清道夫受体CD36基因缺陷对正常高值血压患者动态血压节律及代谢指标的影响研究

背景　处于正常高值血压阶段的患者，随着动脉血压的节律和绝对值的改变，以及受代谢因素的影响，仍然有发生动脉粥样硬化性心血管疾病的风险，而清道夫受体CD36基因缺陷与多种动脉粥样硬化性心血管疾病的发生有关，有必要揭示两者之间的内在联系。目的　对比清道夫受体CD36基因缺陷的正常高值血压患者与清道夫受体CD36基因正常者24 h动态血压指标及代谢指标是否存在差异，以探讨清道夫受体CD36基因缺陷对正常高值血压患者的血压和代谢是否产生影响。方法　选取2018年10月-2019年4月在武汉市武昌医院心内科门诊就诊的200例初诊正常高值血压患者为研究对象。均行24 h动态血压监测，抽取空腹静脉血检测相关代谢指标及清道夫受体CD36基因缺陷情况。以清道夫受体CD36基因缺陷的正常高值血压患者为观察组，以清道夫受体CD36基因正常的正常高值血压患者为对照组。正常高值血压患者CD36基因缺陷影响因素采用多因素Logistic回归分析。结果　200例初诊正常高值患者共检出31例清道夫受体CD36基因缺陷，检出率为15.5%。观察组体质指数（BMI）、24 h平均舒张压（24 hDBP）、夜间平均收缩压（nSBP）、24 h平均动脉压（24 hMAP）、非杓型血压发生率、三酰甘油（TG）、胰岛素抵抗指数（HOMA-IR）高于对照组（P<0.05）。多因素Logistic回归分析，结果显示：BMI〔OR=5.649，95%CI（4.235，14.376）〕、24 hMAP〔OR=5.836，95%CI（4.459，15.132）〕、非杓型血压〔OR=6.228，95%CI（5.876，16.812）〕、TG〔OR=4.348，95%CI（2.247，10.168）〕、HOMA-IR〔OR=4.134，95%CI（1.630，5.245）〕是正常高值血压患者清道夫受体CD36基因缺陷独立影响因素（P<0.05）。结论　正常高值血压患者清道夫受体CD36基因缺陷发生率达15.5%，血压和代谢可能对正常高值血压患者的清道夫受体CD36基因缺陷产生影响。

Effect of Scavenger Receptor CD36 Gene Defect on Ambulatory Blood Pressure Rhythm and Metabolic Parameters in Patients with High-normal Blood Pressure

Background　With the change of arterial blood pressure rhythm and its absolute value，patients with high-normal blood pressure still have the risk of atherosclerotic cardiovascular diseases under the influence of associated metabolic factors.The CD36 gene defect of the scavenger receptor is related to the occurrence of various atherosclerotic cardiovascular diseases，so it is necessary to reveal the relationship between high-normal blood pressure and CD36 gene defect.Objective　To compare the 24-hour ambulatory blood pressure parameters and metabolic parameters between patients with high-normal blood pressure accompanied by CD36 gene defect and those with normal CD36 gene，in order to explore the effect of CD36 gene defect on blood pressure and metabolism in patients with high-normal blood pressure.Methods　A total of 200 patients who were diagnosed with high-normal blood pressure for the first time in the Department of Cardiology of Wuchang Hospital from October 2018 to April 2019 were selected as research subjects.24-hour ambulatory blood pressure monitoring was performed among all patients.Fasting venous blood was collected to detect related metabolic indicators and scavenger receptor CD36 gene defect.Thirty-one patients with high-normal blood pressure and CD36 gene defect were selected as the observation group，and 169 patients with high-normal blood pressure and normal CD36 gene were selected as the control group.Multivariate Logistic regression was used to analyze the influencing factors of CD36 gene defect.Results　A total of 31 cases of scavenger receptor CD36 gene defect were detected，and the detection rate was 15.5%.The body mass index（BMI），24-hour mean diastolic blood pressure（24 hDBP），nighttime mean systolic blood pressure （nSBP），24-hour mean arterial pressure （24 hMAP），incidence of non-dipper blood pressure，triacylglycerol （TG），and insulin resistance index （HOMA-IR）in the observation group were significantly higher than those in the control group （P<0.05）.Multivariate Logistic regression analysis showed that BMI 〔OR=5.649，95%CI（4.235，14.376）〕，24 hMAP 〔OR=5.836，95%CI（4.459，15.132）〕，non-dipper blood pressure〔OR=6.228，95%CI（5.876，16.812）〕，TG 〔OR=4.348，95%CI（2.247，10.168）〕，and HOMA-IR 〔OR=4.134，95%CI（1.630，5.245）〕 were independent influencing factors of scavenger receptor CD36 gene defect in patients with high-normal blood pressure（P<0.05）.Conclusion　The incidence of scavenger receptor CD36 gene defect in patients with high-normal blood pressure is 15.5%.The blood pressure and metabolism may have an effect on scavenger receptor CD36 gene defect in patients with high-normal blood pressure.