醛固酮拮抗剂对原发性高血压免疫炎性损伤的干预研究

发布时间：2018-11-01 12:13

【摘要】：目的:探讨原发性高血压(EH)患者外周血T淋巴细胞亚群的表达与左室结构和功能的关系及醛固酮拮抗剂的干预研究。方法:选择2015年8月到2016年8月期间在我科住院的EH患者60例,其中男性37例,女性23例,年龄60~88岁,平均年龄66.8±5.6(岁),随机分为常规降压治疗30例作为常规降压治疗组(n=30例)和常规降压加螺内酯治疗30例作为螺内酯干预组(n=30例);另选同期健康体检者30例作为健康对照组(n=30例),年龄60~80岁,平均年龄64.4±5.9(岁),其中男性21例,女性9例,健康组年龄、性别与两治疗组无显著性差异(p0.05)。(1)采用EpicsXL流式细胞仪测定各组的外周血总T淋巴细胞百分比、CD3+CD4+T淋巴细胞百分比、CD3+CD8+T淋巴细胞百分比、以及CD4+/CD8+的比值;(2)应用EPIQ5彩色超声心动图测定EH患者左室结构和功能。结果:与健康对照组相比,高血压组患者外周血CD3+CD4+T淋巴细胞及CD4+/CD8+比值明显升高(P0.05),而总T淋巴细胞(CD3+)、CD3+CD8+T淋巴细胞与对照组的差异均无统计学意义(P0.05)。EH患者治疗6个月后,螺内酯干预组外周血总T淋巴细胞(CD3+)与常规降压治疗组相比没有明显差异(P0.05),螺内酯干预组CD3+CD4+T淋巴细胞、CD4+/CD8+较常规降压治疗组均明显降低(P0.05);螺内酯干预组左室后壁(LVPW)厚度、室间隔(IVS)厚度、二尖瓣血流舒张早期流速/心房收缩期流速(E/A)与常规降压组有明显差异(P0.05),左室射血分数(LVEF)两组相比无明显差异(P0.05);CD4+T淋巴细胞百分比与LVPW成正相关(r=0.52,P0.05),CD4+/CD8+与E/A成负相关(r=-0.57,P0.05)。结论:1.高血压病患者存在免疫炎性损伤2.醛固酮拮抗剂可能通过抑制血管炎症反应、调节免疫细胞亚群改善高血压患者左室结构和功能,延缓左室重塑。
[Abstract]:Aim: to investigate the relationship between the expression of T lymphocyte subsets in peripheral blood and left ventricular structure and function in patients with essential hypertension (EH) and the intervention of aldosterone antagonist. Methods: sixty patients with EH were selected from August 2015 to August 2016, including 37 males and 23 females, aged 6088 years, with an average age of 66.8 卤5.6 years. They were randomly divided into two groups: 30 cases were treated with conventional hypotension (n = 30) and 30 cases were treated with conventional hypotension plus spironolactone (n = 30). 30 healthy persons (n = 30) were selected as the healthy control group (n = 30). The average age was 64.4 卤5.9 (n = 20), including 21 males and 9 females, and the age of the healthy group. There was no significant difference between sex and treatment group (p0.05). (1). Total T lymphocyte percentage, CD3 CD4 T lymphocyte percentage, CD3 CD8 T lymphocyte percentage were measured by EpicsXL flow cytometry. And the ratio of CD4 / CD8; (2) left ventricular structure and function were measured by EPIQ5 color echocardiography in patients with EH. Results: compared with the healthy control group, CD3 CD4 T lymphocytes and CD4 / CD8 ratio in patients with hypertension were significantly increased (P0.05), while total T lymphocytes (CD3) were significantly increased. There was no significant difference between CD3 CD8 T lymphocytes and control group (P0.05). EH patients treated for 6 months, the total peripheral blood T lymphocytes (CD3) of spironolactone intervention group and routine hypotension treatment group had no significant difference (P0.05). The levels of CD3 CD4 T lymphocytes and CD4 / CD8 in the spironolactone intervention group were significantly lower than those in the conventional hypotensive treatment group (P0.05). The left ventricular posterior wall (LVPW) thickness, interventricular septal (IVS) thickness, mitral early diastolic velocity / atrial systolic velocity (E / A) in the spironolactone intervention group were significantly different from those in the conventional hypotensive group (P0.05). There was no significant difference in left ventricular ejection fraction (LVEF) between the two groups (P0.05). The percentage of CD4 T lymphocytes was positively correlated with LVPW (P 0.05), and CD4 / CD8 was negatively correlated with E / A (P 0.05). Conclusion: 1. Hypertension patients have immune inflammatory damage 2. 5%. Aldosterone antagonists may delay left ventricular remodeling by inhibiting vascular inflammation and regulating immune cell subsets to improve left ventricular structure and function in hypertensive patients.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.11

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