摘要
目的:探讨原发性高血压伴失眠患者血清神经肽Y（NPY）、5-羟色胺（5-HT）、脑源性神经营养因子（BDNF）水平变化情况及其临床意义。方法:选取2019年1月至2022年10月衡水市人民医院收治的单纯原发性高血压患者204例（高血压组）、原发性高血压伴失眠患者204例（高血压伴失眠组），另选取同期健康体检者204例（对照组），均行血清NPY、5-HT、BDNF水平检测，比较3组指标的变化情况。采用Pearson相关性分析法分析血清NPY、5-HT、BDNF水平与匹兹堡睡眠质量指数（PSQI）的相关性。以单纯原发性高血压患者为对照，采用多元条件Logistic回归分析法分析原发性高血压伴失眠的影响因素。结果:高血压组、高血压伴失眠组血清NPY、5-HT水平均高于对照组，血清BDNF水平均低于对照组，差异均有统计学意义（P均＜0.05）；高血压伴失眠组血清NPY、5-HT水平均高于高血压组，血清BDNF水平低于高血压组，差异均有统计学意义（P均＜0.05）。经Pearson相关性分析显示，高血压患者血清NPY、5-HT水平与PSQI评分呈正相关（r=0.624、0.645，P＜0.05），血清BDNF水平与PSQI评分呈负相关（r=-0.638，P＜0.05）；高血压伴失眠患者血清NPY、5-HT水平与PSQI评分均呈显著正相关（r=0.866、0.879，P＜0.05），血清BDNF水平与PSQI评分呈显著负相关（r=-0.875，P＜0.05）；经多元条件Logistic回归分析显示，高血压3级、高血压病程、饮浓茶或咖啡、吸烟、肥胖、生活工作压力、睡眠习惯不良及血清NPY、5-HT、BDNF水平均是原发性高血压患者伴发失眠的影响因素（OR=2.795、3.062、2.255、2.199、2.413、2.241、2.375、3.232、3.758、0.535，P＜0.05）；进一步校正高血压3级、高血压病程、饮浓茶或咖啡、吸烟、肥胖、生活工作压力、睡眠习惯不良后，多元条件Logistic回归分析显示血清NPY、5-HT水平均是原发性高血压患者伴发失眠的危险因素（OR=2.678、2.849，P＜0.05），而BDNF水平属于保护因素（OR=0.561，P＜0.05）。结论:原发性高血压伴失眠患者血清NPY、5-HT水平升高，而BDNF水平降低，此3项均与患者PSQI存在一定的相关性，均是原发性高血压伴发失眠的影响因素。
Abstract
Objective:To investigate the changes and clinical significance of serum neuropeptide Y (NPY), 5-hydroxytryptamine (5-HT), and brain-derived neurotrophic factor (BDNF) in patients with essential hypertension and insomnia.Methods:204 patients with simple primary hypertension (hypertension group) and 204 patients with primary hypertension and insomnia (hypertension and insomnia group) admitted in Hengshui People’s Hospital from January 2019 to October 2022 were included, and 204 healthy people (control group) at the same period were included, too. The serum NPY, 5-HT, and BDNF levels of them were measured and compared. The correlations between serum NPY, 5-HT, and BDNF levels and Pittsburgh sleep quality index (PSQI) score were analyzed by Pearson correlation analysis. Compared with patients with simple primary hypertension, the influencing factors of essential hypertension with insomnia were analyzed by multivariate conditional Logistic regression analysis method.Results:The levels of serum NPY and 5-HT in the hypertension group and the hypertension with insomnia group were higher than those in the control group, but the level of serum BDNF was lower than that in the control group, with the differences statistically significant (P＜0.05). The levels of serum NPY and 5-HT in the hypertension with insomnia group were higher than those in with hypertension group, but the level of serum BDNF was lower than that in the hypertension group, with the differences statistically significant (P＜0.05). Pearson correlation analysis showed that serum NPY and 5-HT levels were positively correlated with PSQI score in patients with hypertension (r=0.624, 0.645, P＜0.05), and the serum BDNF level was negatively correlated with PSQI score (r=-0.638, P＜0.05). Serum NPY and 5-HT levels in patients with hypertension and insomnia were positively correlated with PSQI score (r=0.866, 0.879, P＜0.05), while the serum BDNF level was negatively correlated with PSQI score (r=-0.875, P＜0.05). Multivariate conditional Logistic regression analysis showed that grade 3 hypertension, course of hypertension, drink strong tea or coffee, smoking, obesity, life and work pressure, poor sleep habits, and serum NPY, 5-HT and BDNF levels were the influencing factors of insomnia in patients with essential hypertension (OR=2.795, 3.062, 2.255, 2.199, 2.413, 2.241, 2.375, 3.232, 3.758, 0.535, P＜0.05). After further correction of hypertension grade 3, hypertension course, drinking strong tea or coffee, smoking, obesity, life and work pressure, and poor sleep habits, multiple conditional Logistic regression analysis showed that the levels of serum NPY and 5-HT were risk factors for insomnia in patients with essential hypertension (OR=2.678, 2.849, P＜0.05), while the BDNF level was a protective factor (OR=0.561, P＜0.05).Conclusion:The levels of serum NPY, 5-HT, and BDNF in patients with primary hypertension and insomnia are increased, while the level of BDNF is decreased, and these three are all related to the PSQI score of patients, and they are the influencing factors of primary hypertension and insomnia.
基金项目
河北省医学科学研究重点课题计划基金资助项目(20181579)
万方数据