中国全科医学 ›› 2023, Vol. 26 ›› Issue (20): 2469-2475.DOI: 10.12114/j.issn.1007-9572.2023.0008

• 论著 • 上一篇    下一篇

剪切力和雌二醇与高血压的相关性研究

禹彤1,2, 杨一1,2, 杜诗虹1,2, 丁梓豪1,2, 洪秀琴1,2,*()   

  1. 1.410000 湖南省长沙市,湖南师范大学第一附属医院 湖南省人民医院
    2.410000 湖南省长沙市,湖南省分子流行病学重点实验室
  • 收稿日期:2022-11-15 修回日期:2023-02-22 出版日期:2023-07-15 发布日期:2023-02-03
  • 通讯作者: 洪秀琴

  • 作者贡献:禹彤负责文章的构思与设计,统计学处理,研究的实施与可行性分析,进行论文的撰写及修订;杨一、杜诗虹负责数据收集、整理;丁梓豪负责结果分析与解释;洪秀琴负责文章的质量控制及审核,监督管理,对文章整体负责。
  • 基金资助:
    国家自然科学基金资助项目(81773530)

Correlation of Shearing Force and Estradiol with Hypertension

YU Tong1,2, YANG Yi1,2, DU Shihong1,2, DING Zihao1,2, HONG Xiuqin1,2,*()   

  1. 1. First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha 410000, China
    2. Key Laboratory of Molecular Epidemiology of Hunan Province, Changsha 410000, China
  • Received:2022-11-15 Revised:2023-02-22 Published:2023-07-15 Online:2023-02-03
  • Contact: HONG Xiuqin

摘要: 背景 低剪切力能诱导血管炎症反应,从而引起高血压的发生、发展。雌激素可以通过雌激素受体介导的途径调节免疫系统和炎症反应,对高血压具有保护作用。 目的 为了解女性高血压流行现状和影响因素,探究剪切力、雌二醇与女性高血压的相关性及在不同剪切力下雌二醇对高血压的影响,进而探究雌二醇与剪切力的交互作用对高血压的影响。 方法 选取2021年1—8月于湖南省人民医院心内科住院的纳入288例女性高血压患者作为病例组,并从湖南省人民医院体检科随机抽取296例女性非高血压体检者作为对照组。使用自行设计的问卷调查研究对象的一般资料,抽取研究对象清晨空腹静脉血进行实验室指标的检测,采用彩超多普勒进行血管彩超检查计算剪切力。采用多因素Logistic回归构建高血压预测模型并绘制列线图,绘制受试者工作特征曲线(ROC曲线)评价高血压预测模型,对雌二醇进行四分组分层分析,探究不同剪切力二分组下各雌二醇分组对高血压发生的影响,利用相乘交互作用模型评价雌二醇和剪切力之间的交互作用。 结果 病例组与对照组年龄、受教育程度、BMI、绝经、高血压家族史、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、雌二醇、尿酸(UA)、肌酐(Scr)、尿素氮(BUN)、剪切力、血液黏稠度(WBV)比较,差异有统计学意义(P<0.05)。多因素Logistic回归结果显示,年龄>60岁〔OR=2.172,95%CI(1.361,3.468)〕、绝经〔OR=14.940,95%CI(1.938,115.176)〕、高血压家族史〔OR=1.614,95%CI(1.014,2.570)〕、BMI 24~28 kg/m2〔OR=3.454,95%CI(2.072,5.758)〕、BMI>28 kg/m2〔OR=6.750,95%CI(2.380,19.146)〕、TG 1.30~1.83 mmol/L〔OR=1.980,95%CI(1.114,3.520)〕、TG>1.83 mmol/L〔OR=2.311,95%CI(1.308,4.082)〕、TC 4.29~5.12 mmol/L〔OR=2.222,95%CI(1.250,3.950)〕、TC>5.12 mmol/L〔OR=1.884,95%CI(1.062,3.341)〕、LDL-C>2.81 mmol/L〔OR=1.546,95%CI(1.150,2.078)〕、HDL-C>1.17 mmol/L〔OR=0.140,95%CI(0.065,0.301)〕、BUN>5.47 mmol/L〔OR=3.249,95%CI(2.380,4.434)〕、Scr>69 μmol/L〔OR=1.166,95%CI(1.126,1.207)〕、UA>324 μmol/L〔OR=1.040,95%CI(1.029,1.050)〕、WBV<3.39 mPa·s或>4.41 mPa·s〔OR=3.456,95%CI(2.557,4.671)〕、雌二醇10.60~<15.39 ng/L〔OR=0.053,95%CI(0.015,0.183)〕、雌二醇15.39~<23.99 ng/L〔OR=0.022,95%CI(0.006,0.077)〕、雌二醇>23.99 ng/L〔OR=0.005,95%CI(0.001,0.020)〕,剪切力>8.21 dyne/cm2〔OR=0.033,95%CI(0.017,0.062)〕是高血压发生的影响因素(P<0.05)。绘制预测模型诊断高血压的ROC曲线,结果显示预测模型ROC曲线下面积为0.907〔95%CI(0.882,0.923),P<0.01〕,灵敏度79.60%,特异度87.90%。模型1、2在剪切力≤8.21 dyne/cm2人群中,随着雌二醇水平的增加,高血压发生风险呈下降趋势(P趋势=0.001)。在剪切力≤8.21 dyne/cm2人群中,雌二醇≥15.39 ng/L与高血压风险降低的关系更显著〔OR=0.037,95%CI(0.017,0.079),P<0.05〕,在剪切力>8.21 dyne/cm2人群中,雌二醇≥15.39 ng/L与高血压降低的关系更显著〔OR=0.012,95%CI(0.005,0.019),P<0.05〕。 结论 雌二醇≥10.60 ng/L是高血压的保护因素;在低剪切力下雌二醇对高血压的保护作用更大;剪切力与雌二醇对高血压具有相乘交互作用。

