C反應蛋白與血壓和TCD參數(shù)的相關性

1、C反應蛋白與血壓和TCD參數(shù)的相關性         10-09-08 09:17:00     編輯：studa20                       作者：王小林張明軍 王永紅【摘要】  目的 了解C反應蛋白(CRP)與血壓和TCD之間的關系。方

2、法 從2008年體檢人群中選取1 286名調查對象，按CRP值將調查對象分為低危組(CRP<3 mg/L)936例，中危組(CRP 310 mg/L)240例和高危組(CRP>10 mg/L)110例;分析各組年齡和TCD各指標的差異，比較不同組別高血壓患者的構成比例，采用多因素Logistic回歸分析高血壓患者構成比例與不同CRP水平之間的相關性。結果 與低危組比較，高危組和中危組左側大腦中動脈和基底動脈的平均流速、舒張期流速明顯降低(P<0.05)，雙側大腦中動脈和基底動脈搏動指數(shù)、阻力指數(shù)有明顯差異(P<0.05)，患病年齡也明顯增大(P<0.05)。高危組

3、(62.73%)和中危組(50.83%)患高血壓的比例比低危組(37.82%)增加明顯，患高血壓的危險度分別是低危組的4.450倍(95%CI:2.9676.674)和2.734倍(95%CI:2.0643.621)。結論 高水平的CRP能降低大腦中動脈和基底動脈血管彈性，誘導其動脈硬化的發(fā)生。同時，人群中患高血壓的患者和風險也隨之增加。 【關鍵詞】  C反應蛋白;動脈硬化;高血壓;TCD【Abstract】 Objective To investigate the association among Creactive protein(CRP) and blood pressure

4、 and the parameters of transcranial doppler (TD). Methods The data was collected from subjects(n=1 286)for annual physical evaluations of 2008 in the Public Health Center of the First Affiliated Hospital of Chongqing Medical University in Chongqing. The datas were randomized by multistep cluster sam

5、pling methods. Subjects were divided into three groups according levels of CRP：(1) lowrisk group：all subjects (n=936) levels of CRP were below 3 mg/L (2) midrangerisk group：all subjects (n=240) levels of CRP were between 3 mg/L and 10 mg/L; (3) highrisk group：all subjects (n=110) levels of CRP were

6、more than 3 mg/L. The variables on subjects selected for this study were parameters of TD, the age of each group, proportionate of hypertension and the association between hypertension and leves of CRP were analyzed.Results The mean glow velocity, relaxing period velocity, pulsatility index and resi

7、stent index were significantly lower in highrisk group and midrangerisk group); the age of those groups was obviously older compared with those in lowrisk group. The proportions of hypertension were significantly higher in highrisk group(62.73%) and midrangerisk group(50.83%) compared to lowrisk gro

8、up(37.82%).The probabilities of hypertension in highrisk group(OR=4.450 CI:2.9676.674) and midrangerisk group(OR=2.734 CI:2.0643.621) were higher than that of lowrisk group. Conclusions High level of CRP can cut down the elasticity of middle cerebral artery and basilar artery, induce the appearance

9、of arteriosclerosis in both arteries. High level of CRP also can improve the risk of hypertension.【Key words】 Creactive protein; Arteriosclerosis; Hypertension; Transcranial Doppler流行病學研究顯示，健康人群中C反應蛋白(CRP)濃度的升高同其后發(fā)生冠心病、腦血管病和周圍動脈疾病等事件的危險性呈正相關。其中，非特異性炎癥反應可能在原發(fā)性高血壓的發(fā)生、發(fā)展過程中起重要作用。 研究表明，CRP雖然是炎性標志物，但血清中高

10、水平的CRP為高血壓和動脈硬化的獨立危險因素1，2。但現(xiàn)在關于CRP與血壓和腦動脈之間關系的研究還比較少。TCD是一種無創(chuàng)性檢測顱底大動脈血流動力學的診斷技術，通過檢測顱底動脈的血流方向、血流速度、頻譜形態(tài)、音頻特點等能較準確地反映腦動脈的狹窄、痙攣、缺血等病理狀態(tài)。因此本研究主要探討CRP與血壓和顱底大動脈血流動力學的關系。1 對象與方法1.1 對象 均為2008年1月1日至2008年12月31日在重慶醫(yī)科大學附屬第一醫(yī)院體檢中心進行健康體檢者，隨機分層選取進行了CRP和TCD檢查的體檢人群1 286例。根據(jù)報道CHS試驗10年隨訪中CRP>10 mg/L的老年人發(fā)生冠心病的危險性比C

11、RP<3 mg/L者增加了1.8倍3，因此本文按CRP值將調查對象分為低危組(CRP<3 mg/L)936例，中危組(CRP 310 mg/L)240例、高危組(CRP>10 mg/L)110例。年齡(46.57±11.87)歲。1.2 方法與儀器1.3 統(tǒng)計學分析 計量資料以x±s表示，計數(shù)資料以%表示，各組間收縮期血流速度、舒張期血流速度、平均血流速度、搏動指數(shù)和阻力指數(shù)的比較采用單因素方差分析檢驗，組間比較采用StudentNewmanKeuls檢驗;高血壓患者隨CRP增加而變化的趨勢分析用趨勢2檢驗;多因素Logistic回歸分析高血壓和CRP的相關性;數(shù)據(jù)分析采用SAS9.1統(tǒng)計軟件。2 結 果2.1 各組間年齡的比較 隨著危險度的增加，低危組(50.59±12.89)、中危組(53.48±13.96)、高危組(56.77±13.48)三組年齡顯著增加(F=13.72，P<0.01)。2.2 各組高血壓發(fā)生比例的多元Logistic回歸分析 高危組和中危組血壓偏高患者的比例明顯增高(P&