Barsukov Anton V, Seidova Alla Yu, Shcherbakova Ksenia A, Black Marina S, Korovin Alexander E, Churilov Leonid P, Tovpeko Dmitry V
S.M. Kirov Military Medical Academy, St. Petersburg 194044, Russia.
Medical-Sanitary Unit of the Ministry of Internal Affairs of the Russian Federation in St. Petersburg and Leningrad Region, St. Petersburg 191015, Russia.
Pathophysiology. 2020 Dec 12;27(1):30-43. doi: 10.3390/pathophysiology27010005.
The aim of this research was to correlate indicators of proinflammatory status and the structural/functional characteristics of the cardiovascular system comparatively in male and female patients with essential hypertension (EH) complicated by diastolic chronic heart failure (CHF) with preserved left ventricular ejection fraction (LVEF). The study included 104 middle-aged patients (55 males (M) and 49 females (F)) with first- or second-degree EH complicated by CHF with preserved LVEF. They all belonged to the low functional class of CHF, with LVEF ≥50%, first- or second-degree of LV diastolic dysfunction (LVDD), LV hypertrophy (LVH), and dilatation of the left atrium (LA) with a sinus rhythm and N-terminal brain natriuretic peptide >125 pg/mL. Serum levels of C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), and interleukin-6 (IL-6) were measured. To identify the relationship between the proinflammatory pattern and cardiovascular parameters, Spearman's rank correlation coefficients were determined. M had markedly higher levels of CRP, TNF-α, and IL-6 compared to F. However, all the mean values corresponded to the reference range. Significant direct associations of CRP level with the LV mass index (LVMI), relative wall thickness (RWT), LA volume index (LAVI), E/e' ratio, and systolic and diastolic blood pressure (SBP, DBP) existed in both M and F, as well as negative correlations of CRP with LVDD parameter e' and distance covered in a 6 min walk test. M and F had a positive association between IL-6 and LVMI, LAVI, E/e' ratio, SBP, RWT, and DBP, as well as strong negative associations between IL-6 and e' and distance passed in 6 min in each group. Significant direct correlations existed between serum TNF-α level and LVMI, RWT, LAVI, E/e', SBP, and DBP both in M and F. Furthermore, there were negative relationships of TNF-α level with e' and the distance covered for the 6 min walk. This study demonstrated a close relationship between the blood levels of proinflammatory autacoids and indicators of EH, exercise tolerance, LVH, LVDD, and LA enlargement, regardless of the patient's sex. Compared to female patients, male patients had stronger correlations of CRP, TNF-α, and IL-6 levels with indicators of LVDD degree.
本研究的目的是比较合并舒张性慢性心力衰竭（CHF）且左心室射血分数（LVEF）保留的原发性高血压（EH）男性和女性患者的促炎状态指标与心血管系统的结构/功能特征。该研究纳入了104例中年患者（55例男性（M）和49例女性（F）），他们患有一级或二级EH并合并LVEF保留的CHF。他们均属于CHF低功能分级，LVEF≥50%，存在一级或二级左心室舒张功能障碍（LVDD）、左心室肥厚（LVH）以及左心房（LA）扩张，窦性心律，N末端脑钠肽>125 pg/mL。检测了血清C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）和白细胞介素-6（IL-6）水平。为确定促炎模式与心血管参数之间的关系，计算了Spearman等级相关系数。与女性相比，男性的CRP、TNF-α和IL-6水平显著更高。然而，所有平均值均在参考范围内。在男性和女性中，CRP水平与左心室质量指数（LVMI）、相对壁厚度（RWT）、LA容积指数（LAVI）、E/e'比值以及收缩压和舒张压（SBP、DBP）均存在显著正相关，CRP与LVDD参数e'以及6分钟步行试验中的步行距离呈负相关。在男性和女性中，IL-6与LVMI、LAVI、E/e'比值、SBP、RWT和DBP呈正相关，且在每组中IL-6与e'以及6分钟内步行距离呈强负相关。血清TNF-α水平与男性和女性的LVMI、RWT、LAVI、E/e'、SBP和DBP均存在显著正相关。此外，TNF-α水平与e'以及6分钟步行距离呈负相关。本研究表明，无论患者性别如何，促炎自分泌物质的血水平与EH、运动耐量、LVH、LVDD和LA扩大指标之间存在密切关系。与女性患者相比，男性患者的CRP、TNF-α和IL-6水平与LVDD程度指标的相关性更强。
