【摘要】：目的:上世紀(jì)中葉開(kāi)始我國(guó)進(jìn)行了3次大規(guī)模成人高血壓病普查,普查結(jié)果發(fā)現(xiàn)我國(guó)高血壓人群比例呈逐年上升趨勢(shì)。在上世紀(jì)90年代的10年中,我國(guó)原發(fā)性高血壓(Primary Hypertension)的患病率以每年3%的速度逐年增長(zhǎng),其中18.8%的患者是18歲以上的成年人。高血壓病是人類歷史上嚴(yán)重威脅人類健康的一種疾病,它的危害不僅在因?yàn)榧毙园Y狀的兇險(xiǎn),如高血壓危象,更可怕的是長(zhǎng)期的高血壓會(huì)引起心、腦、腎、血管、視網(wǎng)膜等臟器的組織損害,繼而引發(fā)的嚴(yán)重并發(fā)癥直接或間接的危害了人類的生活質(zhì)量。那么早期對(duì)高血壓的有效控制是必不可少的。多種高血壓并發(fā)癥的病理基礎(chǔ)和病生理機(jī)制,主要是因?yàn)樵l(fā)性高血壓靶器官的內(nèi)皮細(xì)胞結(jié)構(gòu)和功能的改變。氧化陰離子(Oxide anion,O-2)、脂質(zhì)過(guò)氧化物(Lipid peroxide,LPO)和血清胱抑素C(Cystatin C,Cys-C)對(duì)血管內(nèi)皮功能均有一定的影響作用,在心腦血管的疾病和并發(fā)癥及其預(yù)后評(píng)估中的意義也已有相關(guān)文獻(xiàn)報(bào)道。但是,有關(guān)O-2、LPO、Cys-C水平與各級(jí)高血壓關(guān)系之間的對(duì)比研究甚少,本文將高血壓與正常人、高血壓病人不同等級(jí)血壓水平間氧化應(yīng)激狀態(tài)和臨床意義做初步探討。方法:選擇正常人組30例,為體檢合格健康人,無(wú)心腦血管疾病史,肝腎功能均正常。高血壓組則入組2014年至2016年天津醫(yī)大二院心臟內(nèi)科住院的原發(fā)性高血壓病人。根據(jù)2010年版中國(guó)高血壓防治指南中的高血壓分級(jí)標(biāo)準(zhǔn),將高血壓病人分為三組:(1)1級(jí)高血壓組(BP:140~159/90~99mmHg)30例;(2)2級(jí)高血壓組(BP:160~179/100~109mmhg)30例;(3)3級(jí)高血壓組(BP≥180/110mmhg)45例。原發(fā)性高血壓組入選人員均排除繼發(fā)性高血壓以及合并慢性腎臟病、惡性腫瘤、Ⅲ級(jí)及以上心衰、急性心肌梗塞和急性炎癥等。分別對(duì)LPO、Cys-C應(yīng)用ELISA法、對(duì)O-2用比色法,對(duì)100例高血壓患者血清中的O-2、LPO、Cys-C水平的檢測(cè),并與30名體檢正常人做比較。同時(shí)進(jìn)行正常組與3級(jí)高血壓組心臟多普勒超聲各指標(biāo)及反應(yīng)腎功能的血肌酐和血尿酸的數(shù)據(jù)結(jié)果對(duì)比。研究數(shù)據(jù)使用SPSS20.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。計(jì)量資料數(shù)據(jù)用((?)±s)表示,多組間比較使用方差分析方法,單樣本數(shù)據(jù)使用Kolmogorov-Smirnov檢驗(yàn),獨(dú)立樣本使用T檢驗(yàn),以p0.05為差異有統(tǒng)計(jì)學(xué)意義。計(jì)數(shù)資料采用百分?jǐn)?shù)表示。結(jié)果:不同血壓水平的高血壓患者血清中LPO、Cys-C水平均高于正常健康人組(p0.05);2級(jí)和3級(jí)高血壓病人的LPO和Cys-C水平高于1級(jí)高血壓病人(p0.05),但2級(jí)和3級(jí)高血壓組之間并無(wú)明顯差異(p0.05)。3級(jí)高血壓組的O-2水平明顯高于1級(jí)高血壓組和正常對(duì)照組(p0.05)。3級(jí)高血壓患者血尿酸(Uric Acid,UA)水平、Tei指數(shù)和左心室厚度(Left ventricular wall thickness,LVW)明顯高于正常對(duì)照組(p0.05)。左室射血分?jǐn)?shù)(left ventricular ejection fraction,LVEF)和二尖瓣流速(Mitral flow velocity,VE)與正常組對(duì)照,數(shù)據(jù)呈正態(tài)分布(P0.05)。正常對(duì)照組與3級(jí)高血壓組之間的左室射血分?jǐn)?shù)(LVEF)(P0.05)無(wú)統(tǒng)計(jì)學(xué)意義。二尖瓣流速(VE)存在明顯差異,(P0.05);左房?jī)?nèi)徑和左室舒張末內(nèi)徑,兩組數(shù)據(jù)呈正態(tài)分布(正態(tài)性檢驗(yàn)P0.05)。左房?jī)?nèi)徑(left atrial diameter,LA)和左室舒張末內(nèi)徑(Left ventricular end-diastolic diameter,LV)存在明顯差異(P0.05);室間隔厚度(interventricular septal thickness,IVS)和左室壁厚度,兩組數(shù)據(jù)呈正態(tài)分布(正態(tài)性檢驗(yàn)P0.05),室間隔厚度(IVS)和左室壁厚度(LVW)存在明顯差異,(P0.05);3級(jí)高血壓患者的血肌酐(creatinine,Cr)和血清胱抑素C與正常對(duì)照組進(jìn)行比較,兩組數(shù)據(jù)呈正態(tài)分布(正態(tài)性檢驗(yàn)P0.05),Cr和血清胱抑素C(Cys-c)存在明顯差異(P0.05);3級(jí)高血壓患者的LPO和肌鈣蛋白I(cardiac troponin I,cTnI)正常對(duì)照組,兩組數(shù)據(jù)呈正態(tài)分布(正態(tài)性檢驗(yàn)P0.05),LPO和cTn I存在明顯差異,(P0.05)。結(jié)論:1、血清O-2、LPO、Cys-C水平的變化與高血壓病的發(fā)生發(fā)展密切相關(guān)。2、氧化應(yīng)激指標(biāo)的檢測(cè)對(duì)于早期識(shí)別高血壓的靶器官損害和預(yù)防并發(fā)癥具有重要意義。
