【作者】 李娟；

【导师】 李南方；

【作者基本信息】 石河子大学 ， 内科学， 2011， 硕士

【摘要】 目的:观察原发性醛固酮增多症(primary aldosteronism, PA)血清肿瘤坏死因子-α(tumor necrosis factorα,TNF-α)、白细胞介素6 (interleukin-6, IL-6)及超敏C反应蛋白(high-sensitivity C-creactive protein, hsCRP)水平,探讨血清TNF-α、IL-6及hsCRP与血清醛固酮水平的相关性。方法:入选2009年1月至2010年12月就诊于新疆维吾尔自治区人民医院高血压科的PA患者93例,原发性高血压(essential hypertension, EH)67例,采用放射免疫分析法检测血清TNF-α和IL-6,采用免疫比浊法检测血清hsCRP水平,比较EH患者与PA患者之间血清TNF-α、IL-6及hsCRP水平的差异,以及不同类型PA之间血清TNF-α、IL-6及hsCRP水平有无差异,分析炎症因子与PA患者各临床指标之间的相关性。结果:(1)与EH患者比较,PA患者收缩压水平较高,24h血钾更低,尿钾排泄更高,同时肾素活性(plasma renin activity, PRA)更低,血清醛固酮水平(aldosterone, ALD)更高(均为P<0.05)。(2)与双侧PA患者相比,两组患者的临床特征无明显差异,仅表现为单侧病变的PRA更低,醛固酮/肾素比值(serum aldosterone/plasma renin activity ratio, ARR)更高(均为P<0.05)。(3)与EH组比较：血清TNF-α水平在两组间差异无统计学意义(P>0.05)；PA组的IL-6和hsCRP浓度明显较低(P<0.001)。单双侧PA比较：单侧组TNF-α水平较双侧高(P=0.036);血清IL-6和hsCRP浓度在单双侧PA之间差异无统计学意义(P>0.05)。(4)采用Pearson相关分析显示在所有研究对象中,血清TNF-α与GLU呈有意义的相关(P<0.05)；血清IL-6与血糖(blood glucose,GLU)、甘油三酯(triglyceride, TC)、PRA、ALD及ARR呈有意义相关：与hsCRP呈有意义相关的变量有体重指数(body mass index, BMI)、腹围、GLU、TC、总胆固醇(total cholesterol, TG)、PRA、ARR。其中,血清IL-6与ALD和ARR呈负相关(r分别=-0.183、-0.331,P<0.01)。结论:(1)PA较EH有更低的IL-6及hsCRP水平,二者间TNF-α差异无统计学意义；PA中单侧PA患者血清TNF-α水平较高,IL-6及hsCRP水平在单双侧PA中差异无统计学意义。(2)在总体人群中,血清IL-6与醛固酮和ARR呈负相关,hsCRP与ARR呈负相关,与肾素活性、肥胖及血脂指标正相关。更多还原

【Abstract】 Objective: To investigate the levels of tumor necrosis factor alpha(TNF-a)、interleukin-6(IL-6) and high-sensitivity C-reactive protein (hsCRP) in patients with primary aldosteronism(PA). Then to study the relationship between inflammatory and aldosterone levels.Methods: We recruited 93 PA patients and 67 essential hypertensive (EH) patients from January 2009 to December 2010 in Hypertension department of People’s Hospital of Xinjiang Uygur Autonomous Region.The concentration of TNF-aand IL-6 were measured with radioimmunoassay (RIA); And the concentration of hsCRP were detected with immunoturbidimetry (ITM). Further, the TNF-a,IL-6 and hsCRP levels were compared in two groups and the possible relationship with other factors.Results (1) Compared with EH patients, the PA patients had higher systolic blood pressure(SBP), and lower 24h serum potassium, urinary potassium excretion higher; While plasma renin activity (PRA) were lower, serum aldosterone (ALD) levels were higher (P<0.05). (2) The bilateral PA patients in clinical features showed no significant difference with the patients with unilateral PA. But the unilateral PA showd lower PRA and higher aldosterone/plasma renin activity ratio(ARR) (P<0.05). (3) The concentration of TNF-αshowed no difference between EH and PA groups(P>0.05), but PA patients had lower levels of IL-6 and hsCRP (P<0.001).Compared of unilateral and bilateral PA, the unilateral PA had higher TNF-αlevels(P= 0.036); But no significant difference between the two groups (P>0.05).(4)Using Pearson correlation analysis in all subjects showed TNF-awas significantly associated with GLU (P<0.05); serum IL-6 and blood glucose(GLU), triglyceride(TC), PRA, ALD and ARR was significant correlation (P<0.05);and hsCRP were significant associated with the variables, such as body mass index(BMI), abdominal circumference, GLU, TC, total cholesterol (TG), PRA and ARR (P<0.05). IL-6 showed a remarkable correlation with ALD and ARR in total group(r=0.183、-0.331, P<0.01).Conclusion:Our results showed that PA patients and EH patients had the same levels of TNF-a, but lower IL-6 and hsCRP than EH patients. In the all patients, the level of IL-6 showed a remakble correlation with ALD and ARR; the level of hsCRP showed a negative correlation with ARR, and the positive correlation with PRA, the indicators of obesity and serum lipids.更多还原