关键词: 高血压, 雌二醇, 剪切力, 血流动力学, 影响因素分析

Abstract:

Background

Low shearing force can induce vascular inflammatory response, which leads to the occurrence and development of hypertension. Estrogen can regulate the immune system and inflammatory response through estrogen receptor mediated pathway, with a protective effect on hypertension. Cardiovascular diseases have become the leading cause of death in China.

Objective

To investigate the current prevalence and influencing factors of hypertension in women, explore the correlation of shearing force and estradiol with hypertension as well as the effect of estradiol on hypertension under various shearing force, so as to further explore the effect of the interaction between estradiol and shearing force on hypertension.

Methods

Female patients admitted to the Department of Cardiology of Hunan People's Hospital from January to August 2021 were selected as the study subjects, 288 of whom with essential hypertension were included as the case group, and 296 female non-hypertensive medical examiners in the physical examination department of Hunan People's Hospital were randomly selected as the control group. The self-designed questionnaire was used to investigate the general information of the study subjects, and the fasting venous blood samples of the subjects were taken in the early morning for the examination of laboratory indicators. The color doppler ultrasound was used for ultrasonography on vessels to calculate the shearing force. Multivariate Logistic regression was used to construct the hypertension prediction model and draw the nomogram. Receiver operating characteristic curve (ROC curve) was plotted to evaluate the hypertension prediction model. Stratification analysis was conducted on estradiol in four groups to explore the effect of each estradiol group on the occurrence of hypertension under different shearing force dichotomous groups. The multiplicative interaction model was used to evaluate the interaction between estradiol and shearing force.

Results

There were significant differences in age, education level, body mass index (BMI), menopause, family history of hypertension, triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), estradiol, uric acid (UA), creatinine (Scr), urea nitrogen (BUN), shear force, and blood viscosity between the case group and control group (P<0.05). Multivariate Logistic regression results showed age>60 years old〔OR=2.172, 95%CI (1.361, 3.468) 〕, menopause〔OR=14.940, 95%CI (1.938, 115.176) 〕, family history of hypertension〔OR=1.614, 95%CI (1.014, 2.570) 〕, BMI of 24-28 kg/m2OR=3.454, 95%CI (2.072, 5.758) 〕, BMI>28 kg/m2OR=6.750, 95%CI (2.380, 19.146) 〕, TG of 1.30-1.83 mmol/L〔OR=1.980, 95%CI (1.114, 3.520) 〕, TG>1.83 mmol/L〔OR=2.311, 95%CI (1.308, 4.082) 〕, TC of 4.29-5.12 mmol/L〔OR=2.222, 95%CI (1.250, 3.950) 〕, TC>5.12 mmol/L〔OR=1.884, 95%CI (1.062, 3.341) 〕, LDL-C>2.81 mmol/L〔OR=1.546, 95%CI (1.150, 2.078) 〕, HDL-C>1.17 mmol/L〔OR=0.140, 95%CI (0.065, 0.301) 〕, BUN>5.47 mmol/L〔OR=3.249, 95%CI (2.380, 4.434) 〕, Scr>69 μmol/L〔OR=1.166, 95%CI (1.126, 1.207) 〕, UA>324 μmol/L〔OR=1.040, 95%CI (1.029, 1.050) 〕, WBV<3.39 mPa·s or >4.41 mPa·s〔OR=3.456, 95%CI (2.557, 4.671) 〕, estradiol of 10.60-<15.39 ng/L〔OR=0.053, 95%CI (0.015, 0.183) 〕, estradiol of 15.39-<23.99 ng/L〔OR=0.022, 95%CI (0.006, 0.077) 〕, estradiol >23.99 ng/L〔OR=0.005, 95%CI (0.001, 0.020) 〕, shearing force >8.21 dyne/cm2OR=0.033, 95%CI (0.017, 0.062) 〕were influncing factors for hypertension (P<0.05). ROC curve of clinical prediction model of hypertension was plotted, the results showed that the area under ROC curve of the prediction model was 0.907〔95%CI (0.882, 0.923), P<0.01〕, with sensitivity of 79.60% and specificity of 87.90%. The risk of hypertension tended to decrease in the shearing force≤8.21 dyne/cm2 group (Ptrend =0.001). In the shearing force ≤8.21 dyne/cm2 group, estradiol≥15.39 ng/L was more significantly associated with reduced risk of hypertension〔OR=0.037, 95%CI (0.017, 0.079), P<0.05〕. In the shearing force >8.21 dyne/cm2 group, estradiol≥15.39 ng/L was significantly associated with reduced risk of hypertension〔OR=0.012, 95%CI (0.005, 0.019), P<0.05〕.

Conclusion

Estradiol≥10.60 ng/L as a protective factor for hypertension, with higher protective effect of estrogen on hypertension at low shearing force, and there is a multiplicative interaction between shearing force and estradiol on hypertension.

Key words: Hypertension, Estradiol, Shearing force, Hemodynamics, Root cause analysis