替米沙坦对原发性高血压血小板功能的影响

目的 观察替米沙坦对原发性高血压(EH)的疗效及血小板功能的变化.方法 EH患者(EH组)40例,口服替米沙坦80 mg/d,共16周.比较用药前后24 h动态血压、血小板最大聚集率(PAGTmax)、血小板α颗粒膜蛋白(GMP-140)含量的变化,并与健康者(对照组)35例比较.结果 EH患者PAGTmax、血小板GMP-140含量较对照组明显增加(P＜0.01).应用替米沙坦后,24 h平均血压值降低,同时PAGTmax、血小板GMP-140含量均较治疗前明显下降(P＜0.01),与对照组相比,差异有统计学意义(P＜0.05).结论 原发性高血压存在血小板活性增强,替米沙坦在有效降低血压同时能抑制血小板活化.     

替米沙坦对原发性高血压血小板功能的影响

目的观察替米沙坦对原发性高血压（EH）的疗效及血小板功能的变化。方法EH患者（EH组）40例，口服替米沙坦80mg／d，共16周。比较用药前后24h动态血压、血小板最大聚集率（PAGTmax）、血小板α颗粒膜蛋白（GMP-140）含量的变化，并与健康者（对照组）35例比较。结果EH患者PAGTmax、血小板GMP-140含量较对照组明显增加（P〈0．01）。应用替米沙坦后，24h平均血压值降低，同时PAGTmax、血小板GMP-140含量均较治疗前明显下降（P〈0．01），与对照组相比，差异有统计学意义（P〈0．05）。结论原发性高血压存在血小板活性增强，替米沙坦在有效降低血压同时能抑制血小板活化。     

隐性高血压及白大衣性高血压患者的心率震荡现象

目的探讨隐性高血压(MH)及白大衣性高血压(WCH)患者的窦性心率震荡(HRT)变化及临床意义。方法选择原发性高血压(EH)患者32例(EH组)、MH患者26例(MH组)、WCH患者29例(WCH组)、正常血压者30例(NT组)。根据24 h动态心电图分别计算各组HRT的两个参数初始震荡(TO)与震荡斜率(TS),比较各组之间的差异。结果 EH组、MH组及WCH组较NT组TO增大、TS降低(P均<0.01),TO、TS异常发生率明显增高(P均<0.01);而EH组、MH组及WCH组三组间比较差异无统计学意义(P均>0.05)。结论 MH、WCH、EH患者的HRT均明显减弱,提示MH、WCH与EH患者一样存在自主神经损害,可能对预后有重要影响。     

血小板膜糖蛋白Ⅰa基因多态性与冠状动脉介入治疗术后血小板功能变化关系的探讨

目的探讨经皮冠状动脉介入术(PCI)后血小板功能变化与血小板膜糖蛋白Ⅰa基因807C/T多态性的关系。方法对佳木斯大学附属第一医院2003—2004年46例行PCI的冠心病患者分别于术前、术后即刻、术后24h肘静脉采血,测定血浆中GMP-140、vWF浓度和PAI-1的活性;应用引物序列特异性聚合酶链反应(PCR-SSP)的方法确定基因型,对不同基因型患者冠脉介入术前、术后血小板功能指标的变化情况进行对比观察。结果血小板膜糖蛋白Ⅰa基因为TC基因型25例(占54.35%),CC基因型21例(占45.65%),无TT基因型。2组患者血浆中GMP-140、vWF含量和PAI-1活性在术前无差异(P>0.05);2组患者血浆中GMP-140含量在术后即刻较术前有显著增高,术后24h有所下降,但仍高于术前,TC组增高程度显著高于CC组(P<0.05);2组患者血浆中vWF含量在术后即刻较术前有增高趋势,但均无显著变化,24h后均有显著增高(P<0.05),2组增高程度无差异。2组患者血浆中PAI-1活性术后即刻较术前有显著增高,术后24h增高更为明显,且TC组增高程度显著高于CC组(P<0.01)。结论血小板GPⅠa基因TC基因型患者在PCI术后较CC基因型患者存在更加显著的血小板活化和纤溶功能的改变,提示血小板GPⅠaT等位基因可能是经皮冠状动脉介入术后急性与亚急性冠状动脉血栓形成的一个危险因素。     

