| Part I Association between homocysteine level and Tlymphocyte subsets in patients with H type hypertensionObjective: The aim of this study was to assess the relationship betweenhomocysteine level and T lymphocyte subsets in patients with H type hypertension,further to provide evidence for the mechanism of H type hypertension.Methods: The study included242consecutive H type hypertensive patients, H typehypertension was defined as hypertension with serum homocysteine level≥10μmol/l.According to homocysteine level patients were divided into3groups, group1: thelowest tertile80[11.76(10.91,12.55)μmol/l], group2: the midean tertile82[15.01(14.04,16.08)μmol/l], group3: the highest tertile80[20.44(18.01,26.37)μmol/l].The patients baseline characteristics of indicators were recorded, as following: sex,age, history of smoking, BMI, IMT, EF, serum lipid level(such as HDL, LDL, TC,apolipoprotein A, apolipoprotein B, triglyceride), glycosylated hemoglobin, fastingplasma glucose, serum homocysteine, T lymphocyte subgroups (CD3,CD4,CD8,CD4/CD8), immunoglobulins(IgG,IgA,IgM) and complements (C3,C4), renalfunction(creatinine, uric acid), carotid artery atherosclerotic plaques, complications(such as coronary heart disease, diabetes mellitus, cerebral infarction, atrial flutter oratrial fibrillation) in each group. Analysis of the above indicators was done in eachgroup, to establish the relationship between homocysteine level and the aboveindicators.Results: In the groups from1to3, CD4gradually decreasing and were57.93±13.59%VS51.88±12.22%VS50.83±13.97%，P=0.002, serum creatinine levelsgradually increasing and were62.27±18.01μmol/l VS67.55±18.06μmol/l VS77.62±19.29μmol/l, P<0.001，Serum uric acid level [307.01±87.72μmol/l VS330.36±94.97μmol/l VS365.0±106.02μmol/l, P=0.001], HDL[1.08±0.23mmol/l VS0.98±0.25 mmol/l VS0.98±0.22mmol/l， P=0.015], Apolipoprotein A[1.09±0.16g/l VS1.02±0.18g/l VS1.00±0.17g/l，P=0.002], ejection fraction [67.00(63.00,72.00)%VS65.00(62.00,69.25)%VS64.00(60.00,70.00)%，P=0.046], Glycosylated hemoglobin[5.90(5.70,6.20)%VS6.00(5.80,6.40)%VS5.80(5.60,6.00)%，P=0.008], Fastingplasma glucose [4.91(4.54,5.54) mmol/l VS4.87(4.51,5.96) mmol/l VS4.75(4.27,5.22)mmol/l, P=0.028]，male[29(36%) VS41(50%) VS50(63%),P=0.004]，smokers[14(18%) VS23(28%) VS29(36%)，P=0.028]，Diabetes mellitus[16(20%) VS19(23%) VS6(8%), P=0.02], Univariate analysis showed that CD4(r=-0.158， P=0.009), serum creatinine(r=0.277， P=0.046) were significantlyassociated with serum homocysteine. In addition, serum creatinine and CD4wereindependently correlated with serum homocysteine in the multivariable linearregression model.Conclusions: There are other clinical risk factors involved in the development of Htype hypertension, increased serum homocysteine level is the important characteristic.Serum homocysteine level is independently related to CD4and serum creatinine levelin patients with H type hypertension, indicating that cellular immunity (CD4) is alsoinvolved in the development of H type hypertension. H type hypertension has animportant impact on renal function (creatinine level), and impaired renal functionfurther exacerbates aggravated H type hypertension. So, we should controlhomocysteine levels, regulate immune function and improve renal function, which isimportant to prevent development of H type hypertension. Part II The relationship between hypertension andimmune functionObjective: The aim of this study was to assess the relationship between hypertensionand immune function in different age group and different grades of hypertension,further to provide evidence for the mechanism of hypertension.Methods: The study included286consecutive hypertensive patients,①on the basisof ages, patients were divided into four groups: group1: the young hypertensivepatients33[33.73±8.48year]；group2: the middle age hypertensive patients93[53.49±3.97year]； group3: the old age hypertensive patients118[66.74±4.42year]；group4：the very old hypertensive patients42[78.55±3.28year]。