老年隐蔽性高血压患者踝臂指数变化的临床意义

Clinical implications of the changes of ankle brachial index in elderly patients with masked hypertension

目的探讨老年隐蔽性高血压患者踝臂指数(ABI)的异常情况及临床意义。方法根据动态血压和诊室血压将研究对象分为隐蔽性高血压(MH)组32例、原发性高血压(EH)组45例和正常血压(NT)组40例。测定踝臂指数(ABI)、高敏C反应蛋白(hs-CRP)和髓过氧化物酶(MPO)水平、血管内皮功能。结果与NT组比较,MH组、EH组ABI值显著性降低(P<0.05),hsCRP、MPO水平显著性增高(P<0.05),肱动脉内皮依赖性舒张功能有显著性减低(P<0.05)。老年MH患者ABI与hsCRP、MPO水平呈负相关(r=-0.723、-0.719,P均<0.01),与血管内皮功能障碍呈正相关(r=0.917,P<0.01)。结论 ABI降低与斑块不稳定、炎性反应及血管内皮功能受损密切相关,对提高老年MH患者高血压的诊出率,评价其动脉结构、功能的损害程度、判断预后、指导合理治疗有重要的临床意义。

Objective To investigate the abnormity and the clinical implications of ankle brachial index(ABI) in elderly patients with masked hypertension. Methods 117 elderly patients received the detection of ambulatory blood pressure monitoring and office blood pressuure, and then were divided into masked hypertension group (MH group,n=32),essential hypertension group (EH group,n=45) and normal group (NT group,n=40).ABI and endothelial dependent flow-mediated dilation(FMD) in the brachial artery were evaluated.At the same time,the levels of high sensitive C-reactive protein(hs-CRP) and myeloperoxidase(MPO) were measured. Results Compared with NT group, the levels of ABI and FMD were significantly decreased and the levels of hs-CRP and MPO were significantly increased in MH and EH groups. A negative correlation was observed between the level of ABI and hsCRP, MPO in MH group(r=-0.723,-0.719,P<0.01), and a positive correlation was observed between the level of ABI and FMD in MH group(r=0.917,P<0.01). Conclusions Abnormal ABI level is associated with the instability of plaque,inflammatory reaction and impaired vascular endothelial function in elderly patients with nocturnal hypertension. For the elderly patients with masked hypertension,abnormal ABI can early identify the damage of arterial structure and function, which plays an important role in evaluating the prognosis,and guiding rational therapy.