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目的探讨高血压性肾损害患者内皮功能、血小板活化指标的变化及意义。方法选择原发性高血压患者82例,依据K/DOQI指南CKD分期分成5组,健康体检者20人为对照组。采用ELISA法测定血浆标本中血管性假性血友病因子(vWF)、血栓调节蛋白(TM)、血浆11-去氢-血栓烷B2(11-DH-TXB2)、血小板α-颗粒膜蛋白(GMP-140),并进行统计学分析。结果CKD各期血浆vWF、TM、11-DH-TXB2、GMP-140水平均高于对照组,差异有高度统计学意义(P<0.01或<0.001),且随着CKD分期的升高逐渐升高,相邻两组间差异亦有统计学意义(P<0.05)。经相关分析,高血压患者血浆vWF、TM、11-DH-TXB2、GMP-140与内生肌酐清除率(Ccr)成负相关,与平均动脉压成正相关。除TM外,高血压患者血浆vWF、11-DH-TXB2、GMP-140与24h尿蛋白定量成正相关。结论高血压患者存在不同程度的内皮功能损伤及血小板活化,两者在高血压性肾损害的发生和发展过程中起重要作用,是高血压性肾损害的发病机制之一。
Objective To investigate the changes and significance of endothelial function and platelet activation in patients with hypertensive renal impairment. Methods Eighty-two patients with essential hypertension were divided into five groups according to the K / DOQI guidelines for CKD stage, and 20 healthy subjects as control group. The serum levels of vWF, TM, 11-DH-TXB2, and platelet-derived α-granule membrane protein GMP-140), and statistical analysis. Results The plasma levels of vWF, TM, 11-DH-TXB2 and GMP-140 in CKD group were significantly higher than those in control group (P <0.01 or <0.001), and gradually increased with the rise of CKD stage High, the difference between the two adjacent groups was also statistically significant (P <0.05). Correlation analysis showed that plasma vWF, TM, 11-DH-TXB2 and GMP-140 were negatively correlated with endogenous creatinine clearance (Ccr) and positively correlated with mean arterial pressure. In addition to TM, the plasma levels of vWF, 11-DH-TXB2 and GMP-140 in patients with hypertension were positively correlated with urinary protein excretion in 24 hours. Conclusion There are different degrees of endothelial dysfunction and platelet activation in hypertensive patients. Both of them play an important role in the pathogenesis and progression of hypertensive renal injury and are one of the pathogenesis of hypertensive renal injury.