【摘要】：目的:探討原發(fā)性高血壓(EH)患者外周血T淋巴細(xì)胞亞群的表達(dá)與左室結(jié)構(gòu)和功能的關(guān)系及醛固酮拮抗劑的干預(yù)研究。方法:選擇2015年8月到2016年8月期間在我科住院的EH患者60例,其中男性37例,女性23例,年齡60~88歲,平均年齡66.8±5.6(歲),隨機(jī)分為常規(guī)降壓治療30例作為常規(guī)降壓治療組(n=30例)和常規(guī)降壓加螺內(nèi)酯治療30例作為螺內(nèi)酯干預(yù)組(n=30例);另選同期健康體檢者30例作為健康對照組(n=30例),年齡60~80歲,平均年齡64.4±5.9(歲),其中男性21例,女性9例,健康組年齡、性別與兩治療組無顯著性差異(p0.05)。(1)采用EpicsXL流式細(xì)胞儀測定各組的外周血總T淋巴細(xì)胞百分比、CD3+CD4+T淋巴細(xì)胞百分比、CD3+CD8+T淋巴細(xì)胞百分比、以及CD4+/CD8+的比值;(2)應(yīng)用EPIQ5彩色超聲心動(dòng)圖測定EH患者左室結(jié)構(gòu)和功能。結(jié)果:與健康對照組相比,高血壓組患者外周血CD3+CD4+T淋巴細(xì)胞及CD4+/CD8+比值明顯升高(P0.05),而總T淋巴細(xì)胞(CD3+)、CD3+CD8+T淋巴細(xì)胞與對照組的差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。EH患者治療6個(gè)月后,螺內(nèi)酯干預(yù)組外周血總T淋巴細(xì)胞(CD3+)與常規(guī)降壓治療組相比沒有明顯差異(P0.05),螺內(nèi)酯干預(yù)組CD3+CD4+T淋巴細(xì)胞、CD4+/CD8+較常規(guī)降壓治療組均明顯降低(P0.05);螺內(nèi)酯干預(yù)組左室后壁(LVPW)厚度、室間隔(IVS)厚度、二尖瓣血流舒張?jiān)缙诹魉?心房收縮期流速(E/A)與常規(guī)降壓組有明顯差異(P0.05),左室射血分?jǐn)?shù)(LVEF)兩組相比無明顯差異(P0.05);CD4+T淋巴細(xì)胞百分比與LVPW成正相關(guān)(r=0.52,P0.05),CD4+/CD8+與E/A成負(fù)相關(guān)(r=-0.57,P0.05)。結(jié)論:1.高血壓病患者存在免疫炎性損傷2.醛固酮拮抗劑可能通過抑制血管炎癥反應(yīng)、調(diào)節(jié)免疫細(xì)胞亞群改善高血壓患者左室結(jié)構(gòu)和功能,延緩左室重塑。
[Abstract]:Aim: to investigate the relationship between the expression of T lymphocyte subsets in peripheral blood and left ventricular structure and function in patients with essential hypertension (EH) and the intervention of aldosterone antagonist. Methods: sixty patients with EH were selected from August 2015 to August 2016, including 37 males and 23 females, aged 6088 years, with an average age of 66.8 鹵5.6 years. They were randomly divided into two groups: 30 cases were treated with conventional hypotension (n = 30) and 30 cases were treated with conventional hypotension plus spironolactone (n = 30). 30 healthy persons (n = 30) were selected as the healthy control group (n = 30). The average age was 64.4 鹵5.9 (n = 20), including 21 males and 9 females, and the age of the healthy group. There was no significant difference between sex and treatment group (p0.05). (1). Total T lymphocyte percentage, CD3 CD4 T lymphocyte percentage, CD3 CD8 T lymphocyte percentage were measured by EpicsXL flow cytometry. And the ratio of CD4 / CD8; (2) left ventricular structure and function were measured by EPIQ5 color echocardiography in patients with EH. Results: compared with the healthy control group, CD3 CD4 T lymphocytes and CD4 / CD8 ratio in patients with hypertension were significantly increased (P0.05), while total T lymphocytes (CD3) were significantly increased. There was no significant difference between CD3 CD8 T lymphocytes and control group (P0.05). EH patients treated for 6 months, the total peripheral blood T lymphocytes (CD3) of spironolactone intervention group and routine hypotension treatment group had no significant difference (P0.05). The levels of CD3 CD4 T lymphocytes and CD4 / CD8 in the spironolactone intervention group were significantly lower than those in the conventional hypotensive treatment group (P0.05). The left ventricular posterior wall (LVPW) thickness, interventricular septal (IVS) thickness, mitral early diastolic velocity / atrial systolic velocity (E / A) in the spironolactone intervention group were significantly different from those in the conventional hypotensive group (P0.05). There was no significant difference in left ventricular ejection fraction (LVEF) between the two groups (P0.05). The percentage of CD4 T lymphocytes was positively correlated with LVPW (P 0.05), and CD4 / CD8 was negatively correlated with E / A (P 0.05). Conclusion: 1. Hypertension patients have immune inflammatory damage 2. 5%. Aldosterone antagonists may delay left ventricular remodeling by inhibiting vascular inflammation and regulating immune cell subsets to improve left ventricular structure and function in hypertensive patients.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R544.11

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