白大衣高血压患者的血小板功能

目的:探讨白大衣高血压(WCH)患者的血小板功能.方法:选初诊的原发性高血压(EH)患者、 WCH 患者、正常血压(NT)者各35例,通过诊室血压测量和24 h动态血压监测,同时测定并比较3组血小板最大聚集率(PAGTmax)、血浆血小板α-颗粒膜蛋白(GMP-140)含量、平均血小板容积(MPV) 、血小板数量的变化.结果:和NT对照组相比,EH组和WCH组 PAGTmax、血浆血小板GMP-140含量、MPV均明显增加(P<0.05)而三组血小板计数无统计学差异,同时EH组的PAGTmax、血浆血小板GMP-140含量、MPV均高于WCH组(P<0.05).EH组和WCH组MPV与24 h平均舒张压、GMP-140含量均正相关( P<0.05).结论:WCH存在血小板活化,可能和心血管事件发生率增加有关.     

原发性高血压患者平均血小板体积/血小板计数比值与左心室肥厚的关系

目的探讨原发性高血压患者平均血小板体积/血小板计数比值(MPV/PLC)与左心室肥厚的关系。方法回顾性分析新发的原发性高血压患者111例资料,根据MPV/PLC比值,采用二等分法分为两组:低MPV/PLC组(MPV/PLC≤44.35 f L·10~(-12)·L~(-1))和高MPV/PLC组(MPV/PLC44.35 f L·10~(-12)·L~(-1)),比较两组的基线情况、血压水平、超声心动图参数等指标;采用相关性分析MPV/PLC与左心室心肌质量指数(LVMI)的关系;采用多元线性回归分析LVMI的影响因素。结果与高MPV/PLC组比较,低MPV/PLC组的LVMI较高[(115.29±23.18)g/m~2比(107.37±16.83)g/m~2,P0.05];相关性分析显示,LVMI与MPV/PLC呈负相关(r=-0.196,P0.05);多元线性相关分析显示,MPV/PLC是原发性高血压患者LVMI的影响因素(B=-0.347,P0.05)。结论原发性高血压患者的MPV/PLC与左心室肥厚相关。     

Increased mean platelet volume and mean platelet volume/platelet count ratio in Korean patients with deep vein thrombosis

The mean platelet volume (MPV) is a laboratory marker associated with platelet function and activity. Increased MPV in thromboembolic disease is considered an important risk factor. The aim of this study was to compare the MPV and MPV/platelet count (MPV/P) ratio between deep vein thrombosis (DVT) and control subjects. We retrospectively reviewed the medical records of patients (n?=?91) admitted due to newly diagnosed DVT from December 2010 to March 2012. The control group (n?=?311) underwent health screening at our Hospital. Median MPV was higher in DVT patients compared to controls (8.6?fl vs. 7.9?fl, p?<?0.0001). The DVT patients also had a higher MPV/P ratio compared to the control group (0.0388?fl/(10⁹/l) vs. 0.0308?fl/(10⁹/l), p?<?0.0001). MPV was inversely correlated with platelet count in DVT patients (correlation coefficient?=??0.33, p?=?0.001). Receiver operator characteristic analysis revealed that an MPV cutoff value of 8.2?fl provided 70.3% sensitivity and 72.7% specificity. An MPV/P cutoff value of 0.0363?fl/(10⁹/l) showed 60% sensitivity and 73% specificity. MPV and MPV/P ratio could be considered meaningful laboratory markers for the risk of DVT.     

