脑白质疏松合并高血压对大脑中动脉血管反应性及内皮微粒CD144^+、CD62E^+的影响

Effects of leukoaraiosis and hypertension on vascular reactivity of middle cerebral artery and endothelial microparticles CD144^+ and CD62E^+

目的探讨不同程度脑白质疏松合并高血压患者大脑中动脉博动指数、屏气指数与外周血内皮微粒CD144^+、CD62E^+的表达变化。方法收集我院神经内科住院或门诊完善头部MRI提示脑白质疏松患者103例,其中轻度LA1组58例,中度LA2组30例,重度LA3组15例;同时收集同期门诊健康体检为非脑白质疏松者NLA组50例,各组按有无高血压分为血压正常组、高血压组和血压控制达标组。各组患者均经颅多普勒超声(TCD)测定大脑中动脉博动指数(PI)和屏气指数(BHI);流式细胞仪检测外周血内皮细胞微CD144^+、CD62E^+的表达百分率。结果 (1)高血压、糖尿病、房颤、颈动脉狭窄、LDL-C、Hcy、HbA1c是脑白质疏松的独立危险因素;(2)LA2组、LA3组组内:与血压正常组比较,高血压组、血压控制达标组PI升高、BHI降低,且血压控制达标组较高血压组PI降低、BHI升高,差异有统计学意义(P<0.05);与NLA组的高血压组比较,LA2组、LA3组的高血压组PI升高,BHI降低;且LA3组变化更明显;差异有统计学意义(P<0.05);(3)NLA组、LA1组、LA2组、LA3各组组内分别与血压正常组比较,高血压组、血压控制达标组的CD31^+/CD42b^-和CD62E^+均升高,且血压控制达标组与高血压组比较CD31^+/CD42b^-降低,CD62E^+升高;与NLA组的高血压组比较,LA1组、LA2组、LA3组的高血压组CD31^+/CD42b^-和CD62E^+均升高,且LA2组较LA1组升高明显,LA3组升高最显著,差异有统计学意义(P<0.05)。结论外周血内皮细胞微粒CD31^+/CD42b^-、CD62E^+可做为脑白质疏松伴高血压患者早期预测血管内皮细胞功能状态及脑微循环储备及调节能力的特异性指标。

Objective To investigate the changes of middle cerebral artery index,breath holding index and the expression of peripheral blood endothelial microparticles CD144~＋and CD62E~＋in patients with leukoaraiosis and hypertension. Methods Our hospital or clinic to improve the brain MRI patients with leukoaraiosis in 103 cases,including 58 cases of mild LA1 group,moderate LA2 group 30 cases,15 cases of severe LA3 group; at the same time collected from the outpatient health examination for non leukoaraiosis patients 50 cases in NLA group,each group according to whether high blood pressure blood pressure was divided into normal group,hypertension group and BP control group. Transcranial Doppler ultrasound（TCD） was used to measure the median cerebral arterial activity index（PI） and breath holding index（BHI）,and the percentage of CD144~＋,CD62E~＋expression in peripheral blood endothelial cells was detected by flow cytometry. Results（1） diabetes,hypertension,atrial fibrillation,carotid artery stenosis,LDL-C,Hcy,HbA1c were independent risk factors of leukoaraiosis;（2） LA2 group and LA3 group： compared with the normal blood pressure group,hypertension group,BP control group PI increased and BHI decreased,and blood pressure control the standard group compared with hypertension group,PI decreased and BHI increased,the difference was statistically significant（P 0. 05）; comparison between hypertension group and NLA group,LA2 group,LA3 group,hypertension group PI increased,BHI decreased; and the changes of LA3 group was more obvious; the difference was statistically significant（P 0. 05）;（3） NLA group,LA1 group,LA2 group,LA3 group and normal blood pressure group,hypertension group,BP control group CD31~＋/CD42b^-and CD62E~＋were increased,and the BP control group and hypertension group CD31~＋/CD42b^-decreased,CD62E~＋increased and NLA group; Compared with the hypertension group,the CD31~＋/,CD42b^-and CD62E~＋in the LA1 group,the LA2 group and the LA3 group were increased,and the LA2 group was significantly higher than the LA1 group,and the highest in the LA3 group,the difference was statistically significant（P 0. 05）. Conclusion The peripheral blood endothelial cell microparticles CD31~＋/,CD42b^-and CD62E~＋can be used as the specific indexes for predicting the functional status of vascular endothelial cells and the reserve and regulation of brain microcirculation in hypertensive patients with leukoaraiosis.