原发性高血压血栓前状态标志物变化及其意义

目的探讨血栓前状态(PTS)在原发性高血压(EH)患者的作用和意义.方法使用酶联免疫吸附法和凝固法测量59例EH患者(EH组)和20例正常 者(对照组)外周血浆因子Ⅷ相关抗原(vWFAg)、血小板a颗粒膜蛋白-140(GMP-140) 、D-二聚体(D-dimer)和纤维蛋白原(Fg)的水平变化.并对不同分级或分层的EH患者 的上述指标进行比较.结果与对照组相比,EH组血浆vWFAg、GMP-140、D-dimer、Fg水平均 显著升高(P<0.05).2、3级高血压或中危、高危、极高危EH患者上述指标与正常 者、1级或低危EH患者相比均显著升高(P<0.05,<0.01),而1级或低危EH患 者与正常者相比上述指标无显著意义的升高(P>0.05).结论EH患者存在PTS,PTS与血压水平和危险因素有关.     

高血压患者动态血压与血浆神经肽Y、神经降压素水平的相关性

目的:测定高血压病患者血浆神经肽Y(N europeptide Y,NPY)、神经降压素(N eurotens in,NT)的含量并分析其与24 h动态血压的相关性。方法:对57例高血压病患者进行24 h动态血压监测,并用放射免疫分析法检测患者血浆NPY、NT浓度,同时检测28例健康对照者的血浆NPY、NT浓度。结果:高血压患者血浆NPY水平显著高于正常对照组(P<0.01),而NT水平低于对照组(P<0.01)。高血压患者血浆NPY水平与24 h平均收缩压、平均舒张压、平均动脉压,白昼收缩压、舒张压、平均动脉压,夜间收缩压、舒张压、平均动脉压均呈显著正相关(r=0.44~0.81,P<0.01)。血浆NT水平与24 h平均收缩压、白昼收缩压、夜间收缩压、夜间平均动脉压呈显著负相关关系(r=-0.34~-0.47,P<0.01),与24 h平均动脉压、白昼平均动脉压呈负相关关系(r=-0.31,-0.30,P<0.05)。高血压病患者血浆NPY水平与NT水平呈显著负相关(r=-0.45,P<0.01)。结论:高血压病患者血压水平与血浆NPY、NT水平显著相关,NPY、NT可能参与了高血压病的发病过程。     

培哚普利、非洛地平缓释片对老年原发性高血压患者血小板活化及纤溶活性的影响

目的:探讨培哚普利及非洛地平缓释片对老年原发性高血压(EH)患者血小板活化及纤溶活性的影响.方法:采用放射免疫法及发色底物法测定55例老年Ⅰ、Ⅱ期EH患者分别应用培哚普利(Ⅰ组28例)及非洛地平缓释片(Ⅱ组27例)治疗前后活化血小板α颗粒膜蛋白(GMP-140)、组织型纤溶酶原激活剂(t-PA)及其抑制物(PAI-1)、血管紧张素Ⅱ(AngⅡ)及醛固酮(Ald)水平.结果:治疗后,两组患者GMP-140含量及PAI-1活性均显著下降(P分别＜0.01,0.05),t-PA活性显著升高(P＜0.05);Ⅰ组患者AngⅡ及Ald显著下降(P＜0.01),Ⅱ组患者AngⅡ及Ald未见明显变化(P＞0.05).治疗前,55例EH患者GMP-140含量与PAI-1水平呈显著正相关(r=0.407 6,P＜0.01),二者与AngⅡ水平均呈显著正相关(r=0.416 2,0.4237,P＜0.01).结论:以上结果提示,培哚普利降低体内AngⅡ水平是其抑制老年EH患者血小板活化、改善纤溶活性的机制之一,而非洛地平缓释片抑制血小板活化、改善纤溶活性的作用与肾素-血管紧张素系统无关.     

