| 褚 杰,王喜福,杨 婷,殷少杰,郭 玮.无左室肥厚的非杓型高血压患者血清GDF-15、YKL-40水平表达及其临床意义[J].,2022,(11):2143-2148 |
| 无左室肥厚的非杓型高血压患者血清GDF-15、YKL-40水平表达及其临床意义 |
| Expression and Clinical Significance of Serum GDF-15 and YKL-40 in Patients with Non Dipper Hypertension with No Left Ventricular Hypertrophy |
| 投稿时间：2022-01-05 修订日期：2022-01-28 |
| DOI：10.13241/j.cnki.pmb.2022.11.028 |
| 中文关键词: 无左室肥厚 非杓型高血压 人软骨糖蛋白39 生长分化因子15 颈动脉粥样硬化 |
| 英文关键词: No left ventricular hypertrophy Non dipper hypertensive GDF-15 YKL-40 Clinical significance |
| 基金项目:国家高技术研究发展计划（863计划）项目（2015AA020102） |
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| 中文摘要: |
| 摘要 目的：探讨无左室肥厚（NLVH）的非杓型高血压患者血清生长分化因子15（GDF-15）、人软骨糖蛋白39（YKL-40）水平的表达及其临床意义。方法：选取2019年6月至2020年6月张家口学院附属人民医院收治的NLVH原发性高血压患者104例为研究对象，根据夜间收缩压下降率（SBPF）将其分为非杓型组（SBPF＜10%，n=60）和杓型组（10%≤SBPF≤20%，n=44）。另选取同期于张家口学院附属人民医院进行体检的健康志愿者49例记为对照组。比较三组受试者的血清GDF-15、YKL-40水平，比较非杓型和杓型NLVH患者的舒张压、收缩压、颈动脉内膜中层厚度（IMT）值、僵硬度、紧张度和扩张性、超声心动图参数、血压昼夜节律指标，分析NLVH的非杓型高血压患者血清GDF-15、YKL-40水平与超声心动图参数、血压昼夜节律、颈动脉粥样硬化指标的相关性。采用多元线性逐步回归分析非杓型高血压发病的影响因素。结果：非杓型NLVH组和杓型NLVH组患者的血清GDF-15、YKL-40水平均高于对照组患者，且非杓型NLVH组高于杓型NLVH组（P<0.05）；与杓型NLVH组患者比较，非杓型NLVH组患者的IMT、僵硬度、夜间平均收缩压（nSBP）、平均舒张压（nDBP）、左室舒张末期内径（LVEDD）、左房内径（LAD）、室间隔厚度（LVSD）、左室后壁厚度（PWD）均升高，LVEF、紧张度、扩张性则降低（P<0.05），但两组患者的白天平均收缩压（dSBP）、白天平均舒张压（dDBP）比较差异无统计学意义（P>0.05）。经Pearson相关性分析显示，NLVH的非杓型高血压患者的血清GDF-15、YKL-40水平与IMT、僵硬度、LAD、LVEDD、LVSD、PWD、nSBP、nDBP呈正相关，与LVEF、紧张度、扩张性呈负相关（P<0.05），而与dSBP、dDBP无明显相关性（P>0.05）；GDF-15与YKL-40水平呈正相关（P<0.05）。多元线性逐步回归分析显示：颈动脉IMT、僵硬度、LAD、LVEDD、nSBP、nDBP、LVEF、颈动脉紧张度、GDF-15是非杓型高血压发病的独立影响因素（P<0.05）。结论：NLVH的非杓型高血压患者血清GDF-15、YKL-40水平异常升高，且与超声心动图参数、血压昼夜节律、颈动脉粥样硬化具有一定关联，患者发病受多种因素影响，临床工作中应结合相关因素对患者进行适当干预。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the expression and clinical significance of serum growth differentiation factor-15 (GDF-15) and human cartilage glycoprotein 39 (YKL-40) in non dipper hypertensive patients with no left ventricular hypertrophy (NLVH). Methods: 104 patients with NLVH essential hypertension in People's Hospital Affiliated to Zhangjiakou University from June 2019 to June 2020 were selected as the research objects, and they were divided into the non dipper group (SBPF<10%, n=60) and dipper group (10%≤SBPF≤20%, n=44) according to nocturnal systolic blood pressure reduction rate (SBPF). Another 49 healthy volunteers in People's Hospital Affiliated to Zhangjiakou University during the same period were selected as the control group. The levels of serum GDF-15 and YKL-40 were compared among the three groups. The diastolic blood pressure, systolic blood pressure, carotid intima-media thickness (IMT), stiffness, tension and distensibility, echocardiographic parameters and circadian rhythm of blood pressure were compared between non dipper and dipper NLVH patients, the correlation of levels of serum GDF-15 and YKL-40 with echocardiographic parameters, circadian rhythm of blood pressure and carotid atherosclerosis in patients with non dipper hypertension with NLVH were analyzed. Multiple linear stepwise regression was used to analyze the influencing factors of non dipper hypertension. Results: The levels of serum GDF-15 and YKL-40 in non dipper NLVH group and dipper NLVH group were higher than those in control group, and the levels in non dipper NLVH group were higher than those in dipper NLVH group(P<0.05). Compared with dipper NLVH group, IMT, stiffness, nocturnal mean systolic blood pressure (nSBP), mean diastolic blood pressure (nDBP), left ventricular end diastolic diameter (LVEDD), left atrial diameter (LAD), interventricular septal thickness (LVSD) and left ventricular posterior wall thickness (PWD) in non dipper NLVH group were increased, while LVEF, tension and expansibility were decreased (P<0.05), but there was no significant difference in daytime mean systolic blood pressure (dSBP) and daytime mean diastolic blood pressure (dDBP) between the two groups (P>0.05). Pearson correlation analysis showed that the levels of serum GDF-15 and YKL-40 were positively correlated with IMT, stiffness, LAD, LVEDD, LVSD, PWD, nSBP and nDBP, negatively correlated with LVEF, tension and dilation(P<0.05), but not significantly correlated with dSBP and dDBP(P>0.05). GDF-15 was positively correlated with YKL-40(P<0.05). Multiple linear stepwise regression analysis showed that carotid IMT, stiffness, LAD, LVEDD, nSBP, nDBP, LVEF, carotid tension, GDF-15 were the main risk factors of non dipper hypertension(P<0.05). Conclusion: The levels of serum GDF-15 and YKL-40 in non dipper hypertensive patients with NLVH are abnormally increased, and they are related to echocardiographic parameters, circadian rhythm of blood pressure and carotid atherosclerosis. The onset of NLVH is affected by many factors. Appropriate intervention should be carried out in combination with relevant factors in clinical work. |
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