老年原发性高血压患者超重和肥胖与凝血功能及血小板平均容积相关性研究

目的探讨老年原发性高血压患者超重、肥胖与凝血功能、血小板平均容积(MPV)之间的关系。方法选取老年原发性高血压患者204例,根据体质量指数(BMI)将患者分为对照组79例、超重组67例、肥胖组58例。检测血浆纤维蛋白原(Fib)、D-二聚体、抗凝血酶Ⅲ、血小板分布宽度、MPV等指标,并进行相关性分析。结果与对照组比较,超重组及肥胖组患者TG、空腹血糖、BMI、Fib、D-二聚体、MPV水平显著增高,差异有统计学意义(P<0.05)。Pearson相关分析显示,Fib(r=0.393,P<0.01)、D-二聚体(r=0.252,P<0.01)、MPV(r=0.275,P<0.01)与BMI呈正相关。结论超重及肥胖与老年原发性高血压患者凝血功能障碍及血小板活化增强有关,其影响随肥胖程度的增加而加深。     

Urinary albumin excretion in elderly patients with white coat hypertension

The so-called white coat effect occurs in about 42% of elderly patients. This phenomenon leads to several problems in treatment and may also cause renal disease. One of the most frequently controlled parameters is microalbuminuria, an index of renal damage. The present case-control study intended to evaluate the urinary excretion of albumin in elderly patients suffering from white coat hypertension, and comparing their data to those of normotensive subjects. In addition, the study searched for correlations between albuminuria and various clinical and ambulatory blood pressure values. A total of 258 patients were enrolled, but after screening, only 129 were considered; 13 of the latter were further excluded because of problems encountered during ambulatory monitoring of arterial blood pressure. Therefore, 116 hypertensive subjects were included in the study. This pool of hypertensive patients was compared to a normotensive group of 33 subjects. The results have shown the occurrence of white coat effect in 25% of cases, and the microalbuminuria of these patients was statistically not significantly different from that of the normotensive group of patients. The microalbuminuria correlated only with ambulatory systolic blood pressure measured during the day.     

Reduction of white coat effect by cilnidipine in essential hypertension.

Stress elevates blood pressure (BP) by increased sympathetic nerve activity. Cilnidipine, a novel dihydropyridine calcium antagonist that has inhibitory actions on N-type as well as L-type voltage-dependent calcium channels, has been reported to attenuate the cold stress-induced increase in plasma norepinephrine and BP in rats. Because white coat effect is associated with an enhanced pressor response to mental stress, we postulated that cilnidipine would attenuate white coat effect in patients with essential hypertension. Sixty-one consecutive outpatients (50 men, 11 women) with essential hypertension were studied prospectively. Twenty-nine patients were treated with either cilnidipine (n = 15) or nifedipine, a representative L-type voltage-dependent calcium antagonist (n = 14). Gender, age, body mass index, duration of hypertension, target organ damage of hypertension, and BP and heart rate (HR) were not significantly different between cilnidipine and nifedipine groups, and both systolic (SBP) and diastolic BP (DBP) were significantly decreased after treatment in both groups. White coat effects on systolic and DBP and HR were not significantly different between groups before antihypertensive treatment. Cilnidipine, but not nifedipine, significantly reduced white coat effects on SBP and HR. Furthermore, white coat effects on systolic BP and HR were significantly lower after treatment in the cilnidipine group compared with the nifedipine group. These data suggest that cilnidipine may reduce white coat effect in hypertensive patients by N-type calcium channel antagonism.     

原发性高血压患者中的白大衣效应及其与血压变异性的相关性

目的 探讨原发性高血压患者中的白大衣效应的发生率及其与血压变异性的相关性.方法 1级、2级原发性高血压患者410例自愿参加本研究.受试者自测1周家庭血压,根据诊室血压与家庭血压情况进行分类:未治疗患者分为白大衣性高血压(n=38)和持续性高血压(n=66);已治疗患者分为已控制高血压(n=131)、白大衣未控制高血压(...     

Platelet and mean platelet volume kinetics in adult patients with sepsis

Abstract

The aims of this study were to evaluate the kinetics of platelet counts and mean platelet volume (MPV) in adults with sepsis and to determine whether the responses are infection-specific. This retrospective cohort study included patients admitted to a tertiary-care teaching hospital with microbiologically proven nosocomial sepsis between January 2006 and January 2011. Platelet counts and MPV measurements were examined daily for 5 days after the onset of sepsis. During the study period, 151 of the 214 sepsis episodes were associated with thrombocytopenia. Gram-positive microorganisms were the most frequently isolated. The decrease in platelet counts was statistically significant for the first 3 days of sepsis in Gram-positive septic patients, for 4 days in Gram-negative septic patients and for all 5 days in fungal septic patients (p?<?0.001). The increase in MPV values was statistically significant for the first 3 days of sepsis in Gram-positive septic patients and for all 5 days in the other groups (p?<?0.001). We conclude that fungal sepsis has a stronger association with thrombocytopenia and increased MPV.     