老年高血压病患者血vWF、GMP-140、CRP含量的研究

目的 :研究老年高血压病 (EH)患者的血管内皮细胞损伤、血小板活化和炎症因子改变。方法 :选择 31例 、 期 EH患者和 2 8例老年正常对照者 ,测定其血浆 v WF因子、α颗粒膜蛋白 - 140 (GMP- 140 )和血清 C反应蛋白 (CRP)含量。结果 :EH组患者血浆 v WF、GMP- 140含量明显高于对照组 ;EH组血浆 v WF含量与收缩压呈正相关。结论 : 、 期老年 EH患者有明显的内皮细胞损伤和血小板活化 ,血管内皮细胞损伤与收缩压呈正相关。     

Lipo-PGE1对心脏瓣膜置换术围体外循环期血小板功能的影响

目的 探讨前列腺素E1脂微球载体制剂(Lipo-PGE1)对围体外循环(CPB)期血小板功能的影响.方法 选择20例择期CPB下行心脏瓣膜置换术的患者,随机分为两组.观察组于麻醉诱导后至CPB结束匀速泵入Lipo-PGE1,速度为10 ng/(kg·min),预充液中加入10 ng/ml Lipo-PGE1;对照组给予相同容量的生理盐水.于诱导后即刻(T1),CPB开始30 min(T2),CPB结束即刻(T3),CPB后1 h(T4)、2 h(T5)、24 h(T6)分别采集外周动脉血测定血浆α-颗粒膜蛋白-140(GMP-140)、血小板最大聚集率(MAR)及血小板计数(PLT).结果 CPB开始至CPB结束后早期两组MAR均显著下降而GMP-140水平显著升高,观察组MAR及GMP-140水平均明显低于对照组(P<0.05),并于CPB结束后24 h均恢复至术前水平;CPB开始至CPB结束后24 h两组PLT均较术前明显下降(P<0.01),对照组下降更明显,但无统计学差异(P>0.05).结论 Lipo-PGE1在CPB过程中能有效减少血小板激活,保护血小板功能.     

原发性高血压患者平均血小板体积的变化及其与左心室肥厚的关系

目的研究原发性高血压(EH)患者平均血小板体积(MPV)的变化,探讨MPV与EH以及左心室肥厚(LVH)的关系。方法回顾性分析2013年1月至2016年12月住院的EH患者189例,以同期体检的正常血压者132名为对照组。EH患者按左心室是否肥厚分为左心室正常组(NLVH组,n=75)和左心室肥厚组(LVH组,n=114)。双变量相关分析MPV与其他指标的相关性。多因素logistic回归探讨MPV与EH及LVH的关系。结果 EH患者LVH组及NLVH组的MPV高于对照组[(9.2±1.0),(8.8±1.1)比(8.2±0.7)fL,均P0.05],LVH组的MPV高于NLVH组。Pearson相关分析显示,在对照组中,MPV与血小板计数呈负相关(r=-0.348,P0.05),在EH组中,MPV与舒张压、左心室质量指数(LVMI)呈正相关(r=0.225、0.148,P0.05);与血小板计数呈负相关(r=-0.199,P0.05)。多因素logistic回归分析显示,在校正性别、年龄、血小板计数等因素后,MPV是EH的相关因素,与MPV低值组(MPV8.5 fL)相比,MPV高值组(MPV≥8.5 fL)发生EH的OR值(95%CI)为3.500(1.992～6.149)。同时MPV也是影响LVH发生的相关因素,与MPV低值组(MPV8.8 fL)相比,MPV高值组(MPV≥8.8 fL)发生LVH的OR值(95%CI)为2.036(1.104～3.757)。结论 EH患者MPV升高,MPV可能与EH及LVH有关。     

The mean platelet volume in patients with essential and white coat hypertension

Mean platelet volume (MPV), a determinant of platelet function, is a newly emerging risk factor for atherothrombosis. The risk profile of white coat hypertension has not yet been completely clear. The present study was designed to evaluate MPV in white coat hypertensive subjects compared with essential hypertensive patients and normotensive subjects. We selected 36 essential hypertensive patients, 36 white coat hypertensive subjects and 36 normotensive control subjects matched for age, gender, and body mass index. MPV was very significantly higher in essential hypertensives and white coat hypertensives than in normotensives (P < 0.00); it was also higher in essential hypertensives than in white coat hypertensives (P < 0.05). Platelet counts were not different among the study groups (P > 0.05). MPV was positively correlated with ambulatory diastolic blood pressure in essential hypertension and white coat hypertension groups (P < 0.05). In conclusion, our data suggests one possible mechanism by which white coat hypertensive subjects may be at increased cardiovascular risk.     

