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中华临床医师杂志(电子版) ›› 2023, Vol. 17 ›› Issue (10) : 1040 -1044. doi: 10.3877/cma.j.issn.1674-0785.2023.10.003

临床研究

抗β1肾上腺素受体自身抗体在高血压并左室舒张功能不全中的临床研究
王亮, 王君, 吕雪白, 袁玉婷, 刘小慧, 张文超()   
  1. 102206 北京,北京大学国际医院心血管内科
    102206 北京,北京大学国际医院综合门诊部
    100039 北京,解放军总医院第三医学中心体检中心
  • 收稿日期:2023-08-08 出版日期:2023-10-15
  • 通信作者: 张文超
  • 基金资助:
    北京市重点实验室开放研究课题项目(2017年代谢紊乱相关心血管疾病北京市重点实验室开放研究课题项目)

Clinical significance of expression of anti-β1-adrenergic receptor autoantibody in hypertension with left ventricular diastolic dysfunction

Liang Wang, Jun Wang, Xuebai Lv, Yuting Yuan, Xiaohui Liu, Wenchao Zhang()   

  1. Department of Cardiology, Peking University International Hospital, Beijing 102206, China
    Comprehensive Outpatient Department, Peking University International Hospital, Beijing 102206, China
    Physical Examination Center, Third Medical Center, The General Hospital of the People's Liberation Army, Beijing 100039, China
  • Received:2023-08-08 Published:2023-10-15
  • Corresponding author: Wenchao Zhang
引用本文:

王亮, 王君, 吕雪白, 袁玉婷, 刘小慧, 张文超. 抗β1肾上腺素受体自身抗体在高血压并左室舒张功能不全中的临床研究[J/OL]. 中华临床医师杂志(电子版), 2023, 17(10): 1040-1044.

Liang Wang, Jun Wang, Xuebai Lv, Yuting Yuan, Xiaohui Liu, Wenchao Zhang. Clinical significance of expression of anti-β1-adrenergic receptor autoantibody in hypertension with left ventricular diastolic dysfunction[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(10): 1040-1044.

目的

探讨抗β1肾上腺素受体自身抗体(β1-AR-Ab)在高血压并左室舒张功能不全中的表达及临床意义。

方法

选取2018年4月~2018年12月就诊的原发性高血压患者及体检健康者作为研究对象,入院后行超声心动图检查,将原发性高血压合并左心室舒张功能不全并左房扩大的49例患者作为研究组,95例体检健康者作为对照组;比较2组左心室射血分数(LVEF)、左心室后壁厚度(LVPW)、室间隔厚度(IVS)、左心室舒张末期内径(LVEDd)、左心房舒张末期内径(LAEDd)、二尖瓣口舒张早期血流峰速/二尖瓣口舒张晚期血流峰速值(E/A比值)、二尖瓣口舒张早期血流峰速/二尖瓣环舒张早期运动速度值(E/e'比值)、血清β1-AR-Ab(OD值);比较2组血清β1-AR-Ab阳性(OD值>2.1)发生率,比较2组间血清β1-AR-Ab的OD值水平;计算2组E/A比值及E/e'比值,采用Logistic多元回归分析进行血清β1-AR-Ab水平与年龄、性别、血压、心率的相关性分析,利用ROC曲线评估血清β1-AR-Ab水平对高血压伴左室舒张功能不全的预测价值。

结果

经检测,研究组血清β1-AR-Ab阳性率显著高于对照组(P<0.05);研究组血清β1-AR-Ab水平(OD值)显著高于对照组(P<0.001);经Logistic多因素回归分析结果显示,血清β1-AR-Ab水平与年龄、性别、血压等因素无显著相关性;以E/A及E/e'比值为金标准,分析血清β1-AR-Ab水平对高血压患者左室舒张功能不全的预测价值:敏感度69.4%,特异度81.1%,AUC=0.788,与Az=0.5相比,差异有统计学意义(P<0.001)。

结论

血清β1-AR-Ab水平在高血压并左室舒张功能不全患者中明显升高,敏感性及特异性较高,对该类患者具有很好的临床预测价值。

Objective

To investigate the expression and clinical significance of anti-β1-adrenergic receptor autoantibody (β1-AR-Ab) in patients with hypertension complicated with left ventricular diastolic dysfunction.

Methods

Patients with essential hypertension and healthy volunteers were selected as the research subjects from April 2018 to December 2018. Echocardiography was performed after admission. Forty-nine patients with essential hypertension complicated with left ventricular diastolic dysfunction and left atrial enlargement were selected as a research group and 95 healthy persons were included as a control group. The left ventricular ejection fraction (LVEF), left ventricular posterior wall thickness (LVPW), ventricular septal thickness (IVS), left ventricular end diastolic diameter (LVEDd), left atrial end diastolic diameter (LAEDd), E/A and E/e' ratios, and serum β1-AR-Ab (OD value) were compared between the two groups. The incidence of serum β1-AR-Ab positivity (OD value > 2.1) and the OD value of serum β1-AR-Ab were compared between the two groups. The correlation of serum β1-AR-Ab level with age, gender, blood pressure, heart rate, and echocardioimagedata indexes was analyzed by logistic multiple regression analysis. The predictive value of serum β1-AR-Ab level in hypertension with left ventricular diastolic dysfunction was evaluated by receiver operating characteristic (ROC) curve analysis.

Results

The positive rate of serum β1-AR-Ab in the study group was significantly higher than that of the control group (P<0.05). Serum β1-AR-Ab level was significantly higher in the study group than in the control group (P<0.001), and in patients with severe left ventricular diastolic dysfunction than in patients with mild and moderate left ventricular diastolic dysfunction as well as healthy volunteers (P<0.001). Logistic multiple regression analysis showed that there was no significant correlation between serum β1-AR-Ab level and age, gender, and blood pressure. Taking E/A and E/e' ratios as the gold standard, the predictive value of serum β1-AR-Ab level for left ventricular diastolic dysfunction in patients with hypertension was analyzed: sensitivity 69.4%, specificity 81.1%, and area under the ROC curve = 0.788, which were statistically better compared with those of Az=0.5 (P<0.001).

Conclusion

Serum β1-AR-Ab significantly increases in hypertensive patients with left ventricular diastolic dysfunction, and it has high sensitivity and specificity in predicting hypertension with left ventricular diastolic dysfunction.

表1 对照组和研究组一般资料的对比
表2 对照组和研究组超声心动图检查结果的比较(
表3 对照组和研究组血清β1-AR-Ab水平结果的比较(
图1 对照组和研究组各亚组间血清β1-AR-Ab水平结果的比较 注:与正常对照组相比,*P<0.05,**P<0.001;与Ⅰ级左室舒张功能不全组相比,##P<0.001;与Ⅱ级左室舒张功能不全组相比,&&P<0.001;正常对照(n=95,0.34±0.53),Ⅰ级(n=24,1.30±1.17),Ⅱ级(n=22,0.98±1.14),Ⅲ级(n=3,10.21±4.66)
表4 2组β1-AR-Ab阳性检出率的比较
表5 血清β1-AR-Ab水平与年龄、性别、血压等Logistic多因素回归分析
图2 ROC曲线分析结果
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