代谢综合征患者危险因素聚集对血管内皮功能的影响

Effect of risk factor aggregation on vascular endothelial function in patients with metabolic syndrome

目的:了解代谢综合征患者的血管内皮功能以及心血管危险因素聚集对血管内皮功能的影响。方法:通过高分辨率超声分别测定代谢综合征患者(n=35)、原发性高血压患者(n=35)、2型糖尿病患者(n=31)和正常对照组(n=21)反应性充血后和含服硝酸甘油后肱动脉内经和血流量。结果:三酰甘油、收缩压、舒张压,空腹血糖,餐后2h血糖和体质量指数在4组中差异有显著性。与正常对照组比较,代谢综合征组、原发性高血压组和糖尿病组反应性充血后肱动脉内经变化率(percentageofdi-ameterchangeofreactivehyperemia,ΔDRH)降低,差异有显著性犤代谢综合征组为(6.94±3.15)%,原发性高血压组为(9.46±4.96)%,糖尿病组为(9.03±4.92)%,对照组为(15.46±3.00)%,F=18.55,P<0.001犦,含服硝酸甘油后肱动脉内经变化率(percentageofdiameterchangeofnitroglycerinsublingualadministration,ΔDNTG)降低,差异也有显著性犤代谢综合征组为(13.55±6.37)%,原发性高血压组为(18.50±6.04)%,糖尿病组为(17.29±8.43)%,对照组为(23.33±3.48)%;F=10.21,P<0.001犦。与原发性高血压组和糖尿病组比较,代谢综合征组ΔDRH和ΔDNTG差异有显著性。代谢综合征患者ΔDRH降低,分别与年龄、三酰甘油、收缩压、舒张压、空腹血糖、餐后2h血糖和体重指数呈负相?

AIM:To investigate the effect of vascular endothelial function and cardiovascular risk factor clustering on vascular endothelial function in patients with metabolic syndrome. METHODS:Brachial artery diameter and blood flow after reactive hyperemia in the patients with metabolic syndrome(MS)(n=35),patients with hypertension(HT)(n=35), patients with type 2 diabetes mellitus DM) (n=31) and subjects in the normal control group(n=21) were measured by high-resolution ultrasonography. RESULTS:The differences of triglyceride(TG),systolic blood pressure, diastolic blood pressure,fasting blood glucose, postprandial blood glucose and body mass index were significant among 4 groups. As compared with the normal control group, percentage of diameter change of reactive hyperemia(ΔDRH)of the patients in the MS, HT and DM groups were decreased,which indicated great significance[(6.94±3.15)%in the MS group,(9.64±4.96)%in the HT group,(9.03±4.92)%in the DM group and(15.46±3.00)%in the normal control group,F=18.55,P< 0.001]. And the percentage of diameter change of nitroglycerin sublingual administration(ΔDNTG) was decreased, which also showed significant difference[(13.55±6.37)%in the MS group(18.50±6.04)%in the HT group(17.29±8.43)%in the DM group and (23.33±3.48)%in the normal control group (F=10.21,P< 0.001)].ΔDRH and ΔDNTG of patients in the MS group were significantly decreased as compared with those in the HT and DM groups.ΔDRH in patients with metabolic syndrome was negatively related with age(r=-0.29,P< 0.05),TG(r=-0.38,P< 0.005),systolic blood pressure(r=-0.71,P< 0.001)diastolic blood pressure(r=-0.61,P< 0.001),fasting blood glucose(r=-0.62,P< 0.001),postprandial blood glucose(r=-0.66,P< 0.001) and body mass index(r=-0.47,P=0.046) respectively. CONCLUSION: Endothelial dysfunction in patients with metabolic syndrome is more serious than that in patients with hypertension or diabetes mellitus alone.The more the risk factors are in cardiovascular disease, the more severe is the endothelial dysfunction.Endothelium-dependent dilatation in patients with metabolic syndrome is significantly negatively related with age,TG,blood pressure,blood glucose and body mass index.