Target organ effects in untreated hypertension

The parallel investigation of the renal and cardiac complications of recent and never treated systemic hypertension has only rarely been undertaken. The aim of this study was to define the renal function of never treated hypertensive subjects, separated into white coat hypertensives (HTbb: n = 19, BP at consultation 153/97 mmHg) or permanent hypertensives (HT: n = 49, BP at consultation 169/104 mmHg) as a function of their 24 hour BP. Their renal functions were then compared with those of normotensive subjects (NT: n = 10). The 68 hypertensive subjects seen consecutively underwent renal function investigation (DFG: glomerular filtration rate, DPR: renal plasmatic debit, and muAlb: microalbuminuria over 24 hours), and myocardial echography (measurement of the left ventricular mass index, IMVG). The white coat hypertensives had a normal renal function, while the permanent hypertensives had a significant decrease in DPR and a significantly higher muAlb compared to the normotensives. Compared to the white coat hypertensives, the permanent hypertensives had a significantly lower DFG and DPR, as well as a higher muAlb and IMVG. In all the hypertensives (white coat and permanent) the 24 hour systolic BP was significantly correlated with muAlb (r = 0.51, p < 0.001), filtration fraction (r = 0.30, p < 0.05), and IMVG (r = 0.52, p < 0.001). The renal and myocardial parameters were not significantly correlated. In conclusion, there seems to be a continuum between the level of ambulatory BP and the effect on target organs without a parallel progression of the renal and myocardial effects. From a practical point of view, only ambulatory BP measurement allows differentiation of permanent hypertensives who have a very early renal and/or myocardial effect, while white coat hypertensives are spared.     

白大衣高血压血管紧张素转换酶基因多态性分析

目的：研究白大衣高血压与血管紧张素转换酶（angiotensin converting enzyme，ACE）基因I／D多态性的关系。方法：应用多聚酶链式反应（PCR）方法对白大衣高血压，高血压病Ⅰ级患者和正常血压者各30例进行ACE I／D基因型检测，并分析比较。结果：白大衣高血压和高血压病Ⅰ级组Ⅱ基因型低于正常组（P〈0．01），白大衣高血压和高血压病Ⅰ级组DD基因型高于正常组（P〈0．01），白大衣高血压ID基因型显著高于高血压病Ⅰ级组和正常组（P〈0．01）。高血压病Ⅰ级组ID基因型低于正常组（P〈0．01）。结论：白大衣高血压与ACE基因多态性有关，ID基因型者易患白大衣高血压。     

White coat hypertension is a cardiovascular risk factor: a 10-year follow-up study

The objective of this paper was to evaluate the cardiovascular risk in white coat hypertension (WCH). WCH is a well-known clinical entity defined by persistently elevated blood pressure (BP) in the doctor's office, whereas BP in other conditions is normal. The prognosis of WCH is unsettled, although two prospective studies that include normal control groups imply that the condition is benign. This study is a 10-year follow-up study on 420 patients with grade I-II hypertension newly diagnosed by their general practitioner and 146 normal controls (NTs). Ambulatory blood pressure (ABP) monitoring was performed at baseline. With our protocollated cutoff value of daytime-ABP <135/90 mmHg, 76 (18.1%) of the 420 hypertensives were white coat hypertensives (WCHs) and 344 were established hypertensives (EHs). With a lower cutoff of 135/85 mmHg, 40 (9.5%) were WCHs. Complete follow-up data were obtained for all 566 subjects. The mean duration of follow-up was 10.2 years (range 9.0-12.5). In the WCH group, 14 first events were recorded (18.4%) consisting of two cardiovascular deaths and 12 nonfatal cardiovascular events. In the EH group, the corresponding number of events were 56 first events (16.3%), 12 cardiovascular deaths and 44 nonfatal cardiovascular events, and in the NT group 10 first events (6.8%), two cardiovascular deaths and eight nonfatal cardiovascular events. The event rate was similar in the WCH group and the EH group and significantly lower in the NT group (P<0.05). When corrected for daytime-ABP, age and other confounders, the difference remained statistically significant. When using the lower cutoff of 135/85 mmHg, WCH was still associated with a significantly higher cardiovascular event rate. In conclusion, the main finding of this 10-year follow-up study is an increased cardiovascular risk in WCH compared to normotensive controls.     

