高血压病患者血清TLR4和HMW-ADP的水平变化与临床意义研究

发布时间：2018-01-08 23:27

  本文关键词：高血压病患者血清TLR4和HMW-ADP的水平变化与临床意义研究　出处：《江苏大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 原发性高血压 Toll样受体4 高分子量脂联素 炎症 血压

【摘要】：目的:研究高血压病患者血清Toll样受体4(toll-like receptor 4,TLR4)及其相关炎症因子与脂肪因子高分子量脂联素(high molecular weight adiponectin,HMW-ADP)的表达,并探讨其与血压水平、靶器官损害的关系及对降压疗效的影响。方法:入选新诊断为原发性高血压1级、2级和3级的住院患者共150例(按血压水平分为3组,每组50例),同时入选50例血压正常者作为对照组。于应用降压药物前空腹抽取研究对象外周静脉血,采用酶联免疫吸附法(ELISA)分别检测血清TLR4及相关炎症因子C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和脂肪因子HMW-ADP的表达。6个月后门诊随访患者血压控制情况。采用Pearson相关性分析研究高血压病患者TLR4与HMW-ADP之间的相关性;分别应用多元线性回归和logistic回归分析TLR4及相关炎症因子和HMW-ADP与血压水平、靶器官损害的关系;采用多元线性回归研究高血压病患者血清TLR4、HMW-ADP初始水平对6个月后降压疗效的影响。结果:(1)高血压病1级、2级和3级组患者血清TLR4的表达水平分别为(14.51±4.37)ng/m L、(23.57±6.05)ng/m L和(36.41±7.68)ng/m L,与正常组[(7.77±3.24)ng/m L]相比,差异有显著性(均P0.01)。血清CRP在高血压病1级、2级和3级组的含量分别是(4.50±1.23)mg/L、(6.19±1.00)mg/L和(8.69±1.53)mg/L,与正常组(3.71±1.59)mg/L相比,差异有显著性(均P0.01)。在高血压病1级、2级和3级组中IL-6的表达水平分别是(6.94±1.30)ng/L、(8.66±1.35)ng/L和(11.88±1.11)ng/L,与正常组[(3.77±0.85)ng/L]相比,差异有显著性(均P0.01)。TNF-α在高血压病1级、2级和3级组的含量分别是(47.00±5.46)ng/L、(55.19±9.75)ng/L和(69.08±8.83)ng/L,与正常组[(37.39±3.65)ng/L]相比,差异有显著性(均P0.01)。(2)血清HMW-ADP水平在高血压病1级、2级和3级组患者分别为(7.48±1.33)mg/L、(5.48±1.21)mg/L和(3.44±1.04)mg/L,与正常组[(11.36±3.20)mg/L]相比,差异有显著性(均P0.01)。(3)Pearson相关性分析显示,在所有研究对象,血清TLR4与HMW-ADP表达水平呈负相关(r值为-0.782,P0.05),与C-反应蛋白(CRP)及体质量指数(BMI)呈正相关(r值分别为0.747、0.721,均P0.05)。(4)多元回归分析及logistic回归分析显示,在高血压患者,血清TLR4和HMW-ADP均为平均动脉压(B值分别为0.408与-2.51,均P0.01)和靶器官损害的独立影响因素(OR分别为1.335与0.717,均P0.05)。血清TLR4/HMWADP比值预测靶器官损害及临床状况的ROC曲线下面积为0.95,高于单独TLR4的曲线下面积0.88及HMW-ADP的曲线下面积0.83(均P0.05)。(5)多元回归分析显示,对于6个月后的血压控制水平,TLR4是不同降压药物治疗患者唯一公共的影响因素(P≤0.01)。结论:1.在高血压病患者,血清TLR4和HMW-ADP表达量与血压水平及靶器官损害密切相关,其中TLR4介导的炎症是血压升高及靶器官损害的促进因素,而HMW-ADP是保护因素。2.高血压病患者血清TLR4初始水平影响随访6个月时的降压效果。
[Abstract]:Objective: to study the serum Toll like receptor 4 toll-like receptor 4 in patients with hypertension. TLR4), its related inflammatory factors and adiponectin, high molecular weight adiponectin (molecular weight adiponectin). To investigate the relationship between HMW-ADP and blood pressure level, target organ damage and antihypertensive effect. There were 150 inpatients of grade 2 and grade 3 (50 cases in each group according to blood pressure level). At the same time, 50 patients with normal blood pressure were selected as the control group. The subjects' peripheral venous blood was drawn on an empty stomach before the use of antihypertensive drugs. Elisa was used to detect serum TLR4 and related inflammatory factor C- reactive protein (CRP) and interleukin-6 (IL-6). Tumor necrosis factor- 伪 (TNF- 伪). Blood pressure control in outpatient follow-up patients after 6 months. Pearson correlation analysis was used to study the relationship between TLR4 and HMW-ADP in patients with hypertension. Relevance; Multivariate linear regression and logistic regression were used to analyze the relationship between TLR4, related inflammatory factors and HMW-ADP with blood pressure level and target organ damage. Multivariate linear regression was used to study the effect of the initial serum TLR4 HMW-ADP level on the hypotensive effect after 6 months. The level of serum TLR4 expression in grade 2 and grade 3 patients was 14.51 卤4.37 ng / mL, respectively. 