冠心病合并微量白蛋白尿患者中心动脉压与颈动脉粥样硬化及Vaspin水平的研究
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摘要
目的探讨冠心病合并微量白蛋白尿患者的中心动脉压与颈动脉粥样硬化及血清脂肪特异性丝氨酸蛋白酶抑制剂水平的关系,旨在能够早期发现高血压病的亚临床靶器官损害,为心血管疾病的及时诊断及治疗提供新的思路。方法入选的冠心病患者于冠脉造影时测量中心动脉压并行颈动脉超声检查,同时进一步检测尿微量白蛋白。将136例阳性患者据颈动脉超声结果分为斑块组(n=85)与非斑块组(n=51),比较2组的中心动脉血压及血清脂肪特异性丝氨酸蛋白酶抑制剂水平;另将尿微量白蛋白阳性患者据中心动脉脉压分为宽脉压组(n=82)及非宽脉压组(n=54),比较其颈动脉硬化程度及血清脂肪特异性丝氨酸蛋白酶抑制剂水平。结果冠心病合并微量白蛋白尿患者中心动脉血压及颈动脉硬化程度显著增高(P<0.05);颈动脉斑块组中心动脉收缩压及脉压高于非斑块组,脂肪特异性丝氨酸蛋白酶抑制剂水平低于非斑块组(P<0.05);宽脉压组颈动脉内中膜厚度、斑块检出率、斑块厚度及斑块面积均高于非宽脉压组,脂肪特异性丝氨酸蛋白酶抑制剂水平低于非宽脉压组(P<0.05)。结论冠心病合并微量白蛋白尿患者中心动脉压及颈动脉粥样硬化程度与脂肪特异性丝氨酸蛋白酶抑制剂呈负相关,其血清水平可以作为一个预测指标,为今后研究和治疗冠心病及相关疾病提供新的思路。
Objective To detect subclinical target organ damage in hypertension on early stage, so as to provide new ideas for timely diagnosis and treatment of cardiovascular diseases by exploring the relationship between central aortic pressure, carotid atherosclerosis and the Vaspin level of the patients with coronary heart disease(CHD) combined with microalbuminuria.Methods The central aortic pressure of the patients with CHD enrolled in the study were measured while carotid ultrasound and coronary angiography were performed, and the urinary albumin was detected. A total of 136 positive patients were divided into plaque group(n=85) and non-plaque group(n=51) according to carotid ultrasound examination results. The central arterial blood pressure and Vaspin levels of patients in both groups were compared. Moreover, the positive patients were divided into wide pulse pressure group(n=82) and non-wide pulse pressure group(n=54) according to the central artery pulse pressure. The degree of carotid atherosclerosis and Vaspin level of the patients in both groups were compared.Results The central arterial blood pressure and the degree of carotid atherosclerosis of the patients with CHD combined with microalbuminuria were significantly increased(P<0.05). The central aortic systolic blood pressure(CSP) and pulse pressure(CPP) of the patients in plaque group were higher than those in non-plaque group.And the Vaspin levels were lower than those in non-plaque group(P<0.05). Moreover, the thickness of carotid intima-media, plaque detection rate, plaque thickness and plaque area in wide pulse pressure group were higher than those in non-wide pulse pressure group. And the Vaspin levels were lower than those in non-wide pulse pressure group(P<0.05). Conclusion The CSP and the degree of carotid atherosclerosis of the patients with CHD combined with microalbuminuria are negatively correlated with Vaspin,and the serum levels can regarded as a predictive index to provide an new idea for future research and treatment of CHD and related diseases.
Objective To detect subclinical target organ damage in hypertension on early stage, so as to provide new ideas for timely diagnosis and treatment of cardiovascular diseases by exploring the relationship between central aortic pressure, carotid atherosclerosis and the Vaspin level of the patients with coronary heart disease(CHD) combined with microalbuminuria.Methods The central aortic pressure of the patients with CHD enrolled in the study were measured while carotid ultrasound and coronary angiography were performed, and the urinary albumin was detected. A total of 136 positive patients were divided into plaque group(n=85) and non-plaque group(n=51) according to carotid ultrasound examination results. The central arterial blood pressure and Vaspin levels of patients in both groups were compared. Moreover, the positive patients were divided into wide pulse pressure group(n=82) and non-wide pulse pressure group(n=54) according to the central artery pulse pressure. The degree of carotid atherosclerosis and Vaspin level of the patients in both groups were compared.Results The central arterial blood pressure and the degree of carotid atherosclerosis of the patients with CHD combined with microalbuminuria were significantly increased(P<0.05). The central aortic systolic blood pressure(CSP) and pulse pressure(CPP) of the patients in plaque group were higher than those in non-plaque group.And the Vaspin levels were lower than those in non-plaque group(P<0.05). Moreover, the thickness of carotid intima-media, plaque detection rate, plaque thickness and plaque area in wide pulse pressure group were higher than those in non-wide pulse pressure group. And the Vaspin levels were lower than those in non-wide pulse pressure group(P<0.05). Conclusion The CSP and the degree of carotid atherosclerosis of the patients with CHD combined with microalbuminuria are negatively correlated with Vaspin,and the serum levels can regarded as a predictive index to provide an new idea for future research and treatment of CHD and related diseases.
