| Background: The incidence of cardiovascular disease increases significantly,and the occurrence of cardiovascular disease may be related to the inflammatory mechanism.Neutrophil to lymphocyte ratio(NLR)is a useful marker of inflammation because it is repeatable,inexpensive,accessible,and stable.Hypertension and type 2 diabetes are the two most potent risk factors for cardiovascular events.Inflammation affects the endothelial function.Endothelium-dependent flow-mediated Dilation(FMD)is a noninvasive detection technique to evaluate the endothelial function.The decrease of FMD indicates that vascular endothelial function is impaired.Currently,there are few reports on relationship between NLR and vascular endothelial dysfunction in patients with essential hypertension and essential hypertension complicated with diabetes.Objective: This study was to observe the changes of NLR and endothelial function in patients with hypertension and hypertension complicated with diabetes,and to detect the correlation between NLR and other risk factors with endothelial function.Method: A total of 736 essential hypertension patients aged between 18 and 75 who were hospitalized in our school from November 2014 to January 2018 were enrolled as the hypertension group.They were divided into the isolate essential hypertension group(n = 589)and the essential hypertension complicated with diabetes(n = 147)according to whether they had diabetes mellitus or not.300 healthy volunteers were selected as control group.Clinical characteristics were collected.Blood plasma was collected for laboratory examination,including fasting FPG,TC,LDL-C,TG,HDL-C,Cre,Cys C,Hcy,BNP,hs-CRP,Hb A1 c,WBC,N,L and other indicators.FMD and ambulatory blood pressure monitoring were evaluated.Data was processed by statistical R3.3.0 software.Data were expressed as mean ± standard deviation((?)± s).When comparing the differences among groups,if the normal distribution is followed,the variance analysis was used,if not the Kruskal-Wallis H test was chosen.Differences in the enumeration data between groups were analyzed by chi-square test.Pearson correlation analysis was used to investigate the correlation between FMD and other measures through correlation analysis.If the data is in line with the normal distribution,Pearson correlation analysis was used,otherwise,Spearman correlation analysis was used.Multivariate linear regression analysis was used to fit multiple regression equations of FMD and its related factors.The inspection level of this paper was two-sided test.a= 0.05.Result:1.The comparison of the backgroundThere were no statistical differences of sex,age,smoking or not,lipids,Cre and BNP in the three groups(P > 0.05).The main clinical drugs used among the three groups were different,however,there were no statistical differences between the two groups of hypertension(P > 0.05);FPG,Cys C,Hcy,Hb A1 c in the three groups were statistically different(P < 0.05).Further statistical analysis between groups:Compared with the isolate hypertension group and the control group,FPG and Hb A1 c in the hypertension with diabetes group were higher,and the difference were statistically significant;Cys C in the hypertension group was higher than the control group,the difference was statistically significant,while there was no significant difference in Cys C between the two groups of hypertension;Compared with the other two groups,Hcy in the isolate hypertension group was higher,and the difference was statistically significant,however,Hcy had no significant difference between the hypertension with diabetes group and the control group.2.Comparison of ambulatory blood pressure among three groups24 hours mean SBP,daytime average SBP,night average SBP,24 hours mean DBP,daytime average DBP,night average DBP and 24 hours mean heart rate were significantly different among the three groups.24 hours mean SBP,daytime average SBP and night average SBP all showed an increasing trend among the three groups,and there was statistical significance between the groups.Compared with the control group,24 hours mean DBP,daytime average DBP,night average DBP,24 hours mean heart rate in the hypertension group were higher,and the differences were statistically significant(P < 0.01),but the above data in the two groups of hypertension showed no significant difference(P > 0.05).3.Comparison of WBC,NLR,hs-CRP among groupsWBC were statistically significant(P < 0.01)among three groups.A further comparison between groups demonstrated that WBC increased significantly in the hypertension groups(P < 0.01),however,there was no significant difference between the two groups of hypertension(P > 0.05).NLR was 1.71±1.92(median 1.52),1.80±0.71(median 1.67),and 1.84±0.69(median 1.68)in the control group,the isolate hypertension group,and the hypertension with diabetes group respectively.NLR was statistically significant among the three groups(P < 0.01).NLR increased significantly in the hypertension groups compared with that of the control group(P < 0.01),however,it had no significant difference between the two hypertension groups(P > 0.05);hs-CRP was 1.22±2.03(median 0.64),1.89±3.07(median 1.01),and 2.58±3.79(median 1.28)in the control group,the isolate hypertension group,and the hypertension with diabetes group respectively.Hs-CRP gradually increased among the three groups,with significant difference between the three groups(P < 0.05).4.Comparison of FMD among groupsFMD was 6.35±1.70(median 6.50),5.07±2.65(median 4.70),and 5.01±2.47(median 4.70)in the control group,the isolate hypertension group,and the hypertension with diabetes group respectively.FMD was statistically significant among the three groups(P < 0.01).FMD reduced significantly in the hypertension groups compared with that of the control group(P < 0.01),however,FMD had no significant difference between the two hypertension groups(P > 0.05).5.Analysis of the factors influencing endothelial function:There was a negative correlation between FMD and the number of years of hypertension,age,WBC,NLR,BNP,TG,Cre,Hcy and a positive correlation with LDL-C in hypertension group(all P < 0.05);FMD was negatively correlated with age,WBC,NLR,BNP,TG,creatinine but positively correlated LDL-C in the isolate hypertension group.There was a negative correlation between FMD and the number of years of hypertension,age,NLR,creatinine,Cys C,Hcy,24 hours mean SBP,mean SBP during both daytime and nighttime in the group of hypertensive patients with diabetes mellitus.6.Multiple linear regression of risk factors for FMDFurther use of multiple stepwise regression analysis showed: the number of years of hypertension,age,NLR,Cre were independent risk factors for FMD in the hypertension group;Age and NLR were independent risk factors for FMD in the isolate hypertension group;Age,NLR,Cre were independent risk factors for FMD in the hypertension with diabetes group.Conclusion:1.NLR in patients with essential hypertension was higher than that in patients with normal blood pressure;In the primary hypertension with diabetes group,the inflammatory response may be more obvious than that of the isolate essential hypertension2.Endothelial function in patients with essential hypertension decreased than that of normal population3.NLR was negatively correlated with FMD in patients with essential hypertension,meanwhile NLR was a risk factor for endothelial dysfunction in patients with hypertension associated with diabetes,from which we can speculate that endothelial dysfunction may be related to inflammation. |
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