作者：曾莲，潘宏彬，罗秀峰，王新云

单位：

541002广西壮族自治区桂林市，广西壮族自治区南溪山医院心内科

Units：

Department of Cardiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin 541002, China

关键词：

高血压；心脏扩大；左心室肥厚；NLR家族，热蛋白结构域包含蛋白3

Keywords：

　Hypertension; Cardiomegaly; Left ventricular hypertrophy; NLR family, pyrin domain-containing 3 protein

CLC：

R 544.1

DOI：

10.12114/j.issn.1008-5971.2023.00.213

Funds：

广西壮族自治区卫生健康委员会自筹经费科研课题（Z20200414）

摘要：

　目的　探讨核苷酸结合寡聚化结构域样受体蛋白3（NLRP3）与高血压患者发生左心室肥厚的关系。 方法　回顾性选取2021—2022年广西壮族自治区南溪山医院收治的382例高血压患者为研究对象，收集患者的临床资 料（人口学资料、实验室检查指标、动态血压监测结果、心脏超声检查结果、血清NLRP3 mRNA相对表达量），根据 血清NLRP3 mRNA相对表达量中位数将患者分为高表达组和低表达组，比较两组临床资料。采用多因素Logistic回归 分析探讨高血压患者发生左心室肥厚的影响因素；采用ROC曲线分析血清NLRP3 mRNA相对表达量预测高血压患者发 生左心室肥厚的价值。结果 382例高血压患者血清NLRP3 mRNA相对表达量为0.01～0.75，中位数为0.34，高表达组 （血清NLRP3 mRNA相对表达量≥0.34）194例，低表达组（血清NLRP3 mRNA相对表达量＜0.34）188例。高表达组 血尿酸、24 h平均收缩压（24 h SBP）、白昼平均脉压（DPP）、夜间平均脉压（NPP）、24 h动态脉压、左心室舒张 末期内径（LVEDD）、左心室收缩末期内径（LVESD）、室间隔厚度（IVST）、左心室后壁厚度（LVPW）、左心室 质量指数（LVMI）及左心室肥厚发生率高于低表达组（P＜0.05）。382例高血压患者发生左心室肥厚108例，未发生 左心室肥厚274例。发生左心室肥厚患者HDL-C、血尿酸、24 h SBP、DPP、NPP、24 h动态脉压、LVEDD、LVESD、 IVST、LVPW、血清NLRP3 mRNA相对表达量高于未发生左心室肥厚患者（P＜0.05）。多因素Logistic回归分析结果显 示，血尿酸、24 h SBP、DPP、NPP、24 h动态脉压和血清NLRP3 mRNA相对表达量是高血压患者发生左心室肥厚的影 响因素（P＜0.05）。ROC曲线分析结果显示，血清NLRP3 mRNA相对表达量预测高血压患者发生左心室肥厚的AUC为 0.706〔95%CI（0.651，0.761）〕，最佳截断值为0.42，灵敏度为57.41%，特异度为78.47%。结论　血清NLRP3 mRNA 相对表达量较高（≥0.34）者左心室肥厚发生率较高，血尿酸、24 h SBP、DPP、NPP、24 h动态脉压和血清NLRP3 mRNA相对表达量是高血压患者发生左心室肥厚的影响因素，且血清NLRP3 mRNA相对表达量对高血压患者发生左心 室肥厚有一定预测价值。

Abstract：

　Objective To investigate the relationship between NOD-like receptor protein 3 (NLRP3) and left ventricular hypertrophy in hypertensive patients. Methods A total of 382 patients with hypertension admitted to Nanxishan Hospital of Guangxi Zhuang Autonomous Region from 2021 to 2022 were retrospectively selected as the research subjects. Clinical data (demographic data, laboratory examination indexes, ambulatory blood pressure monitoring results, and cardiac ultrasound examination results, serum relative expression level of NLRP3 mRNA) of patients were collected, the patients were divided into high expression group and low expression group according to the median serum relative expression level of NLRP3 mRNA. The clinical data was compared between the two groups. Multivariate Logistic regression analysis was used to analyze the influencing factors of left ventricular hypertrophy in hypertensive patients, and the ROC curve was used to analyze the predictive value of the serum relative expression level of NLRP3 mRNA for left ventricular hypertrophy in hypertensive patients. Results The serum relative expression level of NLRP3 mRNA in 382 hypertensive patients was from 0.01 to 0.75, with a median of 0.34. There were 194 cases in the high expression group (serum relative expression level of NLRP3 mRNA was ≥ 0.34) and 188 cases in the low expression group (serum relative expression level of NLRP3 mRNA < 0.34) . Uric acid, 24 h systolic blood pressure (24 h SBP) , day pulse pressure (DPP) , night pulse pressure (NPP) , 24-hour dynamic pulse pressure, left ventricular end diastolic dimension (LVEDD) , left ventricular end systolic dimension (LVESD) , interventricular septal thickness (IVST) , left ventricular posterior wall (LVPW) , 1eft ventricular mass index (LVMI) and the incidence of left ventricular hypertrophy in the high expression group were higher than those in the low expression group (P < 0.05) . Among 382 hypertensive patients, 108 had left ventricular hypertrophy and 274 did not. HDL-C, uric acid, 24 h SBP, DPP, NPP, 24-hour dynamic pulse pressure, LVEDD, LVESD, IVST, LVPW, serum relative expression level of NLRP3 mRNA in the patients with left ventricular hypertrophy were higher than those in the patients without left ventricular hypertrophy (P < 0.05) . Multivariate Logistic regression analysis showed that the uric acid, 24 h SBP, DPP, NPP, 24-hour dynamic pulse pressure and serum relative expression level of NLRP3 mRNA were the influencing factors of left ventricular hypertrophy in hypertensive patients (P < 0.05) . The results of ROC curve analysis showed that the AUC of the serum relative expression level of NLRP3 mRNA in predicting left ventricular hypertrophy in hypertensive patients was 0.706 [95%CI (0.651, 0.761) ] , the best cut-off value was 0.42, sensitivity was 57.41%, and specificity was 78.47%. Conclusion The incidence of left ventricular hypertrophy is higher in patients with higher serum relative expression level of NLRP3 mRNA ( ≥ 0.34) , uric acid, 24 h SBP, DPP, NPP, 24-hour dynamic pulse pressure and serum relative expression level of NLRP3 mRNA are the influencing factors of left ventricular hypertrophy in hypertensive patients. Serum relative expression level of NLRP3 mRNA has certain predictive value for left ventricular hypertrophy in hypertensive patients.

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