23.57 卤6.05 ng / mL and 36.41 卤7.68 ng / mL, respectively, and normal group. [Compared with 7.77 卤3.24 ng / mL, the difference was significant (all P 0.01). Serum CRP was in grade 1 of hypertension. The contents of grade 2 and grade 3 were 4.50 卤1.23 mg / L and 8.69 卤1.53 mg / L, respectively. There was a significant difference compared with the normal group (3.71 卤1.59 mg / L) (all P 0.01) in grade 1 of hypertension. The expression levels of IL-6 in grade 2 and grade 3 were 6.94 卤1.30 ng / L and 11.88 卤1.11 ng / L, respectively. Normal group. [Compared with 3.77 卤0.85 ng / L, there was a significant difference (all P 0.01). TNF- 伪 was in grade 1 of hypertension. The contents of grade 2 and grade 3 were 47.00 卤5.46 ng / L, 55.19 卤9.75 ng / L and 69.08 卤8.83 ng / L, respectively. [There was a significant difference in serum HMW-ADP level in grade 1 of hypertension (P 0.01g / L, P < 0.01), compared with 37.39 卤3.65 ng / L (P < 0.05). Grade 2 and grade 3 patients were 7.48 卤1.33 mg / L and 5.48 卤1.21 mg / L, respectively, and 3.44 卤1.04 mg / L, respectively, as compared with the normal group. [Compared with 11.36 卤3.20 mg / L, there was a significant difference (all P 0.01). Pearson correlation analysis showed that there were significant differences in all the subjects. There was a negative correlation between serum TLR4 and HMW-ADP expression (r = -0.782, P 0.05). There was a positive correlation between CRP and BMIand CRP and BMI. the r values were 0.721 and 0.721, respectively. Multiple regression analysis and logistic regression analysis showed that in patients with hypertension. The mean arterial pressure B values of serum TLR4 and HMW-ADP were 0.408 and -2.51, respectively. The OR of the independent influencing factors of target organ damage were 1.335 and 0.717, respectively. The area under the ROC curve for predicting target organ damage and clinical status was 0.95. Multiple regression analysis showed that the area under the curve was 0. 88 higher than that of TLR4 alone and the area under the curve of HMW-ADP was 0. 83 (all P 0. 05). TLR4 was the only common influencing factor in patients with different antihypertensive drugs after 6 months. Conclusion: 1. In hypertensive patients, TLR4 is the only common influencing factor for blood pressure control after 6 months. Conclusion: TLR4 is the only common factor in patients with different antihypertensive drugs (P 鈮，

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