老年H型高血压亚临床炎症变化与颈动脉损害特点的关系和临床意义  

Clinical significance and relationship of subclinical inflammation and carotid artery structure in elderly patients with H-type hypertension

作　　者：黄芪[1] 刘先铃 徐海[1] 吴强[2] 

机构地区：[1]重庆三峡中心医院老年科,重庆404000 [2]重庆三峡中心医院超声科,重庆404000

出　　处：《中国医学前沿杂志（电子版）》2016年第7期69-72,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：重庆市万州区科学技术项目(201303033)

摘　　要：目的探讨老年H型高血压亚临床炎症变化与颈动脉损害特点的关系及临床意义。方法选取2013年6月至2015年8月本院老年科收治的175例高血压患者为研究对象,根据同型半胱氨酸(Hcy)水平(≥10μmol/L为H型高血压,<10μmol/L为非H型高血压)和年龄(≥60岁为老年,≥40岁且<60岁为中年)将入选患者分为老年H型高血压组(H1组,66例)、中年H型高血压组(H2组,48例)及老年非H型高血压组(NH组,61例)。测定三组患者颈部血管的彩色超声及血清炎性标志物水平,分析H型高血压患者颈动脉结构、功能的变化及其与炎性标志物的相关性。结果 H1组与H2组患者年龄、舒张压(DBP)及脉压比较差异均具有显著性(P<0.05),而性别比例、收缩压(SBP)、血脂、Hcy水平比较差异均无显著性(P>0.05)。H1组与NH组患者Hcy水平比较差异具有极其显著性(P<0.01),而年龄、性别比例、血压、血脂水平比较差异均无显著性(P>0.05)。H1组患者颈动脉内-中膜厚度(IMT)、斑块积分(PS)均显著大于H2组和NH组(P<0.01,P<0.05),动脉扩张性系数(DC)、双侧颈总动脉平均僵硬度参数(CCA-mβ)均显著小于H2组(P<0.01),但与NH组比较差异均无显著性(P>0.05)。H1组患者血清白介素(IL)-6、IL-8、肿瘤坏死因子-α(TNF-α)水平均明显高于H2组和NH组(P<0.01,P<0.05),但高敏C反应蛋白(hs-CRP)、胱抑素C(Cys C)水平均高于H2组(P<0.05,P<0.01),与NH组比较差异无显著性(P>0.05)。H1组患者颈动脉IMT、PS、血清IL-6、IL-8、TNF-α、Cys C水平与Hcy水平均呈正相关(r_(分别)=0.435、0.316、0.337、0.341、0.281、0.429,P<0.01)。结论老年H型高血压的动脉损害情况与炎症过程密切相关,应采取积极的干预措施尽早达到理想血压并减少并发症的发生。Objective To investigate the relationship and clinical significance of subclinical inflammation and carotid artery structure in elderly patients with H-type hypertension. Method 175 patients with hypertension from June 2013 to August 2015 in our hospital were chosen as the subjects of study, and acccording to the levels of Hcy（ ≥ 10 μmol/L： H-type hypertension; 〈10 μmol/L： non-H-type hypertension） and ages（ ≥ 60 years old： elderly, ≥ 40 years also 〈60 years old： middle-aged）, patients were divided into three groups as follows： elderly patients with H-type hypertension（H1 group, 66 cases）, middle-aged grouped in H-type hypertension（H2 group, 48 cases） and elderly with non-H-type hypertension（NH group, 61 cases）. The serum subclinical inflammatory markers and carotid artery ultrasound were conducted to analyze the structure and function of carotid artery and the relationship with inflammatory markers in H-type hypertension. Result The difference of age, diastolic blood pressure（DBP） and pulse pressure between H1 group and H2 group were significant（P〈0.05）, but there were no significant differences in sex ratio, systolic blood pressure（SBP）, blood lipid and Hcy levels（P〉0.05）. The difference of Hcy level between H1 group and NH group was significant（P〈0.01）, but there were no significant differences in age, sex ratio, blood pressure and blood lipid levels（P〉0.05）. The IMT and PS in H1 group were significantly higher than H2 group and NH group（P〈0.01, P〈0.05）, only DC and CCA-mβ in H1 group were significantly lower than H2 group（P〈0.01）, and there was no significantly difference when compared to NH group（P〈0.05）. The levels of serum IL-6, IL-8, TNF-α in H1 group were significantly higher than H2 group and NH group（P〈0.01, P〈0.05）, and the levels of hs-CRP, CysC in H1 group were significantly higher than H2 group（P〈0.05, P〈0.01）, but not significant when compared to NH group（P〉0.05）. IMT, PS, IL-6, IL-

关 键 词：H型高血压 老年 动脉粥样硬化 炎性标志物 

分 类 号：R544.1[医药卫生—心血管疾病]