C-reactive protein and nitric oxide level in patients with white coat hypertension

Abstract Background. There are controversial results regarding the endothelial function in patients with white coat hypertension (WCH). The aim of this study was to assess endothelial function measuring nitric oxide (NO) and C-reactive protein (CRP) level in WCH and to compare those with essential hypertension (EH) and healthy subjects. Methods. The 40 newly diagnosed patients with EH, 40 patients with WCH and 40 healthy volunteers were included to study. Plasma CRP levels were measured by immunonephelometery method. Plasma NO level was also detected by using the Griess method. Results. Plasma CRP level was significantly higher in patients with EH when compared with those with WCH and healthy subjects (6.3 ± 2.1 mg/l, 2.1 ± 0.9 mg/l and 1.6 ± 1.3 mg/l, p < 0.05, respectively). However, there was no significant difference with respect to CRP level between those with WCH and healthy subjects. NO level was significantly lower in patients with EH when compared with those with WCH and healthy subjects (4.6 ± 1.1 μmol/l, 6.9 ± 1.2 μmol/l and 8.1 ± 1.5 μmol/l, p < 0.05, respectively). There was no significant difference with respect to NO level between those with WCH and healthy subjects. Plasma CRP level was positively correlated with office, daytime, night-time and 24-h blood pressure values, whereas NO level was inversely correlated with these parameters. Plasma CRP level was also inversely correlated with NO level. Conclusions. Our data suggest that CRP concentration is significantly higher and NO level is meaningfully lower in patients with essential hypertension when compared with those with WCH and controls. This may suggest that endothelial functions are preserved in patients with WCH in contrast to essential hypertension.     

持续性、隐蔽性和白大衣3种高血压患者血压变异性分析

目的：探讨持续性,隐蔽性高血压患者与白大衣高血压患者的血压变异性（BPV）特点。方法：选择2010年12月～2012年12月在我院查体人群527例作为分析对象,并按照血压的特点全部病例被分成高血压组（SH 组,143例）、隐蔽性高血压组（MH 组,93例）、白大衣高血压组（86例）和正常对照组（NC 组,205例）。血压变异系数（CV）＝BPV/平均血压。结果：隐蔽性高血压组、持续高血压组血压 CV 较 NC 组显著增大[24h 收缩压 CV（27.73±5.36）％比（29.83±5.95）％比（17.93±4.85）％,24h 舒张压 CV（23.02±4.63）％比（22.69±4.63）％比（14.32±4.21）％,白昼收缩压 CV（25.12±4.79）％比（25.98±4.73）％比（14.97±4.29）％,白昼舒张压 CV（21.03±4.59）％比（20.92±4.53）％比（11.79±4.43）％,夜间收缩压 CV（21.52±4.93）％比（22.37±4.98）％比（11.57±4.19）％,夜间舒张压CV（18.79±4.83）％比（20.09±5.19）％比（6.98±3.69）％],P 均＜0.01;而白大衣高血压组与 NC 组之间,持续高血压组与隐蔽性高血压组之间血压 CV 差异均无统计学意义（P ＞0.05）。结论：持续性,隐蔽性高血压患者血压变异性较为显著,这可能是这类患者靶器官损害比较严重的主要原因之一。     

The mean platelet volume in gestational diabetes

Objective: To compare the platelet count and mean platelet volume (MPV) values of pregnancies diagnosed with gestational diabetes with those of healthy pregnancies. Material—method: Between June 2003 and September 2004, 100 healthy pregnancies and 100 pregnancies with gestational diabetes were studied at Gazi University, Department of Obstetrics and Gynecology. Results: While no statistically significant difference was observed in the platelet count between the two groups, the MPV of the gestational diabetes group (9.4 ± 1.6 fl) was evaluated to be significantly higher than the MPV of the healthy pregnancy group (8.3 ± 1.1 fl). Additionally, when linear regression analysis was performed an inverse relationship was observed between platelet number and MPV. Conclusion: There is a need for further research focusing on the platelet function in the observation and treatment of gestational diabetes, which can pose the risk of developing Type 2 diabetes for the mother and has negative consequences for the fetus.     

