高血压合并心绞痛患者颈动脉内膜中膜厚度与脂蛋白相关磷脂酶A2、炎性因子、T淋巴细胞及血管内皮功能的关系研究

Relationship between Carotid Intima-media Thickness and Lipoprotein-related Phospholipase A2,Inflammatory Factors,T Lymphocytes and Vascular Endothelial Function in Patients with Hypertension and Angina Pectoris

背景高血压是多种心血管疾病的危险因素,可诱导动脉粥样硬化,进而发生心绞痛,对心脏产生较为严重的损伤,危及患者生命。而颈动脉内膜中膜厚度(CIMT)变化与冠状动脉硬化关系密切,故对高血压合并心绞痛患者CIMT的相关因素进行分析尤为重要。目的探讨高血压合并心绞痛患者CIMT与脂蛋白相关磷脂酶A2(Lp-PLA2)、炎性因子、T淋巴细胞及血管内皮功能的关系,以为其临床诊治提供参考。方法选择石家庄市第三医院2017年5月—2019年5月收治的高血压合并心绞痛患者60例为病例组,另选取同期于本院体检健康者60例为对照组。检测并比较两组CIMT、Lp-PLA2、炎性因子〔单核细胞趋化蛋白1(MCP-1)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白介素6(IL-6)〕、T淋巴细胞〔辅助性T淋巴细胞(Th)17、Th1、Th2〕及血管内皮功能指标〔一氧化氮(NO)、内皮素1(ET-1)〕;两变量间的相关性分析采用Pearson相关分析;高血压合并心绞痛患者CIMT影响因素分析采用多元线性回归分析。结果病例组CIMT大于对照组,Lp-PLA2、MCP-1、CRP、TNF-α、IL-6、Th17、Th1、ET-1高于对照组,NO低于对照组(P<0.05)。Pearson相关分析结果显示,高血压合并心绞痛患者CIMT与Lp-PLA2、MCP-1、CRP、TNF-α、IL-6、Th17、Th1、ET-1呈正相关,与NO呈负相关(P<0.05)。多元线性回归分析结果显示,Lp-PLA2(β=7.743)、CRP(β=6.087)、TNF-α(β=5.213)、IL-6(β=7.542)、ET-1(β=5.234)是高血压合并心绞痛患者CIMT的影响因素(P<0.05)。结论Lp-PLA2、炎性因子(CRP、TNF-α、IL-6)、血管内皮功能(ET-1)是高血压合并心绞痛患者CIMT的影响因素,但尚未发现T淋巴细胞是高血压合并心绞痛患者CIMT的影响因素。

Background Hypertension is a risk factor for a variety of cardiovascular diseases,which can induce atherosclerosis,and then angina pectoris,and cause serious damage to the heart and endanger the lives of patients.The change of carotid intima-media thickness(CIMT)is closely related to coronary atherosclerosis,so it is particularly important to analyze the related factors of CIMT in patients with hypertension and angina pectoris.Objective To explore the relationship between CIMT and lipoprotein-related phospholipase A2(Lp-PLA2),inflammatory factors,T lymphocytes and vascular endothelial function in patients with hypertension and angina pectoris,so as to provide references for clinical diagnosis and treatment.Methods A total of 60 patients with hypertension and angina pectoris admitted to the Third Hospital of Shijiazhuang from May 2017 to May 2019 were selected as the case group,and 60 healthy patients who received physical examination in this hospital during the same period were selected as the control group.CIMT,Lp-PLA2,inflammatory factors(MCP-1,CRP,TNF-α,IL-6),T lymphocytes(Th17,Th1,Th2)and vascular endothelial function indicators(NO,ET-1)were detected and compared between the two groups.Pearson correlation analysis was used to analyze the correlation between the two variables.Multiple linear regression analysis was used to analyze the influencing factors of CIMT in patients with hypertension and angina pectoris.Results The CIMT of the case group was greater than that of the control group,Lp-PLA2,MCP-1,CRP,TNF-α,IL-6,Th17,Th1,ET-1 of the case group were higher than those of the control group,and NO of the case group was lower than that of the control group(P<0.05).Pearson correlation analysis showed that,CIMT was positively correlated with Lp-PLA2,MCP-1,CRP,TNF-α,IL-6,Th17,Th1,ET-1,and negatively correlated with NO in patients with hypertension and angina pectoris(P<0.05).The results of multiple linear regression analysis showed that,Lp-PLA2(β=7.743),CRP(β=6.087),TNF-α(β=5.213),IL-6(β=7.542),ET-1(β=5.234)were the influencing factors of CIMT in patients with hypertension and angina pectoris(P<0.05).Conclusion Lp-PLA2,inflammatory factors(CRP,TNF-α,IL-6),vascular endothelial function(ET-1)are the influencing factors of CIMT in patients with hypertension and angina pectoris,but T lymphocytes is not found to be an influencing factor of CIMT in patients with hypertension and angina pectoris.