左室肥厚与单纯收缩,舒张或双期血压增高的关系

目的研究高血压病患者单纯收缩期（ＩＳＨ）、单纯舒张期（ＩＤＨ）或双相高血压（ＴＨ）上左室肥厚的关系。方法根据２４小时动态血压将病人分为４组：１．对照组（ｎ＝２７）平均收缩压＜１４０ｍｍＨｇ，平均舒张压＜９０ｍｍＨｇ；２．ＩＳＨ组（ｎ＝１６）平均收缩压＞１４０ｍｍＨｇ，平均舒张压＜９０ｍｍＨｇ；３．ＩＤＨ组（ｎ＝３１）平均收缩压＜１４０ｍｍＨｇ，平均舒张＞９０ｍｍＨｇ；４．ＴＨ组（ｎ＝１９）平均收缩压＞１４０ｍｍＨｇ和平均舒张压＞９０ｍｍＨｇ。超声心动图检测或计算舒张末期左室内径（ＥＤＤ）、室间隔及左室后壁厚度（ＬＶＳＴ，ＬＶＰＷＴ）、左室重量指数（ＬＶＭＩ）。结果ＩＳＨ、ＩＤＨ及ＴＨ组ＬＶＭＩ明显大于对照组Ｐ＜０．００１。ＩＳＨ和ＩＤＨ间、ＩＤＨ和ＴＨ组间无明显统计学差异。结论２４小时动态血压监测诊断为高血压病的患者ＬＶＭＩ明显大于偶测血压增高者。双期血压均高者左室肥厚最重。     

Characteristics of white coat hypertension in Chinese Han patients with type 2 diabetes mellitus

Objectives: This study documented the prevalence and clinical features of white coat hypertension (WCH) among Chinese Han patients with type 2 diabetes mellitus (T₂DM). Methods: Clinic and ambulatory blood pressure (BP) measurements were compared in 856 patients with T₂DM to determine the frequency of WCH (WCH was defined as clinical blood pressure ≥140/90?mmHg and daytime blood pressure <135/85?mmHg and/or 24-h ambulatory BP (ABP) mean value of <130/80?mmHg on ambulatory BP monitoring (ABPM). Weight, waist circumference (WC), body mass index (BMI), waist to height ratio (WHtR), fasting blood glucose, glycosylated hemoglobin level and circadian BP patterns were also measured to find clinical features predictive of WCH in T₂DM. Results: The prevalence of WCH was 7.36% (63/856) in the overall population, 6.13% (29/473) in male and 8.88% (34/383) in female (p?2DM, male WC were independent protective factors, whereas female sex, smoking and alcohol consumption were independent risk factors for WCH in T₂DM. Non-dippers and reverse dippers made up larger proportion of the WCH group (p?Conclusion: WCH is relatively common among T₂DM patients, it is a unique condition distinct from essential hypertension (EH), and WCH patients also exhibit significant differences in clinical parameters.     

血小板活化在高血压病中的临床意义

采用放免法测定36例高血压病患者和20例正常人血小板膜表面α-颗粒膜蛋白（GMP－140）分子数。结果显示，高血压病患者血小板膜表面GMP－140分子数显著高于正常组，且其含量与舒张压正相关（r＝0．6512，P＜0．01），而与高血压病分期无关。10例高血压病患者经降压药治疗后，血小板膜表面GMP－140分子数随血压下降而显著减少。提示血小板活化可能参与高血压病的病理生理过程。     

White coat effect in treated and untreated patients with high office blood pressure. Relationship with pulse wave velocity and left ventricular mass index.

