中华老年心脑血管病杂志

目的 分析外周血胞膜上嘌呤受体P2X配体门控离子通道7(P2X7R)水平与老年高血压合并冠心病患者心肌缺血及自主神经改变的关系。方法 前瞻性选取2020年8月至2022年8月三二〇一医院诊治的老年冠心病患者146例，根据心肌缺血情况分为心肌缺血组86例，非心肌缺血组60例。比较2组外周血P2X7R水平与心肌缺血总负荷(TIB)差异，分析P2X7R与TIB的相关性。采用ROC曲线分析P2X7R对心肌缺血的预测价值。以P2X7R预测心肌缺血的截断值分为高水平组76例，低水平组70例，比较2组心率变异性时域指标、频域指标差异。结果 心肌缺血组外周血P2X7R及TIB明显高于非心肌缺血组(P<0.01)。Pearson相关性分析显示，P2X7R水平与TIB呈正相关(r=0.624,P<0.01)。ROC曲线分析显示，P2X7R预测老年高血压合并冠心病患者心肌缺血的截断值为698.94 ng/L,曲线下面积为0.800(95%CI:0.726～0.874),敏感性、特异性分别为70.9%、88.3%。P2X7R、TIB是老年高血压合并冠心病患者心肌缺血发生的危险因素(OR=2.056,95%CI:1.373～3.079,P<0.01;OR=1.276,95%CI:1.128～1.444,P<0.01)。高水平组心率变异性时域指标明显低于低水平组，心率变异性频域指标明显高于低水平组，差异有统计学意义(P<0.01)。结论 外周血P2X7R是老年高血压合并冠心病患者心肌缺血的影响因素，与心肌缺血严重程度相关，可反映自主神经功能损害程度。

Objective To analyze the relationship of purine 2X ligand-gated ion channel receptor 7(P2X7R) level on peripheral blood membrane with myocardial ischemia and autonomic nervous changes in elderly hypertension patients with coronary heart disease.Methods A total of 146 elderly patients with coronary heart disease and treated in the 3201 Hospital from August 2020 to August 2022 were enrolled and divided into myocardial ischemia group(86 cases) and non-myocardial ischemia group(60 cases).The expression of P2X7R in peripheral blood and total myocardial ischemia burden(TIB) were compared between the two groups, and the correlation between them was analyzed.ROC curve was plotted to analyze the predictive value of P2X7R for myocardial ischemia.According to the cut-off value of P2X7R in the prediction, the patients were divided into high level group(76 cases) and low level group(70 cases).The differences of heart rate variability in time domain and frequency domain was compared between the two groups.Results The peripheral blood level of P2X7R and TIB were significantly higher in the myocardial ischemia group than the non-myocardial ischemia group(P<0.01).Pearson correlation analysis showed that P2X7R level was positively correlated with TIB(r=0.624,P<0.01).ROC curve analysis indicated that the cut-off value of P2X7R in predicting myocardial ischemia in elderly patients with hypertension and coronary heart disease was 698.94 ng/L,and the AUC value was 0.800(95%CI:0.726-0.874),with a sensitivity and specificity of 70.9% and 88.3%,respectively.TIB and P2X7R were risk factors for myocardial ischemia of coronary heart disease combined with hypertension(OR=2.056,95%CI:1.373-3.079,P<0.01;OR=1.276,95%CI:1.128-1.444,P<0.01).The high level group had significantly lower time domain but higher frequency domain of heart rate than the low level group(P<0.01).Conclusion Peripheral blood P2X7R is an influencing factor of myocardial ischemia in elderly hypertensive patients with coronary heart disease and associated with the severity of myocardial ischemia, and can reflect the impairment of autonomic nerve function.