生长分化因子-15与初诊原发性高血压患者血压变异性和脂质代谢的关系

目的观察生长分化因子-15（GD-15）在体检健康者、高血压病非左室肥厚和左室肥厚患者中的变化，并探讨其与血压变异性和血脂代谢之间的关系。方法将98例初诊原发性高血压患者按左心室质量指数分为高血压非左心室肥厚组（NI，VH）60例；高血压左室肥厚组（LVH）38例。以同期年龄、性别与之匹配的体检健康者30例为对照组。观察三组受试者血清GDF-15浓度、动态血压数据以及相关脂质代谢指标。并用Pearson相关性分析高血压病患者GDF_15与血压变异性和血脂指标是否存在相关性。结果（1）GDF_15在对照组、NLVH组和LVH组中的浓度逐渐升高，且两两组间差异，经检验具有统计学意义（P〈O．01）。（2）三个组别各个时段的平均收缩压、平均舒张压和BPV相比较均具有统计学意义（P〈0．01），且LVH组〉NLVH组〉对照组，具有统计学意义（P〈0．01）。（3）三个组间的甘油三脂（TG）和高密度脂蛋白胆固醇（HDL—c）相比较，差异具统计学意义（P〈O．01或P％0．05），其中TG水平为LVH〉NI。VH〉对照组（P〈0．01或P％0．05），HDLc水平为对照组〉NLVH〉LVH（P〈0．01或P％0．05）。（4）GDF-15与舒张期室间隔厚度（LVsT）（r=0．437，P〈0．01）、左室后壁厚度（PWT）（r=0．412，P％0．01）、白昼收缩压标准差（r=0．248，P=0．037）、24小时收缩标准差（24hSsD）（r-0．284P=0．019）、夜间收缩压标准差（NssD）（r=0．372，P％0．01），甘油三酯（TG）（r=0．263，P=0．021）呈显著正相关，与高密度脂蛋白胆固醇（HDL—c）（r=0．397，P〈0．01）呈显著负相关。结论生长分化因子-15可能参与高血压患者早期的左室重构，并与部分血压变异和血脂指标具有相关性。

Relationship of growth and differentiation factor-15 with blood pressure variability and lipid metabolism in patients with newly diagnosed essential hypertension

Objective To observe the changes of growth differentiation factor-（GDF-15） in healthy subjects,hyper- tension without left ventricular hypertrophy subjects and hypertension with left ventricular hypertrophy subjects,then to investigate the relationship of GDF-15 with blood pressure variability and lipid metabolism. Methods According to the mass fraction of left Ventricular, the authors divided 98 patients with newly diagnosed hypertension into 60 cases that without left ventricular hypertrophy as a grbup （NLVH）; and 38 cases that with left ventricular hypertrophy （LVH） as a group,and took 30 cases in healthy subjects as control group. Then to observe serum concentration of GDF-15,ambulatory blood pressure data and lipid metabolism indicators in three groups. Then to analyze the 4orrela- tion of GDF-15 with blood pressure variability and serum lipids in patients with hypertension by the pearson correlation analysis. Results （1） GDF-15 were gradually increased in three groups, and the differences between two groups were statistically significant （P〈0.01）. （2）In the three groups, the mean systolic blood pressure,mean diastolic blood pres- sure and BPV in various time periods were statistically significant （P〈0. 01） ,and the LVH group〉 NLVH group〉 control group,and the differences were statistical significance （P〈0.01）. （3） The differences of triglyceride （TG） and high density lipoprotein cholesterol （HDL-C） in three groups were statistically significant （P〈0.01 or P〈0.05） ,and TG levels in LVH group〉 control group〉NLVH group （P〈0.01 or P〈0.05） ,and HDL-C level in control group〉 NLVH group〉 LVH group （P〈0. 01 or P〈0. 05）. （4） GDF-15 and diastolic interventricular septum thickness （LVST） （r=0. 437 ,P〈0.01） ,left ventricular posterior wall thickness （PWT） （r=o. 412 ,P〈0. 01） ,the standard de- viation of daytime systolic blood pressure （r=0. 248, p ： 0. 037）, 24-hour systolic blood pressure standard deviation （24SSD） （r= 0. 284, p = 0. 019）, the standard differential of nighttime systolic blood pressure （NSSD） （r= 0. 372, P〈 0.01）, triglyceride （TG） （r = 0. 263, P = 0.021 ） were significantly positively correlated , and with high-density lipo-protein cholesterol （HDL-C） （r=- 0. 397,P d0.01） was significantly negatively correlated. Conclusion The growth and di{ferentiation factor -15 may be related with early left ventricular remodeling in hypertensive patients,and has cor- relation with blood pressure variability and serum lipids.