老年单纯收缩期高血压患者胰岛素样生长因子1与靶器官损害

Insulin-like Growth Factor-1 and Target Organ Damage in Elderly Patients with Isolated Systolic Hypertension

    摘要
  • 摘要: 目的观察老年单纯收缩期高血压(ISH)患者血清胰岛素样生长因子(IGF)-1水平与血压水平、左心室质量指数(LVMI)、颈动脉内膜中层厚度(I MT)及尿白蛋白排泄率(UAER)的关系。方法入选160例老年ISH患者(ISH组,n=160),按是否合并左心室肥厚(LVH)将患者分为单纯ISH组(ISH组,n=78)和高血压合并左心室肥厚组(ISH+LVH,n=82);依照血压等级不同分为:高血压1级组(n=45),2级组(n=58)和3级组(n=57);按颈动脉硬化程度分为3组:I MT正常组(I MT≤0.9 mm,n=44),I MT增厚组(I MT1.0～1.2 mm,n=54)和粥样斑块组(I MT≥1.2 mm,n=62);按UAER是否正常分为UAER正常组(n=69)和UAER异常组(n=91)。选择同期年龄、性别相匹配的健康体检者为正常对照组(正常对照组,n=110)。酶联免疫法测定血清IGF-1水平;多普勒超声心动仪测量I MT、LVMI;散射比浊法测定UAER。结果ISH组血清IGF-1水平高于正常对照组(27.4±9.1)比(20.3±9.4)μg/L,P<0.05,ISH+LVH高于单纯ISH组(47.8±18.5)比(27.4±9.1)μg/L,P<0.05。IGF-1水平随高血压分级升高而增加高血压1级:(24.3±8.6)比高血压2级:(32.2±12.3)比高血压3级:(51.0±16.7)μg/L,P<0.05。粥样斑块组血清IGF-1高于I MT增厚组(51.4±10.3)比(29.5±9.6)μg/L,P<0.01,I MT增厚组高于I MT正常组(29.5±9.6)比(20.8±8.0)μg/L,P<0.01。UAER异常组IGF-1显著高于UAER正常组(48.8±18.6)比(27.4±12.0)μg/L,P<0.01。血清IGF-1与收缩压(r=0.40,P<0.05)、LVMI(r=0.47,P<0.05)、I MT(r=0.50,P<0.05)和UAER(r=0.53,P<0.05)均呈正相关。多元回归分析也显示IGF-1是造成靶器官损害的重要因素(P<0.05)。结论IGF-1与血压升高和靶器官损害相关,IGF-1升高可能是高血压左心室肥厚、动脉粥样硬化以及肾脏损害的共同病理生理基础之一。

     

    Abstract: Objective To investigate the relationship between IGF-1 and left ventricular mass index（LVMI）,carotid arterial intima-media thickness（IMT）,urinary albumin excretion rate（UAER） in elderly patients with isolated hypertension（ISH）.Methods One hundred and sixty elderly patients with ISH were classified into several groups according to left ventricular mass index,blood pressure,IMT and UAER respectively.Serum IGF-1 was measured by enzyme-linked immunoassay,IMT and LVMI were determined by echocardiography.UAER was measured by ratenephelometry.One hundred and ten age and gender matched normal subjectives served as control.Results Serum IGF-1 in ISH+LVH was higher than that in ISH and in controls（47.8±18.5） vs ISH group（27.4±9.1）μg/L vs control（20.3±9.4）μg/L,all P＜0.05.IGF-1,LVMI,IMT and UAER were increased with increasing of BP.IGF-1 was higher in the patients with carotid plaque than that in thickening IMT and normal IMT （51.4±10.3） vs thickening IMT（29.5±9.6）μg/L vs control（20.8±8.0）μg/L,all P＜0.01.IGF-1 in patients with abnormal UAER was higher than in normal UAER （48.8±18.6） vs normal UAER group（27.4±12.0）μg/L,P＜0.01.IGF-1 positively related with SBP,LVMI,IMT and UAER（r=0.40,P＜0.05;r=0.47,P＜0.05;r=0.50,P＜0.05;r=0.53,P＜0.05,respectively）.After adjusting for age,BMI,FPG,TG,TC,HDL-C and LDL-C,multiple regression analysis shows that IGF-1 was the predominantly predisposing factor

     

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