高血压患者血清自噬相关蛋白9a、褪黑素与左心室肥厚的关系及其影响因素分析

Study of the Relationship and the influence factors between serum ATG9a,melatonin and left ventricular hypertrophy in patients with hypertension

目的:探讨高血压患者血清自噬相关蛋白9a(ATG9a)、褪黑素(melatonin)水平与左心室肥厚的关系,并分析左心室肥厚的影响因素。方法:选取2016年6月至2019年6月广西壮族自治区南溪山医院收治的177例原发性高血压患者,按照左心室质量指数将其分为左心室肥厚组(n=75)和左心室正常组(n=102)。采用酶联免疫吸附测试(ELISA)法检测血清ATG9a、褪黑素水平,同时收集两组人口学资料、实验室检测指标、超声心动图参数。采用Pearson相关分析法分析血清ATG9a、褪黑素与超声心动图参数的关系,采用多因素Logistic回归分析左心室肥厚的影响因素,绘制受试者工作特征曲线(ROC曲线),评估血清ATG9a、褪黑素对左心室肥厚的诊断价值。结果:与左心室正常组患者比较,左心室肥厚组患者年龄大,收缩压、舒张压升高,血清ATG9a水平增高,血清褪黑素水平降低,左心室后壁厚度(LVPWT)、室间隔厚度(IVST)增加,左心室射血分数(LVEF)降低,(P<0.05)。多因素Logistic回归分析显示,年龄、收缩压、舒张压、ATG9a、LVPWT、IVST是高血压患者并发左心室肥厚的独立危险因素(P<0.05),褪黑素、LVEF是左心室肥厚的保护因素(P<0.05)。高血压并发左心室肥厚患者血清ATG9a与LVPWT、IVST呈正相关关系(r=0.579、0.604,P<0.05),与LVEF呈负相关关系(r=-0.672,P<0.05);血清褪黑素与LVPWT、IVST呈负相关关系(r=-0.629、-0.671,P<0.05),与LVEF呈正相关关系(r=0.708,P<0.05)。血清ATG9a、褪黑素对左心室肥厚均具有诊断价值,且联合检测诊断价值最高,AUC为0.941,灵敏度和特异度分别为0.95、0.90,准确性为0.91,约登指数为0.85。结论:血清ATG9a升高、褪黑素降低可能参与高血压患者左心室肥厚过程,是左心室肥厚的影响因素,可作为早期临床辅助诊断高血压患者左心室肥厚的标志物。

Objective:To investigate the relationship between serum autophagy-related protein 9a(ATG9a),melatonin levels and left ventricular hypertrophy in patients with hypertension,and to analyze the influencing factors of left ventricular hypertrophy.Methods:A total of 177 patients with primary hypertension admitted to Nanxishan Hospital of Guangxi Zhuang Autonomous Region from Jun.2016 to Jun.2019 were enrolled in this study and they were divided into left ventricular hypertrophy group(n=75)and normal left ventricle group(n=102)according to left ventricular mass index.Enzyme-linked immunosorbent assay(ELISA)was employed to detect the serum level of ATG9a and melatonin.Meanwhile,the demographic data,laboratory testing indicators,and echocardiographic parameters of the two groups were collected.Pearson correlation analysis was used to analyze the relationship between serum ATG9a,melatonin and echocardiographic parameters.Multivariate Logistic regression was used to analyze the influencing factors of left ventricular hypertrophy.Receiver operating curve(ROC)to evaluate the diagnostic value of serum ATG9a and melanin in left ventricular hypertrophy.Results:Compared with patients in the normal left ventricle group,patients in the left ventricular hypertrophy group were older and they have higher systolic and diastolic pressures,higher serum ATG9a levels,lower serum melatonin levels,higher left ventricular posterior wall thickness(LVPWT),higher interventricular septal thickness(IVST),and lower left ventricular ejection fraction(LVEF)(P<0.05).Multivariate Logistic regression analysis showed that age,systolic blood pressure,diastolic blood pressure,ATG9a,LVPWT,IVST were independent risk factors for hypertension patients combined with left ventricular hypertrophy(P<0.05).Melatonin and LVEF were protective factors of left ventricular hypertrophy(P<0.05).Serum ATG9a was positively correlated with LVPWT and IVST(r=0.579,0.604,P<0.05),and negatively correlated with LVEF(r=-0.672,P<0.05)in hypertension patients combined with left ventricular hypertrophy.Serum melatonin was negatively correlated with LVPWT and IVST(r=-0.629,-0.671,P<0.05)and positively correlated with LVEF(r=0.708,P<0.05).Serum ATG9a and melatonin both had diagnostic value for left ventricular hypertrophy,with the combined detection of which having the highest value.AUC was 0.941,sensitivity and specificity were 0.95 and 0.90,accuracy was 0.91,and Jordan index was 0.85.Conclusion:Elevated serum ATG9a and decreased melatonin may be involved in the process of left ventricular hypertrophy in patients with hypertension.ATG9a and melatonin are influencing factors of left ventricular hypertrophy and can be used as biomarkers for early auxiliary diagnosis of left ventricular hypertrophy in patients with hypertension.