Stroke prediction using mean platelet volume in patients with atrial fibrillation

Platelet size, measured as mean platelet volume (MPV), is associated with platelet reactivity. MPV has been identified as an independent risk factor for future stroke and myocardial infarction. The aim of this study was to determine the association of MPV with the development of stoke in patients with atrial fibrillation (AF). MPV, N-terminal pro B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hsCRP) were analysed in 200 patients with AF (mean age 69 years; 56% male). The primary endpoint was ischaemic stroke event. The mean MPV was 8.5?±?1.0?fL and the median NT-proBNP was 1916.5 (IQR 810-4427) pg/mL. The median hsCRP was 0.47 (IQR 0.32-2.46)?mg/dL. There were 14 stroke events during a mean of 15.1 months of follow up. Kaplan-Meier analysis revealed that the higher tertile MPV group (≥8.9 fL) had a significantly higher stroke rate compared to the lower tertile MPV group (<8.0 fL) (14.7% vs. 3.1%, log-rank: P?=?0.01). A higher MPV was an independent predictor of stroke risk after adjusting for age, gender, and other CHADS(2) (congestive heart failure, hypertension, diabetes, and previous stroke or transient ischemic attack (TIA) history) score components (hazard ratio: 5.03, 95% CI 1.05-24.05, P?=?0.043) in Cox proportional hazard analysis. When the MPV cut-off level was set to 8.85 fL using the receiver operating characteristic curve, the sensitivity was 71% and the specificity was 69% for differentiating between the group with stroke and the group without stroke. This value was more useful in patients with a low to intermediate traditional thromboembolic risk (CHADS(2) score <2). Furthermore, AF patients with an MPV over 8.85 fL had high stroke risk without anticoagulation, especially in the low thromboembolic risk group (Log-Rank <0.0001). The results of this study show that MPV was a predictive marker for stroke; its predictive power for stroke was independent of age, gender, and other CHADS(2) score components in patients with AF. These findings suggest that anticoagulation may be needed in patients with a high MPV, even if they have low to intermediate traditional thromboembolic risk (CHADS(2) score <2).     

Stroke prediction using mean platelet volume in patients with atrial fibrillation

Platelet size, measured as mean platelet volume (MPV), is associated with platelet reactivity. MPV has been identified as an independent risk factor for future stroke and myocardial infarction. The aim of this study was to determine the association of MPV with the development of stoke in patients with atrial fibrillation (AF). MPV, N-terminal pro B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hsCRP) were analysed in 200 patients with AF (mean age 69 years; 56% male). The primary endpoint was ischaemic stroke event. The mean MPV was 8.5?±?1.0?fL and the median NT-proBNP was 1916.5 (IQR 810–4427) pg/mL. The median hsCRP was 0.47 (IQR 0.32–2.46)?mg/dL. There were 14 stroke events during a mean of 15.1 months of follow up. Kaplan-Meier analysis revealed that the higher tertile MPV group (≥8.9 fL) had a significantly higher stroke rate compared to the lower tertile MPV group (<8.0 fL) (14.7% vs. 3.1%, log-rank: P?=?0.01). A higher MPV was an independent predictor of stroke risk after adjusting for age, gender, and other CHADS₂ (congestive heart failure, hypertension, diabetes, and previous stroke or transient ischemic attack (TIA) history) score components (hazard ratio: 5.03, 95% CI 1.05–24.05, P?=?0.043) in Cox proportional hazard analysis. When the MPV cut-off level was set to 8.85 fL using the receiver operating characteristic curve, the sensitivity was 71% and the specificity was 69% for differentiating between the group with stroke and the group without stroke. This value was more useful in patients with a low to intermediate traditional thromboembolic risk (CHADS₂ score <2). Furthermore, AF patients with an MPV over 8.85 fL had high stroke risk without anticoagulation, especially in the low thromboembolic risk group (Log-Rank <0.0001). The results of this study show that MPV was a predictive marker for stroke; its predictive power for stroke was independent of age, gender, and other CHADS₂ score components in patients with AF. These findings suggest that anticoagulation may be needed in patients with a high MPV, even if they have low to intermediate traditional thromboembolic risk (CHADS₂ score <2).     

