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背景原发性高血压患者常伴有内皮功能障碍及炎症反应,已有研究表明原发性高血压患者血液中作为血管内皮功能指标的血栓调节蛋白(TM)和作为炎症指标的肿瘤坏死因子α(TNF-α)存在异常,二者与原发性高血压患者动脉僵硬度的关系报道较少。目的探讨原发性高血压患者脉搏波传导速度与TM和TNF-α的关系。方法将入选的303例受试者分为正常对照组(n=137)和高血压组(n=166),并检测血压、身高、体质量、腰围、臀围、体质量指数(BMI)。应用VP-1000动脉硬化分析仪测定受试者臂踝脉搏波传导速度(baPWV),用酶联免疫吸附法检测血浆TM水平,放射免疫法检测血清TNF-α水平。结果高血压组baPWV、TM和TNF-α显著高于正常对照组[baPWV:(1539.7±233.4)比对照组:(1303.0±149.4)cm/s,P<0.01;TM:(12.5±3.8)比对照组:(10.5±2.8)μg/L,P<0.01;TNF-α:(5.3±1.3)比对照组:(4.1±0.8)μg/L,P<0.01]。Pearson相关分析显示:高血压组血浆TM水平与年龄(r=0.335)、收缩压(SBP,r=0.280)、脉压(PP,r=0.284)、TNF-α(r=0.307)、baPWV(r=0.473)呈微弱正相关,均P<0.01;高血压组TNF-α与年龄(r=0.288)、SBP(r=0.299)、舒张压(DBP,r=0.164)、PP(r=0.212)、TM(r=0.307)、baPWV(r=0.512)相关较明显(均P<0.05)。多元逐步回归分析显示:高血压组在校正DBP、PP、BMI、HDL-C后,SBP、年龄、TM、TNF-α是baPWV的影响因素。结论原发性高血压患者血液中TM、TNF-α水平增高,它们可能参与了原发性高血压患者大动脉硬化形成的过程。
BACKGROUND: Patients with essential hypertension are often associated with endothelial dysfunction and inflammatory response. Studies have shown that thrombomodulin (TM), a marker of vascular endothelial function in the blood of patients with essential hypertension, and tumor necrosis factor α (TNF-α) is abnormal, and the relationship between them and arterial stiffness in patients with essential hypertension is less reported. Objective To investigate the relationship between pulse wave velocity and TM and TNF-α in patients with essential hypertension. Methods The 303 selected subjects were divided into normal control group (n = 137) and hypertension group (n = 166). Blood pressure, height, body mass, waist circumference, hip circumference and body mass index (BMI) were measured. The brachial-ankle pulse wave velocity (baPWV) was measured by VP-1000 atherosclerosis analyzer. Plasma TM was detected by enzyme-linked immunosorbent assay and serum TNF-α was measured by radioimmunoassay. Results The levels of baPWV, TM and TNF-α in hypertensive group were significantly higher than those in normal control group [(1539.7 ± 233.4) vs control group (1303.0 ± 149.4) cm / s, P <0.01; Control group: (10.5 ± 2.8) μg / L, P <0.01; TNF-α: (5.3 ± 1.3) vs control group: (4.1 ± 0.8) μg / L, P <0.01; Pearson correlation analysis showed that plasma levels of TM in hypertension group were significantly lower than those in patients with hypertension (r = 0.335), systolic blood pressure (SBP, r = 0.280), pulse pressure (PP r = 0.284), TNF- (r = 0.273), diastolic blood pressure (DBP, r = 0.164), PP (r = 0.212, r = 0.473) ), TM (r = 0.307) and baPWV (r = 0.512) (all P <0.05). Multivariate stepwise regression analysis showed that SBP, age, TM, TNF-α were the influencing factors of baPWV after adjusting for DBP, PP, BMI and HDL-C in hypertension group. Conclusion The levels of TM and TNF-α in the blood of patients with essential hypertension are increased, which may be involved in the process of the formation of arteriosclerosis in patients with essential hypertension.