C反应蛋白与血压和TCD参数的相关性

1、C反应蛋白与血压和TCD参数的相关性         10-09-08 09:17:00     编辑：studa20                       作者：王小林张明军 王永红【摘要】  目的 了解C反应蛋白(CRP)与血压和TCD之间的关系。方

2、法 从2008年体检人群中选取1 286名调查对象，按CRP值将调查对象分为低危组(CRP<3 mg/L)936例，中危组(CRP 310 mg/L)240例和高危组(CRP>10 mg/L)110例;分析各组年龄和TCD各指标的差异，比较不同组别高血压患者的构成比例，采用多因素Logistic回归分析高血压患者构成比例与不同CRP水平之间的相关性。结果 与低危组比较，高危组和中危组左侧大脑中动脉和基底动脉的平均流速、舒张期流速明显降低(P<0.05)，双侧大脑中动脉和基底动脉搏动指数、阻力指数有明显差异(P<0.05)，患病年龄也明显增大(P<0.05)。高危组

3、(62.73%)和中危组(50.83%)患高血压的比例比低危组(37.82%)增加明显，患高血压的危险度分别是低危组的4.450倍(95%CI:2.9676.674)和2.734倍(95%CI:2.0643.621)。结论 高水平的CRP能降低大脑中动脉和基底动脉血管弹性，诱导其动脉硬化的发生。同时，人群中患高血压的患者和风险也随之增加。 【关键词】  C反应蛋白;动脉硬化;高血压;TCD【Abstract】 Objective To investigate the association among Creactive protein(CRP) and blood pressure

4、 and the parameters of transcranial doppler (TD). Methods The data was collected from subjects(n=1 286)for annual physical evaluations of 2008 in the Public Health Center of the First Affiliated Hospital of Chongqing Medical University in Chongqing. The datas were randomized by multistep cluster sam

5、pling methods. Subjects were divided into three groups according levels of CRP：(1) lowrisk group：all subjects (n=936) levels of CRP were below 3 mg/L (2) midrangerisk group：all subjects (n=240) levels of CRP were between 3 mg/L and 10 mg/L; (3) highrisk group：all subjects (n=110) levels of CRP were

6、more than 3 mg/L. The variables on subjects selected for this study were parameters of TD, the age of each group, proportionate of hypertension and the association between hypertension and leves of CRP were analyzed.Results The mean glow velocity, relaxing period velocity, pulsatility index and resi

7、stent index were significantly lower in highrisk group and midrangerisk group); the age of those groups was obviously older compared with those in lowrisk group. The proportions of hypertension were significantly higher in highrisk group(62.73%) and midrangerisk group(50.83%) compared to lowrisk gro

8、up(37.82%).The probabilities of hypertension in highrisk group(OR=4.450 CI:2.9676.674) and midrangerisk group(OR=2.734 CI:2.0643.621) were higher than that of lowrisk group. Conclusions High level of CRP can cut down the elasticity of middle cerebral artery and basilar artery, induce the appearance

9、of arteriosclerosis in both arteries. High level of CRP also can improve the risk of hypertension.【Key words】 Creactive protein; Arteriosclerosis; Hypertension; Transcranial Doppler流行病学研究显示，健康人群中C反应蛋白(CRP)浓度的升高同其后发生冠心病、脑血管病和周围动脉疾病等事件的危险性呈正相关。其中，非特异性炎症反应可能在原发性高血压的发生、发展过程中起重要作用。 研究表明，CRP虽然是炎性标志物，但血清中高

10、水平的CRP为高血压和动脉硬化的独立危险因素1，2。但现在关于CRP与血压和脑动脉之间关系的研究还比较少。TCD是一种无创性检测颅底大动脉血流动力学的诊断技术，通过检测颅底动脉的血流方向、血流速度、频谱形态、音频特点等能较准确地反映脑动脉的狭窄、痉挛、缺血等病理状态。因此本研究主要探讨CRP与血压和颅底大动脉血流动力学的关系。1 对象与方法1.1 对象 均为2008年1月1日至2008年12月31日在重庆医科大学附属第一医院体检中心进行健康体检者，随机分层选取进行了CRP和TCD检查的体检人群1 286例。根据报道CHS试验10年随访中CRP>10 mg/L的老年人发生冠心病的危险性比C

11、RP<3 mg/L者增加了1.8倍3，因此本文按CRP值将调查对象分为低危组(CRP<3 mg/L)936例，中危组(CRP 310 mg/L)240例、高危组(CRP>10 mg/L)110例。年龄(46.57±11.87)岁。1.2 方法与仪器1.3 统计学分析 计量资料以x±s表示，计数资料以%表示，各组间收缩期血流速度、舒张期血流速度、平均血流速度、搏动指数和阻力指数的比较采用单因素方差分析检验，组间比较采用StudentNewmanKeuls检验;高血压患者随CRP增加而变化的趋势分析用趋势2检验;多因素Logistic回归分析高血压和CRP的相关性;数据分析采用SAS9.1统计软件。2 结 果2.1 各组间年龄的比较 随着危险度的增加，低危组(50.59±12.89)、中危组(53.48±13.96)、高危组(56.77±13.48)三组年龄显著增加(F=13.72，P<0.01)。2.2 各组高血压发生比例的多元Logistic回归分析 高危组和中危组血压偏高患者的比例明显增高(P&