A Clinical Research About The Nuclear Factor-KB Activation,hs-CRP Levels And Target Organ Damage In Patients With Essential Hypertension Complicated By Impaired Glucose Tolerance

Objective: From detecting the activated level of Nuclear Factor -кB/p65(NF-κB/p65) of peripheral blood mononuclear cells(PBMCs), the levels of serum high-sensitivity C-reactive protein(hs-CRP),left ventricular mass index (LVMI),microalbuminuria(UMA ) and serum creatinine (SCr) in patients with essential hypertension complicated by impaired glucose tolerance (IGT),we explore the inflammatory mechanisms of essential hypertension complicated by impaired glucose tolerance and the possible mechanisms of target organ damage, this study may provide new ideas for the clinical diagnosis and treatment. Methods: A total of 55 cases of patients with essential hypertension came from the cardiovascular medicine of Affiliated Hospital of Luzhou Medical College from April 2008 to September 2008, which were out-patients and patients in hospital wards; control group had 25 people, which were the patients with Paroxysmal supraventricular tachycardia in internal medicine and the health examination people from out-patient department of Luzhou Medical College Hospital. All selected cases and controls were not stable and unstable angina,myocardial infarction,heart failure,infection,rheumatic diseases,diabetes and so on, no more than half month they have not the history of using non-steroidal anti-inflammatory drugs. To collected the name,age,sex,height,weight,blood pressure and other general information, we measured cholesterol (TC),fasting blood glucose (FBG),triglyceride (TG),high density lipoprotein cholesterol(HDL-ch),low-density lipoprotein cholesterol(LDL-ch),high- sensitivity C-reactive protein (hs-CRP),liver function,serum creatinine (SCr),uric acid (UA),blood routine examination using fasting elbow venous blood samples, 4ml elbow venous blood was collected in the anticoagulant tube for the use of mononuclear cells, this followed by oral glucose tolerance test (OGTT), according to blood pressure,fasting blood glucose and OGTT 2h blood glucose, we decide whether the case was selected into control group, hypertension group or hypertension complicated by impaired glucose tolerance group. All the people were examined by the color doppler ultrasonography of heart, MAU,hs-CRP was detected,we calculated all the selected people′s body mass index(BMI),body surface area(BSA) and LVMI. In the laboratory, we isolate PBMCs using lymphocyte separation medium (Ficoll hypaque, d = 1.077) by density gradient centrifugation from 4ml elbow venous blood in the anticoagulation tube, then the number of the PBMCs were regulated at 2×107/ml with PBS liquid. Cells suspended fluid was smeared and fixed, after that we detected the activated level of Nuclear Factor -кB/p65(NF-κB/p65) of PBMCs with SP staining method, under the microscope to calculate their rate of positive cells. Random sample T test,X2 fourfold table test and pearson correlation analysis Were carried out on all the indicators. Results: Total 55 cases who meet the inclusion criteria were selected, including 28 with simple hypertension,27 with hypertension complicated by impaired glucose tolerance, 25 people were selected in control group. 1,Comparison in clinical general situation: between the each group, gender composition,age,fasting blood glucose,triglyceride,low density lipoprotein were no differences (P>0.05); Hyper- tension complicated by IGT group′s OGTT 2h glucose was higher than simple hypertension group and control group(P <0.05); Two case groups′BMI,SBP,DBP,TC were higher than control group(P <0.05), were: BMI (26.29±4.00 & 24.30±1.52 vs 22.93±1.41),systolic blood pressure (170.2±17.1 & 163.2±15.7 vs 110.0±10.1),diastolic blood pressure (96.2±5.4 & 97.5±9.7 vs 70.8±7.2),TC (5.18±0.79 & 5.35±1.26 vs 3.60±0.40); two case groups′HDL–ch was lower than the control group (1.19±0.25 & 1.28±0.32 vs 1.76±0.44, P <0.05); Between two case groups, body mass index,hypertension,age,systolic blood pressure,diastolic blood pressure,TC level,HDL-ch were no difference(P>0.05). 