原发性高血压合并冠心病患者血清骨膜素和血管紧张素Ⅱ水平及其相关性

Levels of serum periotin and AngⅡin patients with hypertension complicated by coronary heart disease

目的探讨高血压合并冠心病患者血清骨膜素(PN)和血管紧张素Ⅱ(AngⅡ)水平及其临床意义.方法选取2018年10月至2019年7月在山西医科大学第二医院就诊患者163例,分为原发性高血压合并冠心病(EH+CHD)组81例,原发性高血压(EH)组48例和正常对照组34例;其中EH+CHD组分为陈旧性心肌梗死(OMI)亚组(22例),不稳定型心绞痛(UA)亚组(31例)和急性心肌梗死(AMI)亚组(28例).比较各组研究对象血清PN、AngⅡ、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平变化并分析其相关性.结果血清PN、AngⅡ、TC、TG、LDL-C水平在对照组、EH组及EH+CHD组三组间比较差异有统计学意义,且EH+CHD组>EH组>对照组[PN:(1629.70±209.03)ng/L比(1774.20±230.22)ng/L比(1952.78±282.41)ng/L;AngⅡ:(403.52±23.56)ng/L比(579.87±52.36)ng/L比(605.54±67.38)ng/L;TC:(3.92±0.75)mmol/L比(3.95±0.89)mmol/L比(4.87±1.03)mmol/L;TG:(1.29±0.56)mmol/L比(1.49±0.57)mmol/L比(1.91±0.86)mmol/L;LDL-C:(2.27±0.69)mmol/L比(2.19±0.73)mmol/L比(2.67±0.77)mmol/L](P<0.05);血清HDL-C水平在对照组、EH组及EH+CHD组三组间比较差异有统计学意义,且EH+CHD组0.05),在其余各组间两两比较差异均有统计学意义(P<0.05).EH+CHD的三个亚组中,血清PN与AngⅡ水平各组之间两两比较均有统计学差异,且AMI组>UA组>OMI组[PN:(2131.88±303.95)ng/L比(1955.60±196.48)ng/L比(1720.84±175.38)ng/L;AngⅡ:(646.41±78.86)ng/L比(602.59±47.88)ng/L比(557.68±37.21)ng/L](P<0.05).Pearson相关性分析显示,血清PN与AngⅡ、TC、TG、LDL-C水平呈正相关关系(rAngⅡ=0.580,rTC=0.338,rTG=0.384,rLDL-C=0.318,P<0.05),血清PN与HDL-C水平呈负相关关系(rHDL-C=-0.320,P<0.05).结论血清PN水平与冠心病及高血压密切相关,联合检测PN和AngⅡ可以更好的反映高血压合并冠心病患者疾病的严重程度;PN可能是高血压合并冠心病治疗的靶点.

Objective To investigate the clinical significance of periostin and angiotension Ⅱ(Ang Ⅱ)in patients with hypertension complicated by coronary heart disease.Methods All patients(n=163)were chosen from the second hospital of Shanxi Medical University from October 2018 to July 2019.They were divided into essential hypertension patients complicated by coronary heart disease(EH+CHD)group(n=81)and essential hypertension(EH)group(n=48)and 34 healthy cases were chosen as control group.The EH+CHD group was divided into old myocardial infarction(OMI)subgroup(n=22),unstable angina(UA)subgroup(n=31)and acute myocardial infarction(AMI)subgroup(n=28).The serum levels of periostin,Ang U,TC,TG,LDL-C and HDL-C were compared among all groups.The correlation between periostin level and relevant indexes was analized.Results Serum PN,Ang Ⅱ,TC,TG and LDL-C levels were significantly different among the control group,EH group and EH+CHD group(P<0.05)and EH+CHD group>EH group>control group.The level of serum HDL-C was significantly different among the control group,EH group and EH+CHD group[PN:(1629.70±209.03)ng/L vs.(1774.20±230.22)ng/L vs.(1952.78±282.41)ng/L;Ang Ⅱ:(403.52±23.56)ng/L vs.(579.87±52.36)ng/L vs.(605.54±67.38)ng/L;TC:(3.92±0.75)mmol/L vs.(3.95±0.89)mmol/L vs.(4.87±1.03)mmol/L;TG:(1.29±0.56)mmol/L vs.(1.49±0.57)mmol/L vs.(1.91±0.86)mmol/L;LDL-C:(2.27±0.69)mmol/L vs.(2.19±0.73)mmol/L vs.(2.67±0.77)mmol/L](P<0.05).The level of serum HDL-C was significantly different among the control group,EH group;EH+CHD group and EH+CHD group<EH group<control group[HDL-C:(1.21±0.28)mmol/L vs.(1.13±0.27)mmol/L vs.(0.98±0.28)mmol/L](P<0.05).The levels of serum TC,TG,LDL-C and HDL-C were statistically significant except in the control group and the hypertension group(P>0.05).In the three subgroups of EH+CHD,there was statistical difference between pairwise comparison groups about periostin and Ang Ⅱ level and AMI group>UA group>OMI group[PN:(2131.88±303.95)ng/L vs.(1955.60±196.48)ng/L vs.(1720.84±175.38)ng/L;Ang H:(646.41±78.86)ng/L vs.(602.59±47.88)ng/L vs.(557.68±37.21)ng/L](P<0.05).Pearson correlation analysis showed that serum periostin was positively correlated with Ang H,TC,TG and LDL-C(rAngH=0.572,rTC=0.338,rTG=0.384,rLDL-C=0.318,P<0.05),while serum periostin was negatively correlated with HDL-C(rHDL-C=-0.320,P<0.05).Conclusion The level of serum periostin is closely related to coronary heart disease.Combined detection of periostin and Ang U could better reflect the severity of the disease in patients with hypertension complicated by coronary heart disease.