摘要目的 探讨血CD34+、Toll样受体2(TLR2)、Toll样受体4(TLR4)和高敏C反应蛋白(hs-CRP)的水平变化与老年人单纯收缩期高血压(EISH)患者左心功能的关系. 方法 2008年2月至2010年2月徐州医学院淮安附属医院老年病科入住EISH合并慢性左心衰竭患者98例和同期健康体检者30例(对照组).根据美国纽约心脏病学会(NYHA)心功能分级、左心室射血分数(LVEF)和收缩压将EISH患者分Ⅰ级组25例、Ⅱ级组29例、Ⅲ级组24例和Ⅳ级组20例.使用双标记单克隆抗体和相应的对照抗体(由美国Beckman Coulter公司提供)标记血液中的白细胞,测定外周血CD34+,采用流式细胞仪检测对照组和EISH患者TLR2和TLR4的平均荧光强度(MFI),免疫散射比浊法测定hs -CRP的水平. 结果 Ⅰ级组、Ⅱ级组、Ⅲ级组、Ⅳ级组LVEF分别为(40.5±3.6)％、(30.8±2.5)％、(28.5±1.9)％和(26.4±2.1)％,收缩压分别为(151.1±5.9)mm Hg(1mm Hg=0.133 kPa)、(171.1±6.0)mm Hg、(190.7±7.3)mm Hg和(211.1±8.4)mm Hg.Ⅳ级组和Ⅰ级组比较,LVEF、收缩压、CD34+[分别为(0.5±0.2)×109/L和(2.5±0.4)×109/L]、TLR2[(8.0±1.0)MFI与(3.2±1.1)MFI]、TLR4[( 6.4±1.3)MFI与(2.4±1.1) MFI]、hs-CRP[( 14.7±0.3)mg/L与(4.90±0.61) mg/L]差异有统计学意义(均P＜0.05). 结论 TLR2、TLR4和hs-CRP水平增高及CD34+水平的下降与收缩压升高、LVEF下降和NYHA心功能分级升高相关.

abstractsObjective To study the relationship of left-ventricular function change with circulation levels of CD34+ cells,toll like receptor 2 (TLR2),TLR4 and high sensitivity C-reactive protein (hs-CRP)in elderly isolated systolic hypertension.Methods According to New York Heart Association (NYHA)class,left ventricular ejection fraction (LVEF) and systolic blood pressure (SBP),the healthy subjects and the patients were divided into 5 groups:control 30 cases,class Ⅰ 25 cases,class Ⅱ 29 cases,class Ⅲ 24 cases and class Ⅳ 20 cases.The expressions of circulating CD34 + cells,TLR2 and TLR4 in the patients and healthy subjects were measured by flow cytometry.The level of hs CRP was measured by nephelometry immunoassay.Results In class Ⅳ versus class Ⅰ,the levels of LVEF[(26.4±2.1)％vs.(40.5±3.6)％]and CD346 [(0.5±0.2) × 109 vs.(2.5±0.4) ×109 /L]were decreased,while SBP[(211.1±8.4)mm Hg vs.(151.1±5.9)mm Hg],TLR2 [(8.0±1.0) vs.(3.2±1.1)MFI],TLR4 [(6.4±1.3)MFT vs.(2.4±1.1)MFI]and hs-CRP [(14.7±0.3)mg/L vs.(4.9±0.6)mg/L]were increased (all P＜0.05).Conclusions The lower levels of CD34+ cells,higher TLR2,TLR4 and hs CRP levels are correlated with increasing SBP,decreasing LVEF and higher NYHA class.