2010 Guidelines for the diagnosis and treatment of hypertension, 150 cases of elderly patients （over 65 years） were divided into elderly hypertension group （100 cases） and healthy elderly control group （50 cases）. 100 cases of hypertension patients were divided into the morning blood pressure peak group （MBPS ,56 cases） and the non morning blood pressure peak group （44 cases）. The serum level of melatonin, the circa-dian rhythm of melatonin secretion and ambulatory blood pressure were measured. Results Compared with the control group,the serum level of melatonin were significantly decreased in the moming blood pressure peak group and the non morning blood pressure peak group （P 〈 O. O1 ） ;The ratio of melatonin level at nighttime/daytime was lower in the morn- ing blood pressure peak group than that in the control group and the non morning blood pressure peak group（P 〈0. O1 ）, There were negative relation in the control group, the non morning blood pressure peak group and the morning blood pressure peak group between the ratio of melatonin level at nighttime/daytime and the level of morning blood pressure peak （P 〈 O. O1 ）. Conclusion The secretion of melatonin in the morning blood pressure peak group is lower in the day- time, not increased significantly in the nighttime, abnormal circadian secretion, with the inhibition of neuroendocrine hormones which causing elevated blood pressure is decreased, the level of morning blood pressure peak increases.