OBJECTIVE: To evaluate in hypertensive patients whether the white coat effect is associated with target-organ damage and whether it is modified by anti-hypertensive therapy. METHODS: In a cross-sectional study we evaluated blood pressure (BP) measured in the office and by 24-h ambulatory blood pressure monitoring (ABPM), carotid-femoral pulse wave velocity (PWV) as an index of aortic stiffness, and left ventricular mass index (LVMI) in 88 subjects (aged 49 +/- 2 years) with white-coat hypertension (WCH, office BP > 140/90, daytime BP < 130/84 mmHg), 31 under antihypertensive therapy, 57 untreated, and in 115 patients with office and ambulatory hypertension (HT, aged 51 +/- 2 years, office BP > 140/90, daytime BP > 135/85), 65 under antihypertensive therapy, 50 untreated. In a longitudinal study in 15 patients with HT and in 11 patients with WCH we evaluated the influence of antihypertensive therapy (> 6 months) on office and ambulatory BP and on PWV. RESULTS: The intensity of the white coat effect (office BP-daytime BP) was greater in WCH than in HT. Taking all subjects, the white coat effect did not correlate with PWV (r = 0.08, ns) or with LVMI (r = 0.01, ns), whereas daytime BP correlated significantly with PWV (r = 0.41, p < 0.01) and with LVMI (r = 0.32, p < 0.05). WCH subjects showed lower PWV and LVMI than HT subjects. Treated and untreated WCH, with similar office and daytime BP, showed similar values of PWV and LVMI. Treated and untreated HT showed similar office BP values but treated HT showed lower daytime BP and PWV values. In the longitudinal study, antihypertensive therapy significantly reduced daytime BP and PWV values in the 15 HTs, whereas in the 11 WCH it did not alter daytime BP or PWV values. CONCLUSIONS: 1. In both WCH and HT (treated and untreated) the intensity of the white coat effect does not reflect either the severity of hypertension measured by target organ damage or the efficacy of antihypertensive treatment. 2. In WCH antihypertensive therapy does not improve either ambulatory BP values or damage to target organs.     

老年白大衣高血压与持续性高血压、正常血压人群基本情况比较

目的通过对老年白大衣高血压患者与持续性高血压、正常血压者基本代谢情况的比较,探讨三组人群代谢特点及差异,同时探讨三者在心血管疾病危险因素方面的差异。方法根据详细的询问病史、体格检查及血脂、肾功能等生化指标检测,分析三组人群之间的差异。结果1.三组病例基本生化指标无明显差异(P>0.05)。2.白大衣高血压组超重和高脂血症现象普遍存在,与正常血压组存在显著差异(P<0.05);白大衣高血压组中存在不良生活习惯发生率高于正常血压组和持续性高血压组。3.脑卒中发生率白大衣高血压组与正常血压组相近,而持续性高血压组的发生率是白大衣高血压的3.5倍。结论根据有限的观察病例数,较正常血压组和持续性高血压组,老年白大衣高血压不良生活习惯发生率、超重和高脂血症率均高,但脑卒中发生率明显低于持续性高血压组。     

Diagnosis of white coat hypertension by ambulatory blood pressure monitoring.

White coat hypertension (WCH) is common in referred hypertensive patients. Ambulatory blood pressure monitoring (ABPM) is not free from the white coat syndrome. We examined the use of the elevation of the first and last measurements of ABPM for diagnosis of WCH in a hypertensive population that had been referred to a hospital-based hypertension unit. Data were obtained on 1350 patients for clinic and ABPM parameters. WCH, as diagnosed by conventional clinic blood pressure (BP) measurement, was compared with a variety of alternative methods determined from ABPM. In all cases, mean daytime pressure was <135 mm Hg/85 mm Hg with an elevation of clinic BP >/=140 mm Hg systolic or 90 mm Hg diastolic. The definitions tested for this elevation were first hour mean pressure, first reading, maximum reading in first hour, last hour mean pressure, last reading, maximum reading in the last hour and maximum reading in first or last hour. Elevation of the maximum pressure in the first hour or last hour above 140 mm Hg systolic or 90 mm Hg diastolic showed a high level of agreement (kappa=0.91) with classical WCH for diagnosis of the white coat syndrome. Termed ambulatory white coat hypertension, patients with this finding were older than classic white coat patients and had higher daytime (127+/-6/78+/-5 mm Hg versus 121+/-5.5/74+/-6 mm Hg, P<0.005 for systolic and diastolic) and nighttime (114+/-11/67+/-8 mm Hg versus 106+/-9/61+/-6 mm Hg, P<0.005 for systolic and diastolic) pressures. They also had a significantly greater Sokolow-Lyon index (leads V(1)+V(5), 21+/-7 mV versus 18+/-6 mV). Elevation of BP above 140 mm Hg systolic or 90 mm Hg diastolic in the first or last hour of monitoring diagnoses patients with a white coat response in whom there is a higher BP profile than in patients with classic white coat response alone. We suggest, therefore, that this is a better measure of the white coat phenomenon.