超重伴腹型肥胖的正常高值血压者的动脉僵硬度变化及相关影响因素

The changes of arterial stiffness and its influencing factors in overweight population with abdominal obesity and high-normal blood pressure

目的了解超重合并腹型肥胖正常高值血压人群大动脉僵硬度的变化及其影响因素。方法入选体质量指数(BMI)≥24.0 kg/m^2同时腹围增加(男性≥90,女性≥85 cm),收缩压介于120~139 mm Hg或舒张压80~89 mm Hg者为超重腹型肥胖正常高值血压组(n=87),同时入选BMI<24.0 kg/m^2、血压<120/80 mm Hg无疾病者为对照组(n=87)。所有入选者进行颈股动脉脉搏波传导速度(cfPWV)检测;同时留取清晨空腹血清测定血糖、血脂;并应用酶联免疫吸附试验(ELISA)法进行血清细胞间黏附分子-1(ICAM1)、单核细胞趋化蛋白-1(MCP1)、氧化型低密度脂蛋白(oxLDL)、巨噬细胞炎症蛋白2(GROβ)、中性粒细胞激活蛋白3(NAP3)测定。应用SPSS 17.0统计学软件对数据进行统计学分析。结果超重腹型肥胖正常高值血压组与对照组人群平均年龄[(50.6±9.1)比(51.3±10.4)岁],性别比例差异无统计学意义。超重腹型肥胖正常高值血压组BMI[(28.0±3.1)比(22.1±1.6)kg/m^2],腹围[(96.4±8.1)比(80.0±5.5)cm],血压[(132.3±7.3)/(77.4±7.5)比(114.3±6.0)/(71.1±6.5)mm Hg]高于对照组。超重腹型肥胖正常高值血压组cfPWV[(8.79±1.54)比(8.26±1.51)m/s]、低密度脂蛋白胆固醇(LDL-C)[(3.01±0.71)比(2.80±0.64)mmol/L]、三酰甘油[(1.86±1.32)比(1.10±0.63)mmol/L]、空腹血糖[(5.27±0.98)比(4.89±0.94)mmol/L]、oxLDL高于对照组,血高密度脂蛋白胆固醇(HDL-C)低于对照组。相关性分析结果显示,所有入选者中cfPWV与BMI、腹围、收缩压、舒张压呈正相关(r=0.186,0.211,0.185,0.163;均P<0.05),未发现cfPWV与血脂、空腹血糖、炎症指标相关。分组相关性分析结果显示,超重腹型肥胖正常高值血压组中cfPWV与年龄、收缩压呈正相关(r=0.301,0.218;均P<0.05),对照组未发现cfPWV与检测指标具有相关性。多元逐步线性回归分析结果显示,在排除其他因素影响后,腹围和年龄与cfPWV具有相关性(B=0.031,0.024;均P<0.05)。结论本研究发现在超重合并腹型肥胖的正常高值血压者中已存在大动脉僵硬度的改变,该变化发生的相关因素包括腹围、BMI和血压,而腹围是该人群大动脉僵硬度变化的影响因素之一。

Objective To investigate the changes of arterial stiffness and its influencing factors in overweight population with abdominal obesity and high-normal blood pressure.Methods Subjects with body mass index(BMI)≥24 kg/m^2 and waist circumference≥90(male)or≥85 cm(female),and systolic blood pressure 120-139 mm Hg or diastolic blood pressure 80-89 mm Hg were included into overweight abdominal obesity-high normal blood pressure group(n=87),and subjects with body mass index(BMI)<24 kg/m^2 and blood pressure(BP)<120/80 mm Hg into the control group(n=87).Carotid-femoral pulse wave velocity(cfPWV),sitting blood pressure,body weight,height,abdominal circumference,fasting blood lipid and fasting blood glucose(FBG)were measured in all subjects.Serum intercellular adhesion molecule-1(ICAM1),monocyte chemoattractant protein-1(MCP1),oxidized low density lipoprotein(oxLDL),macrophage inflammatory protein 2(GROβ),neutrophil activated protein 3(NAP3)were measured used enzyme-linked immunosorbent assay.Statistical analysis was used SPSS 17.0 statistics software.Results There was no significant difference in mean age[(50.6±9.1)vs(51.3±10.4)years]and gender between overweight abdominal obesity-high normal blood pressure group and healthy control group.BMI[(28.0±3.1)vs(22.1±1.6)kg/m^2],abdominal circumference[(96.4±8.1)vs(80.0±5.5)cm],blood pressure[(132.3±7.3)/(77.4±7.5)vs(114.3±6.0)/(71.1±6.5)mm Hg]were higher in overweight abdominal obesity-high normal blood pressure group than in control group.The levels of cfPWV[(8.79±1.54)vs(8.26±1.51)m/s],LDL-C[(3.01±0.71)vs(2.80±0.64)mmol/L],triglyceride[(1.86±1.32)vs(1.10±0.63)mmol/L],fasting blood glucose[(5.27±0.98)vs(4.89±0.94)mmol/L]and oxLDL in overweight abdominal obesity-high normal blood pressure group were higher,and the levels of HDL-C in blood were lower than those in control group.Correlation analysis showed that cfPWV was positively related with BMI,abdominal circumference,systolic blood pressure and diastolic blood pressure(r=0.186,0.211,0.185,0.163;all P<0.05).No correlation was found between cfPWV and blood lipid,fasting blood glucose and inflammation.Grouping correlation analysis showed that cfPWV was positively related with age and systolic blood pressure in the overweight abdominal obesity-high normal blood pressure group(r=0.301,0.218;all P<0.05),while not in the healthy control group.Multivariate stepwise regression analysis showed that the abdominal circumference and age were related with cfPWV after excluding other factors(B=0.031,0.024;all P<0.05).Conclusion Changes in arterial stiffness had been observed in abdominal obesity patients with normal high blood pressure,whose main changing factors included abdominal circumference,BMI and blood pressure,suggesting abdominal obesity may play a role in the changes of vascular function in this population.