老年高血压合并高胆固醇血症对大动脉结构和功能的影响

Effects of senile hypertension complicated with hypercholesterolemia on the structure and function of brachial artery

目的观察老年高血压合并高胆固醇血症患者肱动脉结构、缓冲功能、内皮依赖血管扩张功能的变化。方法采用HPIP.IP彩色多普勒超声仪检测高血压患者(高血压组,n=25)、高血压合并高胆固醇血症患者(高血压合并高胆固醇血症组,n=22)和无高血压和高胆固醇血症患者(正常对照组,n=25)肱动脉的结构肱动脉内膜中层厚度(brachialarteryintima-mediathickness,IMT)、肱动脉舒张末期内径(diastolicdiameter,DD)及肱动脉内膜中膜厚度与内径的比值(IMT/DD)和功能的指标肱动脉横断面顺应性(cross-sectionalcompliance,CSC)、容积扩张性(volumedistensibility,VD)及肱动脉内皮依赖血管扩张功能(endothelium-dependentvasodiationfunction,FMD),分析其差异及其相关性。结果IMT,IMT/DD两个高血压组明显大于正常对照组[高血压组和高血压合并高胆固醇血症组IMT分别为(0.37±0.02)和(0.37±0.09)mm;IMT/DD分别为0.08±0.04和0.08±0.02],差异有显著性意义(P<0.01～0.05);两个高血压组之间差异无显著性意义。CSC,VD,FMD高血压组低于正常对照组[高血压组和高血压合并高胆固醇血症组CSC分别为(19.22±4.86)和(14.76±3.36)×10-3mm2/mmHg;VD分别为(1.56±0.11)和(1.33±0.12)×10-3mm2/mmHg;FMD分别为(10.31±0.87)%和(7.01±1.36)

AIM:To evaluate the changes of structure,buffering function and endothelium dependent vasodilation function of brachial artery in the elderly hypertensive patients with hypercholesterolemia.METHODS:HPIP.IP color Doppler ultrasound was used to examine the structure of brachial artery:brachial artery intima media thickness(IMT),diastolic diameter(DD) and IMT/DD of brachial artery,and the functional indexes:cross sectional compliance(CSC),volume distensibility(VD) and endothelium dependent vasodiation function(FMD) of brachial artery in 25 hypertensive patients(hypertension group),22 hypertensive patients with hypercholesterolemia (hypertension+hypercholesterolemia) and 25 subjects without hypertension and hypercholesterolemia(normal control group).The differences and correlation were analyzed.RESULTS:The IMT and IMT/DD in the hypertensive group [(0.37±0.02) mm,0.08±0.04] and hypertension+hypercholesterolemia group[(0.37±0.09) mm,0.08±0.02] were significantly higher than those in the normal control group(P< 0.01-0.05),while there was no significant difference between the two hypertension groups.CSC,VD and FMD in the hypertension group[(19.22±4.86)×10-3 mm2/mm Hg,(1.56±0.11)×10-3 mm2/mm Hg,(10.31±0.87)%] and the hypertension+hypercholesterolemia group [(14.76±3.36)×10-3 mm2/mm Hg,(1.33±0.12) ×10-3 mm2/mm Hg,(7.01±1.36)%] were significantly lower than those in the normal control group(P< 0.01-0.05),and those in the hypertension+hypercholesterolemia group were obviously lower than those in the hypertension group(P< 0.01-0.05).The systolic pressure and FMD were the closest parameters related with VD(F=118.91,92.21,P< 0.01).CONCLUSION:The buffering function of brachial artery is decreased by hypertension,and it can be deteriorated by hypertension combined with hypercholesterolemia.Endothelial functions,especially the FMD,play important roles in decreasing the buffering function of brachial artery and reducing the elasticity of large artery.