2,Comparison in hs-CRP,LVMI,UMA,SCr,positive cells ratio of NF-κB/P65 between hypertension complicated by IGT group,hypertension group and control group: Compared with the control group, simple hypertension group′s hs– CRP,LVMI,UMA,SCr,positive cells ratio of NF-κB/P65 increased (P <0.05) , were: hs-CRP (8.97±4.13 vs 3.15±2.13),LVMI (122±10 vs 97±8),UMA (30.34±6.60 vs 14.32±5.78),SCr (91.18±25.85 vs 55.71±14.48),positive cells ratio of NF-κB/P65(25.73±9.12 vs 11.19±5.62) ; Hypertension complicated by IGT group′s hs-CRP,LVMI,UMA,SCr,positive cells ratio of NF-κB/P65 were significantly higher (P﹤0.001), were: hs-CRP (13.82±5.92 vs 3.15±2.13),LVMI (135±14 vs 97±8),UMA (48.17±25.81 vs 14.32±5.78),SCr (127.4±32.8 vs 55.7± 14.5),positive cells ratio of NF-κB/P65 (38.29±11.03 vs 11.19±5.62); Two case group′s comparison: In hypertension complicated by IGT group, hs-CRP,LVMI,UMA,SCr,positive cells ratio of NF-κB/P65 were higher than simple hypertensive group (P <0.05), were: hs-CRP (13.82±5.92 vs 8.97±4.13),LVMI (135±14 vs 122±10),UMA (48.17±25.81 vs 30.34±6.60),SCr (127.4±32.8 vs 91.18±25.85),positive cells ratio of NF-κB/P65(38.29±11.03 vs 25.73±9.12). 3,The correlation between hs-CRP,OGTT 2h blood glucose,LVMI,UMA,SCr,positive cells ratio of NF-κB/P65 in simple hypertension group and hypertension complicated by IGT group. Hypertensive group: The correlation between hs-CRP and LVMI,UMA,SCr,positive cells ratio of NF-κB/P65 was positively correlated(r=0.532,p=0.004;r=0.543,p=0.003;r=0.627,p﹤0.001;r=0.712,p﹤0.001); The correlation between positive cells ratio of NF-κB/P65 and LVMI,UMA,SCr was positively correlated(r=0.581, p=0.001; r=0.416, p=0.028; r=0.517, p=0.005). Hypertension complicated by IGT group:①The correlation between hs-CRP and LVMI,UMA,SCr,positive cells ratio of NF-κB/P65 was positively correlated(r=0.500,p=0.008;r=0.439,p=0.022;r=0.489,p=0.010;r=0.395,p=0.041); The correlation between positive cells ratio of NF-κB/P65 and LVMI,UMA,SCr was positively correlated(r=0.611, p=0.001; r=0.407, p=0.035; r=0.403, p=0.037).②The correlation between OGTT 2h blood glucose and hs-CRP,LVMI,UMA,SCr,positive cells ratio of NF-κB/P65 was positively correlated(r=0.477,p=0.012;r=0.583,p=0.001;r=0.523,p=0.005;r=0.579,p=0.002;r=0.447,p=0.019). Conclusion: 1. Compared with the simple hypertensive patients and normal people, patients with hypertension complicated by impaired glucose tolerance have more active inflammation in vivo, it is showed that hs-CRP and positive cells ratio of NF-κB/P65 are higher. 2. Hypertension patients complicated by impaired glucose tolerance combine with more serious heart and kidney target-organ damage than simple hypertensive patients. 3. hs-CRP,NF-κB may be involved in the process of target-organ damage in heart and kidney of hypertensive patients and patients with hypertension complicated by impaired glucose tolerance, hs-CRP can predict The degree of target organ damage in patients with hypertension complicated by impaired glucose tolerance.4. Patients with hypertension have a higher incidence of impaired glucose tolerance, the patients combined wih higher blood sugar levels have higher hs-CRP levels, hs-CRP can predict the risk of impaired glucose tolerance in patients with hypertension, can evaluate the degree of impaired glucose tolerance.