Endothelium and angiogenesis in white coat hypertension

Hypertensive patients are at particular risk of cardiovascular complications, possibly related to endothelial damage or dysfunction, or to abnormal angiogenesis. The aim of this study was to compare the risk conferred by white coat hypertension (WCH) vs sustained hypertension in the development of the endothelial dysfunction and abnormal angiogenesis by evaluating nitric oxide (NO=NO2+NO3), endothelin-1 (ET-1), vascular endothelial growth factor (VEGF), and E-selectin levels in plasma. The study group included 102 subjects, 34 with WCH (17 male and 17 female patients) aged 49+/-11 years, 34 sustained hypertensives (HT) (15 male and 19 female patients) aged 47+/-11 years and 34 normotensive control subjects (NT) (16 male and 18 female patients) aged 48+/-10 years. WCH was defined as clinical hypertension and daytime ambulatory blood pressure less than 135/85 mmHg. The subjects were matched for age, gender, body mass index and the patients with smoking habit, dyslipidaemia, and diabetes mellitus were excluded from the study. The NO, ET-1, VEGF and E-selectin levels were analysed by ELISA technique. The WCH subjects had significantly higher levels of NO than the HT (41.68+/-2.23 vs 32.18+/-2.68 micromol/l; P<0.001) and significantly lower values than the NT (48.24+/-4.29 micromol/l; P<0.001). ET-1 levels of the WCH group were significantly higher than the NT (8.10+/-0.92 vs 5.95+/-0.26 ng/ml; P<0.001) and significantly lower than the HT (11.46+/-0.59 ng/ml; P<0.001). Considering with VEGF, the WCH group had significantly higher levels than the NT (195.88+/-11.84 vs 146.26+/-18.67 pg/ml; P<0.001), but the difference from the HT group was not significant (203.35+/-7.48 pg/ml; P=0.062). E-selectin in the WCH group was significantly lower than the HT (4.77+/-0.52 vs 8.49+/-2.85; P<0.001), but the difference from the NT group was not significant (3.86+/-0.67; P=0.077). Our data demonstrate that WCH is associated with endothelial dysfunction and abnormal angiogenesis. The degree of these changes is not as severe as observed in hypertensive population.     

The mean platelet volume in subjects with impaired fasting glucose

Mean platelet volume (MPV), a determinant of platelet function, is a newly emerging risk factor for atherothrombosis. Impaired fasting glucose (IFG) is probably a frequent glycemic disorder in the general population and is considered as a prediabetic state. The present study was designed to evaluate MPV in subjects with IFG compared with diabetic patients and normoglycemic control subjects. We selected 50 patients with type 2 diabetes mellitus, 50 subjects with IFG, and 50 normoglycemic healthy subjects matched for age, gender, and body mass index. MPV was very significantly higher in diabetic and IFG groups than in control group (p?<?0.00, p?<?0.05, respectively); it was also higher in diabetic group than in IFG group (p?<?0.05). Platelet counts were not different among the study groups (p?>?0.05). Platelet mass was significantly higher in diabetic and IFG groups than in normotensives (p?<?0.00, p?<?0.05, respectively); and it was also higher in diabetic group than in IFG group (p?<?0.05). MPV and platelet mass were positively correlated with fasting glucose and HbA1c in diabetic and IFG groups (p?<?0.05). In conclusion, our data suggests one possible mechanism by which subjects with IFG may be at increased cardiovascular risk.