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目的探讨白大衣高血压(white-coat hypertension,WCH)患者血浆肾素活性(plasma renin activity,PRA),血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)、醛固酮(aldosterone,ALD)水平变化及WCH与肾素-血管紧张素-醛固酮系统的关系。方法 WCH患者150例为WCH组,轻中度原发性高血压患者161例为高血压组,同期体检健康者167例为对照组,比较3组诊室血压及24h平均血压;采用ELISA法检测3组血浆三酰甘油(triacylglycerol,TG)、总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)水平;采用离子交换层析法检测3组糖化血红蛋白水平;采用化学发光免疫分析法检测3组卧位、立位血浆PRA及AngⅡ、ALD水平。结果WCH组诊室血压[(159±17)/(98±10)mm Hg]高于对照组[(123±16)/(78±12)mm Hg](P<0.05),与高血压组[(154±11)/(99±10)mm Hg]比较差异无统计学意义(P>0.05);WCH组24h平均血压[(119±20)/(78±10)mm Hg]低于高血压组[(138±10)/(86±12)mm Hg](P<0.05),与对照组[(115±16)/(76±11)mm Hg]比较差异无统计学意义(P>0.05);3组血浆TG、TC、HDL-C、LDL-C、糖化血红蛋白水平比较差异均无统计学意义(P>0.05);WCH组血浆PRA、AngⅡ、ALD水平[立位:(3.70±2.36)ng/(mL·h)、(87.89±40.86)ng/L、(325.49±124.56)ng/L,卧位:(3.08±2.21)ng/(mL·h)、(85.57±42.81)ng/L、(295.69±138.47)ng/L]均高于高血压组[立位:(2.56±2.18)ng/(mL·h)、(72.12±17.16)ng/L、(299.44±111.23)ng/L,卧位:(2.25±2.02)ng/(mL·h)、(73.68±19.08)ng/L、(279.57±121.68)ng/L]和对照组[立位:(1.87±1.37)ng/(mL·h)、(58.73±18.23)ng/L、(247.95±76.83)ng/L;卧位:(1.79±1.32)ng/(mL·h)、(59.68±20.43)ng/L、(251.57±77.69)ng/L],且高血压组高于对照组(P<0.05)。结论 WCH患者血浆PRA及AngⅡ、ALD水平均增高,肾素-血管紧张素-醛固酮系统可能参与WCH发病机制的调节。
Objective To investigate the changes of plasma renin activity (PRA), angiotensin Ⅱ (AngⅡ) and aldosterone (ALD) in white-coat hypertension (WCH) Angiotensin - aldosterone system. Methods WCH patients 150 cases were WCH group, 161 cases of mild to moderate essential hypertension in patients with hypertension group, 167 cases of healthy subjects over the same period as the control group, comparing the three groups of office blood pressure and 24h mean blood pressure; using ELISA assay 3 The plasma levels of triacylglycerol (TG), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol -C) levels were measured. The levels of HbA1c in three groups were detected by ion exchange chromatography. PRA, Ang Ⅱ and ALD levels in the three groups were measured by chemiluminescence immunoassay. Results The blood pressure in the WCH group was significantly higher than that in the control group [(159 ± 17) / (98 ± 10) mm Hg] [(123 ± 16) / (78 ± 12) mm Hg] (154 ± 11) / (99 ± 10) mm Hg] (P> 0.05). The mean blood pressure at 24h in the WCH group was significantly lower than that in the hypertensive group [(119 ± 20) / (78 ± 10) mm Hg] There was no significant difference between the control group [(115 ± 16) / (76 ± 11) mm Hg] and the control group [(138 ± 10) / (86 ± 12) mm Hg] (P> 0.05). The level of plasma PRA, AngⅡ, ALD in the WCH group [standing position: (3.70 ± 2.36 (87.89 ± 40.86) ng / L and (325.49 ± 124.56) ng / L, respectively.The lying position was (3.08 ± 2.21) ng / (mL · h) and (85.57 ± 42.81) ng / L, (295.69 ± 138.47) ng / L] were significantly higher than those in the hypertensive group [(2.56 ± 2.18) ng / mL · h vs 72.12 ± 17.16 ng / L and 299.44 ± 111.23 ng / L, (2.25 ± 2.02) ng / (mL · h), (73.68 ± 19.08) ng / L, (279.57 ± 121.68) ng / L and control group (mL · h), (58.73 ± 18.23) ng / L, (247.95 ± 76.83) ng / L respectively. The supine position was (1.79 ± 1.32) ng / mL · h and 59.68 ± 20.43 ng / 251.57 ± 77.69) ng / L], and hypertension group than the control group (P <0.05). Conclusions Plasma PRA, AngⅡ and ALD levels are increased in patients with WCH, and the renin-angiotensin-aldosterone system may be involved in the pathogenesis of WCH.