Catena Cristiana, Colussi Gianluca, Fagotto Valentina, Sechi Leonardo A
Department of Experimental and Clinical Medical Sciences, Hypertension Unit, Internal Medicine, University of Udine, 33100 Udine, Italy.
J Res Med Sci. 2017 May 30;22:57. doi: 10.4103/jrms.JRMS_619_16. eCollection 2017.
A prothrombotic state is associated with the presence and severity of organ damage in hypertensive patients. In these patients, evidence of subclinical carotid functional changes anticipates major cardiovascular events. The aim of this study was to investigate the association of hemostatic markers with carotid artery stiffness in hypertension.
In 116 untreated essential hypertensive patients recruited at a referral center in the University of Udine, we assessed common carotid artery stiffness by B-mode ultrasonography and measured plasma fibrinogen, D-dimer, plasminogen activator inhibitor-1 (PAI-1), and homocysteine by the currently available methods. For statistical reasons, the patients were divided according to the median value of each index of carotid stiffness, and continuous variables were further analyzed by univariate correlation and stepwise multivariate regression analysis.
PAI-1 levels were significantly higher in patients with low coefficient of distensibility ( = 0.018) and high Young's elastic modulus ( = 0.012), whereas no association of fibrinogen, D-dimer, and homocysteine levels was observed with carotid coefficient of distensibility, Young's elastic modulus, and β-stiffness. On univariate analysis, Young's elastic modulus was significantly and positively correlated with PAI-1 levels ( = 0.286, = 0.002), a correlation that on multivariate regression resulted to be independent of other confounders (β = 0.289, = 0.028).
An independent association of plasma PAI-1 levels with carotid artery stiffness suggests a possible contribution of decreased fibrinolytic activity to the early functional abnormalities of arterial vessels in hypertensive patients. This contribution might be relevant for subsequent development of hypertension-related cardiovascular complications.
血栓前状态与高血压患者器官损害的存在及严重程度相关。在这些患者中，亚临床颈动脉功能改变的证据可预测重大心血管事件。本研究旨在探讨高血压患者止血标志物与颈动脉僵硬度之间的关联。
在乌迪内大学转诊中心招募的116例未经治疗的原发性高血压患者中，我们通过B型超声评估颈总动脉僵硬度，并采用现有方法测量血浆纤维蛋白原、D-二聚体、纤溶酶原激活物抑制剂-1（PAI-1）和同型半胱氨酸。出于统计学原因，根据颈动脉僵硬度各指标的中位数对患者进行分组，并通过单变量相关性分析和逐步多变量回归分析对连续变量进行进一步分析。
在扩张系数低（=0.018）和杨氏弹性模量高（=0.012）的患者中，PAI-1水平显著更高，而未观察到纤维蛋白原、D-二聚体和同型半胱氨酸水平与颈动脉扩张系数、杨氏弹性模量及β僵硬度之间存在关联。单变量分析显示，杨氏弹性模量与PAI-1水平显著正相关（=0.286，=0.002），多变量回归分析结果表明这种相关性独立于其他混杂因素（β=0.289，=0.028）。
血浆PAI-1水平与颈动脉僵硬度之间存在独立关联，提示纤溶活性降低可能对高血压患者动脉血管早期功能异常有一定作用。这种作用可能与高血压相关心血管并发症的后续发展有关。
