H型高血压患者内皮功能损伤与炎症反应及动脉粥样硬化的关系

Study on the relationship between endothelial dysfunction,inflammatory reaction and atherosclerosis in patients with type H hypertension

目的 探讨H型高血压患者内皮功能受损与炎症反应及颈动脉粥样硬化形成的关系。方法 应用病例对照研究设计,选取本院2020年2月-2021年3月确诊的98例H型高血压患者(H型组)、患有高血压但Hcy水平正常的患者100例(高血压组,血Hcy≤15.0μmol/L)、健康体检中血压正常的志愿者100例(对照组),对比3组研究对象的血脂指标、炎症因子指标、颈动脉内膜中层厚度(IMT)、内皮功能指标,并分析血脂指标、炎症因子指标与IMT、内皮功能指标的相关性。结果 H型组患者的TG、TC水平高于对照组,HDL-C水平低于高血压组和对照组,H型组、高血压组的收缩压、舒张压高于对照组(均P<0.05);3组的LDL-C、载脂蛋白A、载脂蛋白B测定值比较,差异无统计学意义(P>0.05);H型组患者的IL-6、TNF-α、sICAM-1水平高于高血压组、对照组,H型组、高血压组的IL-10低于对照组,差异具有统计学意义(P<0.05);高血压组的IL-6、TNF-α-1水平高于对照组,差异有统计学意义(P<0.05),高血压组和H型组的血清IL-10差异无统计学意义(P>0.05);H型组患者的IMT高于高血压组、对照组,H型组的RHI、FMD、NMD值低于对照组(均P<0.05);高血压组的RHI、FMD、NMD值低于对照组且差异显著,高血压组的IMT测定值高于对照组且差异显著(均P<0.05);H型高血压患者的IMT与TG、TC、IL-6、TNF-α、sICAM-1呈正相关,与HDL-C、IL-10呈负相关(P<0.05);H型高血压患者的RHI与IL-6、TNF-α、sICAM-1呈负相关,与IL-10呈正相关(P<0.05);H型高血压患者的FMD与TNF-α、sICAM-1呈负相关(P<0.05);H型高血压患者的NMD与TNF-α、sICAM-1呈负相关(P<0.05);H型高血压患者的Hcy与IL-6、TNF-α、sICAM-1呈正相关(P<0.05),与IL-10呈负相关(P<0.05)。结论 H型高血压患者存在明显的内皮功能受损,内皮功能受损与患者血脂异常、炎症反应增强有明显的关系,并且与患者颈动脉粥样硬化形成有关。

Objective To investigate the relationship between endothelial dysfunction and inflammation and carotid atherosclerosis in patients with type H hypertension.Methods A case-control study design was applied to select 98 patients with H-type hypertension(H-type group),100 patients with hypertension but normal Hcy level(hypertension group,blood Hcy≤15.0μmol/L),and 100 volunteers with normal blood pressure during physical examination in our hospital from February 2020 to March 2021(control group).Blood lipid indexes,inflammatory factors,carotid intima-media thickness(IMT) and endothelial function indexes of the three groups were compared,and the correlation between blood lipid indexes,inflammatory factors and IMT and endothelial function indexes was analyzed.Results The levels of TG and TC in patients with type H were significantly higher than those in the control group(P<0.05).The HDL-C levels in patients with type H were lower than those in patients with hypertension and the control group(P<0.05).The systolic and diastolic blood pressures in patients with type H and hypertension were higher than those in the control group(P<0.05).There was no significant difference in the measured values of LDL-C,apolipoprotein A and apolipoprotein B in the three groups(P>0.05).The levels of IL-6,TNF-α and sICAM-1 in the H-type group were higher than those in the hypertension group and the control group(P<0.05).The IL-10 of the H-type group and the hypertension group was lower than that of the control group(P<0.05).The levels of TL-6 and TNF-α-1 were higher than those in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in serum IL-10 between the hypertension group and the H type group(P>0.05).The IMT of the hypertension group was higher than that of the hypertension group and the control group(P<0.05),the RHI,FMD and NMD values of the H-type group were lower than those of the control group(P<0.05);the RHI,FMD and NMD values of the hypertension group were lower than those of the control group.And the difference was significant(P<0.05),the measured value of IMT in the hypertension group was higher than that in the control group and the difference was significant(P<0.05).IMT was positively correlated with TG,TC,IL-6,TNF-α and sICAM-1 and negatively correlated with HDL-C and IL-10 in patients with type H hypertension(P<0.05).RHI was negatively correlated with IL-6,TNF-α and sICAM-1 and positively correlated with IL-10 in patients with type H hypertension(P<0.05).FMD was negatively correlated with TNF-α and sICAM-1 in patients with type H hypertension(P<0.05).NMD was negatively correlated with TNF-α and sICAM-1 in patients with type H hypertension(P<0.05).Hcy was positively correlated with TNF-α,IL-6,TNF-α,and sICAM-1 in patients with type H hypertension(P<0.05) and negatively correlated with IL-10(P<0.05).Conclusion In patients with type H hypertension,there is obvious impairment of endothelial function.The impairment of endothelial function is significantly related to abnormal blood lipids and enhanced inflammatory response,and is related to the formation of carotid atherosclerosis.