[Abstract]:Objective: In the middle of last century, three large-scale adult hypertension survey was conducted in China. The results showed that the proportion of hypertension population in China was increasing year by year. In the 10 years of the 1990s, the prevalence of primary hypertension increased year by year at 3% a year, of which 18. 8% of patients were adults over 18 years of age. Hypertension is a disease that poses a serious threat to human health in human history. Its harm not only causes damage to tissues of organs such as heart, brain, kidney, blood vessel, retina, etc., because of its dangerous conditions, such as high blood pressure crisis, and more terrible, long-term hypertension. The subsequent serious complications directly or indirectly endanger the quality of life of human beings. The early effective control of hypertension is essential. The pathological basis and function of a variety of hypertension complications are mainly due to the changes of the structure and function of endothelial cells in the target organs of essential hypertension. The effects of oxidation anion (O-2), lipid peroxide (LPO) and cystatin C (OPG-C) on vascular endothelial function were studied. However, the correlation between the levels of O-2, LPO, adiponectin-C and hypertension at all levels was very little, and the status of oxidative stress and its clinical significance in different levels of blood pressure were discussed in this paper. Methods: Thirty patients with normal control group were selected to be eligible for physical examination. There was no history of cardiovascular and cerebrovascular diseases, and the function of liver and kidney was normal. Hypertension group was enrolled in patients with essential hypertension hospitalized in Cardiology Department of Tianjin Medical University from 2014 to 2016. Hypertension patients were divided into three groups: (1) hypertension group (BP: 140 ~ 159/ 90 ~ 99mmHg) in 30 cases; (2) group 2 hypertension group (BP: 160 ~ 179/ 100 ~ 109mmhg) in 30 cases; (3) group 3 hypertension group (BP: 180/ 110mmhg) in 45 cases. All the patients with essential hypertension excluded secondary hypertension and combined with chronic kidney disease, malignant tumor, grade 鈪，

本文編號(hào)：2304899