【摘要】 目的探究高血压合并心功能不全对患者环孢素A结合蛋白(CyP)、生长分化因子-15(GDF-15)、白细胞介素-18(IL-18)水平影响及检测各指标表达的临床意义。方法选取本院2016年12月至2019年12月收治的原发性高血压患者90例,依照患者伴心功能不全程度分为高血压无心功能不全组(A=36)、高血压伴轻度心功能不全组(心功能Ⅰ、Ⅱ级,B=32),高血压伴中重度心功能不全组(心功能为Ⅲ、Ⅳ级,C=22),另选择同期于本院体检的健康志愿者30例作为对照组。心脏超声检测各组心功能,酶联免疫吸附法(ELISA)检测各组血清因子水平,Spearman检验分析CyP、GDF-15、IL-18与高血压合并心功能不全患者左室射血分数(LVEF)的相关性。结果 B、C两组患者左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左房内径(LAD)、室间隔厚度(IVS)较A组和对照组显著增大,LVEF显著降低,差异具有统计学意义(P<0.05);A组和对照组LVEDD、LVESD、LAD、IVS、LVEF比较差异无统计学意义(P>0.05)。A、B、C组患者肿瘤坏死因子-α(TNF-α)、IL-1β、总抗氧化能力(T-AOC)、B型脑钠肽(BNP)、IL-6、CyP-A、CyP-B、GDF-15、IL-18水平均显著较对照组显著升高,且A、B、C三组随着患者心功能不全程度加重各指标水平逐渐升高,差异具有统计学意义(P<0.05)。高血压合并心功能不全患者CyP-A、CyP-B、GDF-15、IL-18与LVEF存在显著负相关性(P<0.05)。结论高血压合并心功能不全患者机体炎症因子、CyP、GDF-15、IL-18水平明显升高,并与心功能障碍程度存在明显关系,临床上应注意观测CyP、GDF-15、IL-18水平变化,以预防和降低高血压患者心功能损伤的发生。更多还原

【Abstract】 Objective To investigate the effect of hypertension combined with cardiac insufficiency on the levels of cyclosporin A binding protein(CyP),growth differentiation factor-15(GDF-15),interleukin-18(IL-18)and the clinical significance of the expression of various indicators. Methods Ninety patients with primary hypertension treated in our hospital from December 2016 to December 2019 were selected. According to the degree of heart failure,the patients were divided into hypertension without cardiac insufficiency group(group A,n=36),hypertension with mild cardiac dysfunction group(group B,cardiac functionⅠ,Ⅱ,n=32),and hypertension with moderate to severe cardiac dysfunction group(group C,cardiac functionⅢ,Ⅳ,n=22). Another thirty healthy volunteers who underwent physical examination in our hospital during the same period were recruited as the control group. Cardiac ultrasound was used to detect the heart function of patients in all group. Enzyme-linked immunosorbent assay(ELISA)was used to detect serum levels of factors. The correlation between CyP,GDF-15,IL-18 and left ventricular ejection fraction(LVEF)in patients with hypertension complicated with cardiac insufficiency were analyzed using Spearman rank correlation. Results The left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left atrial inner diameter(LAD),and ventricular septal thickness(IVS)of the two groups of patients in B and C were significantly larger than those of the group A and the control group,and LVEF was significantly reduced(P<0.05). There was no significant difference in the LVEDD,LVESD,LAD,IVS,and LVEF between the group A and the control group(P>0.05). The levels of tumor necrosis factor-α(TNF-α),IL-1β,total antioxidant capacity(T-AOC),B-type brain natriuretic peptide(BNP),IL-6,CyP-A,CyP-B,GDF-15,and IL-18 in patients in the groups A,B,and C were significantly higher than those in the control group,and the levels of various indicators gradually increased with the increase of patients with cardiac insufficiency,and the differences were statistically significant(P<0.05). There was a significant negative correlation between CyP-A,CyP-B,GDF-15,IL-18 and LVEF in patients with hypertension and cardiac insufficiency(P<0.05). Conclusion The levels of inflammatory factors,CyP,GDF-15,and IL-18 in patients with hypertension and cardiac insufficiency are significantly increased,and have a significant relationship with the degree of cardiac dysfunction. Clinically,it is necessary to monitor the changes of CyP,GDF-15,and IL-18 to prevent and reduce the occurrence of cardiac function impairment in patients with hypertension.更多还原