原发性高血压患者血清I型和Ⅲ型前胶原水平与左心室舒张功能关系的研究  

The relationship between serum levels of procollagen type I / I and left ventricular diastolic function in essential hypertension

作　　者：刘克强[1] 刘绛光[2] 邹操[3] 

机构地区：[1]天津市第二中心医院心内科 [2]南开大学医学院生化教研室,天津300070 [3]南开大学医学院

出　　处：《中国心血管杂志》2001年第3期151-154,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的 研究血清I型和Ⅲ型前胶原(procollagen,PC)水平与左心室舒张功能(LVDF)的相关性。方法 采用放射免疫分析法,测定72名原发性高血压患者及20名同年龄健康者的血清PC I、PCⅢ和肿瘤坏死因子α(TNF-α)的水平,并用超声测量左心室解剖和舒缩功能参数。结果 高血压组血清PC I、PCⅢ和TNF-α较对照组显著升高(P值分别为P<O.005,P<0.001,P<0.001);高血压伴舒张功能减退者血清PC I和PCⅢ水平显著高于高血压但舒张功能正常者(PC I:P<0.05;PCⅢ;P<O.01)。血清PC I浓度与VA(二尖瓣心房收缩期流速)呈正性直线相关(r=0.268;P<0.05),血清PCⅢ浓度与VE(二尖瓣舒张早期流速)呈负性直线相关(r=-0.271;P<0.05);血清PC I和PCⅢ浓度均与VE/VA呈负性直线相关(PC I与VE/VA:r=-O.226;P<O.05;PCⅢ与VE/VA:r=-O.336;P<O.01);血清PCⅢ浓度与TNF-α浓度呈正性直线相关(r=O.338;P<O.01)。结论 (1)PC I和PCⅢ浓度可以作为评价心肌纤维化程度的间接指标,并可能成为临床上诊断高血压患者LVDF减退的生化指标;(2)原发性高血压患者血清TNF-α水平升高,说明TNF-α可能参与了高血压或心肌纤维化的病理生理过程。Objective To study the relationship between serum levels of procollagen type I and type Ⅲ (PC I and PC Ⅲ ) and left ventricular diastolic function (LVDF) in patients with essential hypertension. Methods Serum PC I ,PC Ⅲ and TNF-a were measured by radioimmuoassay in 72 essential hypertensive patients and 20 volunteers in same age group served as control. The LVDF in all patients was evalualed by two-dimentional echocardiography and Doppler blood flow. Results Serum levels of PC I , PC I and TNF-a were significantly increased in hypertensive patients compared to the control (PCI: P<0. 005; PC Ⅲ:P<0. 001; TNF-a: P<0. 001). PC I/PC Ⅲ were also markedly higher in the patients with decreased LVDF than that in the patients with normal LVDF (PC I : P <0. 05; PC Ⅲ:P<0. 01). A positive correlation was found between serum PC I and maximal late transmitral flow velocity (VA) (r=0. 268, P<0. 05), and between serum PC Ⅲ and TNF-a(r=0.338,P<0. 01), while negative correlations were found between PC I and maximal early transmitral flow velocity (VE) (r=-0. 271, P<0. 05), and between PC I or PC Ⅲ and the ratio of VE and VA(PC I and VE/VA: r=-0.226,P<0. 05; PC Ⅲ and VE/ VA: r=-0. 336,P<0. 01) . Conclusion Abnormally increased serum concentrations of PC I and PC Ⅲ can be used as indirect index for assessing myocardial fibrosis and also be used as biochemical index for diagnosis of hypertensive patients with decreased LVDF. The increased serum concentrations of TNF-a in essential hypertension implicated that TNF-a may participate in the process of myocardial fibrosis.

关 键 词：原发性高血压 心肌纤维化 左心室舒张功能 Ⅰ型前胶原 Ⅲ型前胶原 肿瘤坏死因子-Α 

分 类 号：R544.1[医药卫生—心血管疾病] R541.9[医药卫生—内科学]