引文
1 刘青青,李丽琪,冯玫.我国高血压管理与防控:任重而道远.中华高血压杂志,2017,25:705-708.
2 金雅丽,张倩辉,郭艺芳.尿微量自蛋白.中华高血压杂志,2011,17:283-285.
3 奥日瀚,任鸿坤.监测中心动脉压对预防颈动脉斑块形成的研究进展.内蒙古医科大学学报(医学研究进展),2015,37:1-6.
4 Li Z,Ma C,Li L,et al.Vaspin serum concentration in patients with type 2 diabetes and carotid plaque.J Int Med Res,2012,40:1670-1676.
5 Wada M,Nagasawa H,Kurita K,et al.Microalbuminuria is a risk factor for cerebral small vessel disease in community-base elderly Subjects.Neurol Sci,2007,255:27-34.
6 曹晓霞.氨氯地平和坎地沙坦联用对原发性高血压尿微量清蛋白的影响.实用心脑肺血管病杂志,2012,20:594.
7 汪克纯,李家富.高血压患者脉压与靶器官损害的研究进展.中国心血管病研究杂志,2012,4:469-471.
8 梁国钦,廖华.原发性高血压患者中心动脉压与尿微量白蛋白的相关性研究.广州医学院学报,2015:89-91.
9 Debreceni B,Debreceni L.The role of homocysteine-lowering B-vitamins in the primary prevention of cardiovascular disease.Cardiovasc Ther,2014,32:130-138.
10 杨文慧,杨莉,何燕,等.外周动脉粥样硬化与冠状动脉病变Gensini评分的相关性.中国老年学杂志,2015:2391-2393.
11 福林,阿拉木苏,刘琪,等.高频超声检测内中膜厚度和粥样斑块形成与冠心病程度的对比分析.内蒙古医科大学学报,2014,36:12-15.
12 闫伟,王有恒,任骞,等.冠心病患者维生素D浓度与颈动脉内中膜厚度相关性研究.陕西医学杂志,2015,44:321-323.
13 李志根,周颖玲,陈竹君,等.颈动脉斑块比颈动脉内-中膜厚度能更好地预测冠心病多支病变.实用医学杂志,2012,28a:3066-3068.
14 骆莹莹,陈述,王大新.氧化应激对动脉粥样硬化内皮细胞损伤作用的研究进展.医学综述,2015,21:772-775.
15 Blaha MJ,Cainzos-Achirica M,Greenland P,et al.Role of coronary artery calcium score of zero and other negative risk markers for cardiovascular disease:the multi-ethnic study of atherosclerosis (MESA).Circulation,2016,133:849- 858.
16 Kobat MA,Celik A,Balin M,et al.The investigation of serum vaspin level in atherosclerotic coronary artery disease.J Clin Med Res,2012,4:110-113.
17 Sun N,Wang H,Wang L.Vaspin alleviates dysfunction of endothelial progenitor cells induced by high glucose via PI3K/Akt /eNOS pathway.Int J Clin Exp Pathol,2015,8:482-489.
18 Kameshima S,Yamada K,Morita T,et al.Visceral adipose tissuederived serine protease inhibitor augments acetylcholine-induced relaxation via the inhibition of acetylcholine esterase activity in rat isolated mesenteric artery.Acta Physiol (Oxf),2016,216:203-210.
19 Phalitakul S,Okada M,Hara Y,et al.Vaspin prevents methylglyoxal-induced apoptosis in human vascular endothelial cells by inhibiting reactive oxygen species generation.Acta Physiol(Oxf),2013,209:212-219.
20 Phalitakul S,Okada M,Hara Y,et al.Vaspin prevents TNF-α-induced intracellular adhesion molecule-1 via inhibiting reactiveoxygen species-dependent NF-κB and PKCθ activation in culturedrat vascular smooth muscle cells.Pharmacol Res,2011,64:493-500.
21 Liu S,Dong Y,Wang T,et al.Vaspin inhibited proinflammatory cytokine induced activation of nuclear factor-kappa B and its downstream molecules in human endothelial EA.hy926 cells.Diabetes Res Clin Pract,2014,103:482-488.