And②onthe basis of grades of hypertensive patients were divided into three groups(group1:grade1hypertension was19; group2: grade2hypertension was76; group3: grade3hypertension was191). The patients baseline characteristics of indicators wererecorded, as following: gender, age, smoke, BMI, IMT, EF, serum lipid level(such asHDL, LDL, TC, apolipoprotein A, apolipoprotein B, triglyceride), glycosylatedhemoglobin, fasting plasma glucose, serum homocysteine， T lymphocytesubgroups(CD3，CD4，CD8，CD4/CD8)，immunoglobulins(IgG，IgA，IgM)andcomplements(C3, C4), renal function(creatinine， uric acid), carotid arteryatherosclerotic plaques, complications(such as coronary heart disease, diabetesmellitus, cerebral infarction, atrial flutter or atrial fibrillation) in each group. Analysisof the above indicators was done in each group.Results:①In four groups: homocysteine level was gradually increasing[13.06(11.14,16.69)μmol/l VS13.53(11.67,16.20)μmol/l VS14.91(11.63,17.88)μmol/l VS16.15(13.06,23.79)μmol/l，P=0.035]；CD4was also graduallyincreasing [41.00(35.00,57.85)%VS54.53(46.00,61.99)%VS56.94(44.00,63.42)%VS56.00(38.50,66.92)%，P=0.006]；immunoglobulin IgA was alsogradually increasing [1.92(1.51,2.48)g/l VS2.23(1.65,2.63)g/l VS2.34(1.81,3.14)g/lVS2.86(2.00,3.59)g/l， P=0.001], complement C3was gradually decreasing[1.23(1.07,1.55)g/l VS1.14(1.03,1.28)g/l VS1.14(0.97,1.32)g/l VS1.08(0.95,1.28) g/l, P=0.020], serum creatinine levels were [68.20(54.80,74.70)μmol/l VS61.50(52.03,76.80)μmol/l VS66.70(55.15,77.60) μmol/l VS74.75(58.38,96.85)μmol/l, P=0.015]; Glycosylated hemoglobin was gradually increasing [5.75(5.40,6.13)%VS5.90(5.60,6.10)%VS5.90(5.70,6.10)%VS6.20(5.80,6.60)%，P=0.012], carotid atherosclerotic plaques were more towards higher in agegroups[4(12.1%) VS27(29.0%) VS57(48.3%) VS24(57.1%), P<0.001]. Role ofatrial flutter or atrial fibrillation was also gradually increasing towards increased agegroup [0(0%) VS1(1.1%) VS7(5.9%)VS5(11.9%), P=0.019]；Univariate analysisshowed that CD4(r=0.186，P=0.036)，immunoglobulin IgG (r=0.184，P=0.030)，complement C4(r=0.017，P=0.023)，carotid atherosclerotic plaques(r=0.317, P<0.001),triglyceride(r=0.180, P=0.003) were significantly positive associated with age, butCD3(r=-0.083， P=0.015), body mass index (r=-0.185, P=0.005), complementC3(r=-0.200, P<0.001) were significantly negative associated with age. In addition，the multivariable linear regression model show that carotid atheroscleroticplaques(P<0.001)， immunoglobulin IgG(P=0.013)， complement C4(P=0.01)，CD4(P=0.003)，triglyceride (P=0.002)were independently positively correlated withage，but CD3(P=0.011), body mass index(P<0.001)，complement C3(P<0.001) wereindependently negatively correlated with age.②in different grades of hypertension(grade1hypertension VS grade2hypertension VS grade3hypertension),complement C3was gradually increasing(1.04±0.23g/l VS1.13±0.21g/l VS1.20±0.29g/l，P=0.015), and carotid atherosclerotic plaques were more towards highergrades of hypertension[2(10.5%) VS28(36.8%) VS83(43.2%)，P=0.011].Conclusions: As the age increase, CD4and immunoglobulin IgA increase, butcomplement C3decreases indicating that cellular and humoral immunity disorder inhypertension with change in age. But in older age, the risk of atrial flutter or atrialfibrillation, diabetes and carotid atherosclerotic plaques are more occurred. As thegrades of hypertension increase, complement C3increases, indicating that C3involves in the development of the grades of hypertension. |
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