血压晨峰对老年高血压合并冠心病病人外周血核因子 -κB、金属蛋白酶 -9的影响及其相关性研究

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The Influence of Morning Blood Pressure Surge on Peripheral Blood NF -κB and MMP -9 Levels in Elderly Patients with Hypertension and Coronary Heart Disease and Its Correlation

Li Yu,Li Rong,Qiu Qingyan

Mianyang Center Hospital,Mianyang 621000,Sichuan,China

Abstract:Objective To investigate the influence of morning blood pressure surge(MBPS) on peripheral blood mononuclear cell nuclear factor -κB (NF -κB) and serum matrix metalloproteinase 9 (MMP -9) levels in elderly patients with hypertension and coronary heart disease (CHD).Methods One hundred elderly patients with hypertension and CHD were enrolled,including 58 cases in MBPS group and 42 cases in non MBPS group.The activation rate of NF -κB was detected by immunohistochemistry.Serum MMP -9 level was determined by enzyme -linked immunosorbent assay.The carotid vascular atherosclerosis was detected by vascular ultrasound.The coronary angiography was used to assess the degree of coronary artery stenosis.Results The serum MMP -9 level and activation rate of mononuclear cell NF -κB in MBPS group was significantly higher than that in non - MBPS group.The intima -media thickness of the common carotid artery in MBPS group was significantly thicker than that in the non -MBPS group,and the degree of coronary artery stenosis was aggravated.Serum MMP -9 levels were positively correlated with the activation rate of mononuclear cells NF -κB in elderly patients with hypertension and CHD.The serum MMP -9 level and activation rate of NF -κB in peripheral blood mononuclear cells were positively correlated with the intima -media thickness of carotid artery,carotid atheromatous plaque scores and and degree of coronary artery stenosis.Conclusion The MBPS may up -regulate the levels of serum MMP -9 and activation rate of mononuclear cells NF -κB,and aggravate the degree of atherosclerosis in patients with hypertension and CHD.Adjusting the antihypertensive drugs and controlling the degree of MBPS can reduce the target -organ damage in patients with hypertension and CHD.

Keywords: hypertension;coronary heart disease;MBPS;atherosclerosis;nuclear factor -κB;matrix metalloproteinase

血压晨峰(morning blood pressure surge，MBPS)是指清晨人体由睡眠状态转为清醒并开始活动，血压从夜间睡眠时相对较低的水平迅速上升至较高水平，甚至达到一天中最高水平的现象。近年来在高血压研究领域中血压晨峰受到越来越多的关注，血压的昼夜变异性和波动幅度对靶器官损害及其相关分子机制方面的研究是目前高血压研究的热点。国内外大量实验研究证实血压晨峰作为心脑血管病的发病及预后的独立危险因素，是使高血压疾病进展进而引起靶器官损害的机制之一[1]。近年来，高血压与炎症反应之间的关系已非常明确，潜在的慢性低度炎症反应是高血压血管损伤的关键环节，加速了血管硬化的进程[2]。核因子 -κB (nuclear factor -κB，NF -κB)是非常重要的免疫、炎症和应激反应的主要调控因子，参与血管炎症反应及重构。基质金属蛋白酶 -9(MMP -9)引起动脉粥样硬化斑块细胞外基质重构，特别是诱导斑块破裂，血栓形成，在急性冠脉综合征的发生发展中有重要作用。本研究通过观察血压晨峰对老年高血压合并冠心病病人外周血单个核细胞NF -κB、血清MMP -9水平的影响，及血压晨峰与病人颈动脉粥样硬化、冠状动脉病变严重程度的相关性，探讨血压晨峰现象在高血压合并冠心病病人中的作用机制及其防治措施。

1 资料与方法

1.1 研究对象 选取2014年1月—2015年12月在绵阳市中心医院住院并接受冠状动脉造影确诊的老年(年龄≥60岁)高血压合并冠心病病人100例。高血压的诊断标准参照中国高血压防治指南修订委员会制定的《中国高血压防治指南2010》[3]，收缩压(SBP)≥140 mmHg(1 mmHg=0.133 kPa)和(或)舒张压(DBP)≥90 mmHg。……