22 Phalitakul S,Okada M,Hara Y,et al.A novel adipocytokine,vaspin inhibits platelet-derived growth factor-BB-induced migration of vascular smooth muscle cells.Biochem Biophys Res Com-mun,2012,423:844-849.
23 Cura HS,Ozdemir HH,Demir CF,et al.Investigation of vaspin level in patients with acute ischemic stroke.J Stroke Cerebro-vasc Dis,2014,23:453-456.
2 金雅丽,张倩辉,郭艺芳.尿微量自蛋白.中华高血压杂志,2011,17:283-285.
3 奥日瀚,任鸿坤.监测中心动脉压对预防颈动脉斑块形成的研究进展.内蒙古医科大学学报(医学研究进展),2015,37:1-6.
4 Li Z,Ma C,Li L,et al.Vaspin serum concentration in patients with type 2 diabetes and carotid plaque.J Int Med Res,2012,40:1670-1676.
5 Wada M,Nagasawa H,Kurita K,et al.Microalbuminuria is a risk factor for cerebral small vessel disease in community-base elderly Subjects.Neurol Sci,2007,255:27-34.
6 曹晓霞.氨氯地平和坎地沙坦联用对原发性高血压尿微量清蛋白的影响.实用心脑肺血管病杂志,2012,20:594.
7 汪克纯,李家富.高血压患者脉压与靶器官损害的研究进展.中国心血管病研究杂志,2012,4:469-471.
8 梁国钦,廖华.原发性高血压患者中心动脉压与尿微量白蛋白的相关性研究.广州医学院学报,2015:89-91.
9 Debreceni B,Debreceni L.The role of homocysteine-lowering B-vitamins in the primary prevention of cardiovascular disease.Cardiovasc Ther,2014,32:130-138.
10 杨文慧,杨莉,何燕,等.外周动脉粥样硬化与冠状动脉病变Gensini评分的相关性.中国老年学杂志,2015:2391-2393.
11 福林,阿拉木苏,刘琪,等.高频超声检测内中膜厚度和粥样斑块形成与冠心病程度的对比分析.内蒙古医科大学学报,2014,36:12-15.
12 闫伟,王有恒,任骞,等.冠心病患者维生素D浓度与颈动脉内中膜厚度相关性研究.陕西医学杂志,2015,44:321-323.
13 李志根,周颖玲,陈竹君,等.颈动脉斑块比颈动脉内-中膜厚度能更好地预测冠心病多支病变.实用医学杂志,2012,28a:3066-3068.
14 骆莹莹,陈述,王大新.氧化应激对动脉粥样硬化内皮细胞损伤作用的研究进展.医学综述,2015,21:772-775.
15 Blaha MJ,Cainzos-Achirica M,Greenland P,et al.Role of coronary artery calcium score of zero and other negative risk markers for cardiovascular disease:the multi-ethnic study of atherosclerosis (MESA).Circulation,2016,133:849- 858.
16 Kobat MA,Celik A,Balin M,et al.The investigation of serum vaspin level in atherosclerotic coronary artery disease.J Clin Med Res,2012,4:110-113.
17 Sun N,Wang H,Wang L.Vaspin alleviates dysfunction of endothelial progenitor cells induced by high glucose via PI3K/Akt /eNOS pathway.Int J Clin Exp Pathol,2015,8:482-489.
18 Kameshima S,Yamada K,Morita T,et al.Visceral adipose tissuederived serine protease inhibitor augments acetylcholine-induced relaxation via the inhibition of acetylcholine esterase activity in rat isolated mesenteric artery.Acta Physiol (Oxf),2016,216:203-210.
19 Phalitakul S,Okada M,Hara Y,et al.Vaspin prevents methylglyoxal-induced apoptosis in human vascular endothelial cells by inhibiting reactive oxygen species generation.Acta Physiol(Oxf),2013,209:212-219.
20 Phalitakul S,Okada M,Hara Y,et al.Vaspin prevents TNF-α-induced intracellular adhesion molecule-1 via inhibiting reactiveoxygen species-dependent NF-κB and PKCθ activation in culturedrat vascular smooth muscle cells.Pharmacol Res,2011,64:493-500.
21 Liu S,Dong Y,Wang T,et al.Vaspin inhibited proinflammatory cytokine induced activation of nuclear factor-kappa B and its downstream molecules in human endothelial EA.hy926 cells.Diabetes Res Clin Pract,2014,103:482-488.
22 Phalitakul S,Okada M,Hara Y,et al.A novel adipocytokine,vaspin inhibits platelet-derived growth factor-BB-induced migration of vascular smooth muscle cells.Biochem Biophys Res Com-mun,2012,423:844-849.
23 Cura HS,Ozdemir HH,Demir CF,et al.Investigation of vaspin level in patients with acute ischemic stroke.J Stroke Cerebro-vasc Dis,2014,23:453-456.