高血压患者血管内皮功能与左心室舒张功能间关系的超声研究

Relationship between brachial artery endothelial function and left ventricular diastolic function in patients with hypertension by ultrasonography

目的研究原发性高血压患者肱动脉内皮功能改变与左心室舒张功能改变间的关系。方法研究对象包括43例原发性高血压病患者和16例健康对照者。应用高分辨率超声测量静息状态下、反应性充血试验后、舌下含服硝酸甘油后的肱动脉内径,并计算反应性充血试验和硝酸甘油诱发的肱动脉内径百分变化率。应用超声心动图检测二尖瓣口血流频谱,测量舒张早期峰值血流速度(E)、舒张晚期峰值血流速度(A)及其比值(E/A)。结果E/A正常及异常的高血压病患者其反应性充血试验诱发的肱动脉内径百分变化率均低于健康对照者(P<0·001),E/A异常的高血压病患者反应性充血试验诱发的肱动脉内径百分变化率低于E/A正常的高血压病患者[(3·26±2·67)%vs(5·61±2·32)%,P<0·01]。硝酸甘油诱发的肱动脉内径百分变化率在E/A正常及异常的高血压病患者和健康对照者之间差别无显著统计学意义(P>0·05)。单因素相关分析显示,反应性充血试验诱发的高血压病患者肱动脉内径百分变化率与E/A比值无明显相关(r=0·231,P=0·073),与A值明显相关(r=-0·190,P=0·034)。结论高血压病患者肱动脉内皮依赖性舒张功能减低,左心室舒张功能异常者肱动脉内皮依赖性舒张功能减低程度更为明显。

Objective To explore the relationship between brachial artery endothelial function and left ventricular diastolic function in patients with hypertension using ultrasonography. Methods Measurements of brachial artery diameter were performed by high-resolution ultrasonography during baseline, reactive hyperemia (RH) and sublingual nitroglycerin administration (NTG) in 43 patients with essential hypertension and 16 healthy subjects. The percent changes in brachial artery diameter induced by RH and NTG were calculated. Mitral valve flow profiles were detected by echocardiography. Maximal velocities in early diastole (E), and in atrial contraction (A) were measured and the ratio of E/A (E/A) was calculated. Results The percent change in the brachial artery diameter induced by RH in patients with hypertension was significantly less than that in healthy subjects (P<0.001). While in patients with abnormal E/A it was significantly less than that in patients with normal E/A [(3.26±2.67)% vs (5.61±2.32)%, P<0.01]. No significant difference could be found in percent change in the brachial artery diameter induced by NTG between patients and controls (P>0.05). The percent change in the brachial artery diameter induced by RH did not correlate with E/A (r=0.231, P=0.073). However, the percent change in the brachial artery diameter induced by RH correlated with A (r=-0.190, P=0.034). Conclusion Brachial endothelium-dependent dilation is impaired in patients with hypertension. The impairment of brachial endothelium-dependent dilation in patients with abnormal left ventricular diastolic function is more serious than that in patients with normal left ventricular diastolic function.