高血压合并降主动脉夹层患者血清Fibulin-3和肱-踝脉搏波传导速度的相关性研究

The correlation between Fibulin-3 and branchial-ankle pulse wave velocity in patients with hypertension complicated with aortic dissection

目的:探讨高血压合并主动脉夹层(aortic dissection,AD)患者血清Fibulin-3水平改变的临床意义及其与肱-踝脉搏波传导速度(branchial-ankle pulse wave velocity,baPWV)的相关性。方法:纳入广东药科大学附属第一医院心内科和广州军区广州总医院住院高血压合并AD(DebakeyⅢ型或Stanford B型)患者49例(高血压合并AD组),同时收集广东药科大学附属第一医院住院和门诊高血压患者60例(高血压组),以及体检的健康人48例(对照组)。以酶联免疫吸附(ELISA)方法检测血清Fibulin-3和基质金属蛋白酶9(MMP-9)表达;采用脉搏波速度自动测定仪测定baPWV。结果:高血压合并AD组血压水平、男性比例和吸烟比例均高于高血压组和对照组(均P<0.05);高血压合并AD组血清Fibulin-3水平明显低于高血压组,而高血压组低于对照组(均P<0.05);高血压合并AD组血清MMP-9水平明显高于高血压组(P<0.05),而高血压组和对照组比较差异无统计学意义;高血压合并AD组baPWV水平明显高于高血压组和对照组,而高血压组高于正常组(均P<0.05)。在高血压合并AD患者中,Fibulin-3与baPWV呈负相关性(r=-0.463,P<0.01),MMP-9和baPWV无明显相关性。结论:高血压合并AD患者存在主动脉细胞外基质蛋白和MMP水平改变,动脉硬化指标水平升高,血清Fibulin-3、MMP-9水平和baPWV可作为高血压合并主动脉损害的指标之一,对评估血管功能改变有一定临床意义。

Objective:To investigate the clinical significance of serum Fibulin-3 and the correlation between Fibulin-3 and branchial-ankle pulse wave velocity(baPWV)in patients with hypertension complicated with aortic dissection(AD).Method:A tolal of 49 patients with hypertension and AD(Debakey typeⅢor Stanford type B)(hypertension complicated with AD group),60 patients with hypertension(hypertension group),and 48 healthy people(control group)were enrolled.Levels of Fibulin-3 and matrix metalloproteinases-9(MMP-9)were detected by enzyme-linked immunosorbent assay.The branchial-ankle pulse wave velocity(baPWV)was detected by pulse wave velocity automatic analyzer.Result:The leve of blood pressure,man ratio and smoking ratio in hypertension complicated with AD group were higher than those in hypertension group and control group(all P<0.05).The level of serum Fibulin-3 in hypertension complicated with AD group was significantly lower than that in hypertension group(P<0.05).However,hypertension group had even lower Fibulin-3 level than control group(P<0.05).The level of serum MMP-9 in hypertension complicated with AD group was significantly higher than that in hypertension group(P<0.05),while there was no significance between hypertension group and control group.The baPWV in hypertension complicated with AD group was higher than that in hypertension group and control group(P<0.05).Hypertension group had higher baPWV than control group(P<0.05).In patients with hypertension complicated with AD,Fibulin-3 was negatively correlated with baPWV(r=-0.463,P<0.01),While there was no significance between MMP-9 and baPWV.Conclusion:There are changes of protein of the level of extracellular matrix and MMP-9 and the increases of arteriosclerosis indicators in patients with hypertension complicated with AD.The level of serum Fibulin-3,MMP-9 and baPWV can be used as indexes of hypertension complicated with aortic damage,which has certain clinical significances in evaluating vascular function changes.