H型高血压伴冠心病患者CRP VCAM-1 NHR 脂代谢特点及与心功能不全的相关性

doi:10.3969/j.issn.1006-6233.2023.04.021

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摘要 目的: 探讨H型高血压伴冠心病患者C反应蛋白(CRP)、血管内皮黏附分子-1(VCAM-1)、中性粒细胞/高密度脂蛋白胆固醇比值(NHR)、脂代谢特点及与心功能不全的相关性。方法: 选取2020年1月至2022年1月在我院治疗的高血压伴冠心病患者104例,其中H型高血压伴冠心病患者49例(观察组),非H型高血压伴冠心病患者55例(对照组),比较两组血清CRP、VCAM-1、NHR、脂代谢指标及心功能分级等,同时分析不同心功能分级患者相关指标差异。结果: 观察组血清CRP、VCAM-1和NHR分别为(5.15±1.03)mg/L、(780.05±81.16)ng/mL和(5.05±0.79),明显高于对照组(P<0.05),而高密度脂蛋白胆固醇(HDL-C)、载脂蛋白AI(APOAI)分别为(1.03±0.24)mmoL/L和(0.66±0.29)g/L,明显低于对照组(P<0.05)。观察组NYHA分级Ⅲ~Ⅳ级比例、左室舒张末期内径(LVDd)、左心房内径(LAD)和Gensini评分分别为61.22%、(4.66±0.40)cm、(4.66±0.40)cm、(4.01±0.39)cm和(52.26±13.35)分,明显高于对照组(P<0.05),而左心室射血分数(LVEF)为(52.64±5.16)%,明显低于对照组(P<0.05)。观察组心功能Ⅲ~Ⅳ级患者CRP、VCAM-1、NHR和Gensini评分分别为(5.32±0.72)mg/L、(804.69±69.50)ng/mL、(5.30±0.90)和(55.15±9.31)分,明显高于Ⅰ~Ⅱ级患者(P<0.05),而HDL-C和LVEF分别为(0.97±0.23)mmoL/L和(51.52±4.60)%,明显低于Ⅰ~Ⅱ级患者(P<0.05)。NYHA分级与CRP、VCAM-1和NHR呈正相关(P<0.05),而与HDL-C呈负相关(P<0.05);Gensini评分与NHR呈正相关(P<0.05),而与HDL-C呈负相关(P<0.05)。结论: H型高血压伴冠心病患者CRP、VCAM-1、NHR水平升高,三者与患者心功能分级及冠脉严重程度呈正相关。

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关键词 ： H型高血压, 冠心病, C反应蛋白, 血管内皮黏附分子-1, 中性粒细胞/高密度脂蛋白胆固醇比值, 脂代谢, 心功能分级

Abstract：Objective: To investigate the correlation between C-reactive protein (CRP), vascular endothelial adhesion molecule-1 (VCAM-1), neutrophil/HDL cholesterol ratio (NHR), lipid metabolism characteristics and with cardiac insufficiency in patients with H-type hypertension with coronary artery disease. Methods: 104 patients with hypertension complicated with coronary artery disease treated in our hospital from January 2020 to January 2022 were selected, including 49 patients with H-type hypertension complicated with coronary artery disease (observation group) and 55 patients with non-H-type hypertension complicated with coronary artery disease (control group), the serum CRP, VCAM-1, NHR, lipid metabolism indexes and cardiac function grades of the two groups were compared, and the differences in relevant indexes of patients with different cardiac functional grades were analyzed at the same time. Results: Compared with the control group, serum CRP, VCAM-1 and NHR of the observation group were higher [(5.15±1.03) mg/L, (780.05±81.16) ng/ml and (5.05±0.79) ng/ml)](P<0.05), while the high-density lipoprotein cholesterol (HDL-C) and apolipoprotein AI (APOAI) were lower [(1.03 ± 0.24) mmol/l and (0.66±0.29) g/L](P<0.05). Compared with the control group, the NYHA grade III ~ IV ratio, left ventricular end diastolic diameter (LVDD), left atrial diameter (LAD) and Gensini score in the observation group were higher [61.22%, (4.66±0.40) cm, (4.66±0.40) cm, (4.01±0.39) cm and (52.26±13.35) points](P<0.05), while the left ventricular ejection fraction (LVEF) was lower [(52.64±5.16)%](P<0.05). The scores of CRP, VCAM-1, NHR and Gensini in patients with grade III ~ IV cardiac function in the observation group were (5.32±0.72) mg/L, (804.69 ± 69.50) ng/ml, (5.30±0.90) and (55.15±9.31) respectively, which were significantly higher than those in patients with grade I ~ II (P<0.05), while HDL-C and LVEF were (0.97±0.23) mmol/l and (51.52±4.60)% respectively, which were significantly lower than those in patients with grade I ~ II (P<0.05). NYHA grade was positively correlated with CRP, VCAM-1 and NHR (P<0.05), but negatively correlated with HDL-C (P<0.05). Gensini score was positively correlated with NHR (P<0.05), but negatively correlated with HDL-C (P<0.05). Conclusion: The levels of CRP, VCAM-1 and NHR in patients with H-type hypertension complicated with coronary artery disease increase, the three factors are positively correlated with cardiac function grade and coronary severity.

Key words： H-type hypertension Coronary heart disease C-reactive protein Vascular endothelial adhesion molecule-1 Neutrophil / high density lipoprotein cholesterol ratio Lipid metabolism Cardiac function classification

基金资助:甘肃省科技计划项目,(编号:21YF5FA167)

引用本文:

金玉霞, 马莉, 李青青, 陶宇佳, 高亚兰. H型高血压伴冠心病患者CRP VCAM-1 NHR 脂代谢特点及与心功能不全的相关性[J]. 河北医学, 2023, 29(4): 630-636.
JIN Yuxia, MA Li, LI Qingqing, et al. Characteristics of CRP VCAM-1 NHR Lipid Metabolism and Their Correlation with Cardiac Insufficiency in Patients with H-Type Hypertension Complicated with Coronary Artery Disease. HeBei Med, 2023, 29(4): 630-636.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2023.04.021 或 http://www.hbyxzzs.cn/CN/Y2023/V29/I4/630

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