老年原发性高血压微量白蛋白尿与血管内皮功能及颈总动脉粥样硬化

Microalbuminuria and Endothelial Function and Atherosclerosis of Common Carotid Artery in Aged Patients with Essential Hypertension

目的探讨老年原发性高血压(EH)患者微量白蛋白尿(MAU)与内皮依赖性舒张功能(EDF)及颈总动脉粥样硬化的关系。方法筛选老年高血压患者64例,根据24h尿白蛋白排泄率分成正常白蛋白尿组(NAU组)和微量白蛋白尿组(MAU组)。另设30例非EH老年人为对照组(NC组)。采用免疫比浊法测定24h尿白蛋白含量;采用彩色多普勒超声检测肱动脉内皮依赖性舒张功能,颈总动脉内中膜厚度(I MT)及其粥样斑块指数(PI)。结果(1)与对照组(9·1%±1·8%)比较,老年高血压患者NAU组已有内皮依赖性舒张功能降低(6·3%±1·1%,P<0·05),而MAU组内皮依赖性舒张功能则进一步降低(5·0%±1·4%,P<0·05)。(2)MAU组颈总动脉I MT较NAU组增高,且两组均较对照组增高[(1·0±0·2,0·9±0·1vs0·8±0·1)mm,P值均<0·05]。(3)MAU组的微量白蛋白尿与内皮依赖性舒张功能呈负相关(r=-0·597,P<0·001);微量白蛋白尿与颈总动脉I MT呈正相关(r=0·700,P<0·001)。结论老年EH患者均存在内皮依赖性血管舒张功能受损和颈总动脉粥样硬化,内皮依赖性舒张功能和I MT与微量白蛋白尿的发生密切相关。

Objective To investigate the relationship between microalbuminuria and endothelial func tion and atherosclerosis of common carotid artery （CCA） in aged patients with essential hypertension （EH）. Methods Sixty-four aged patients with EH were recruited. According to the albumin excretion rate （AER） in urine measured by immunoturbidimetry, patients were divided into two groups： normoalbuminuria group （NAU group） and mieroalbuminuria group （MAU group）. Thirty aged matched persons without EH served as control. The endothelium-dependent relaxing function of brachial artery（FMD）% intima-media thickness （IMT） and the plaque of CCA were measured by color Doppler ultrasound. Resuits The flow-mediated dilation in the MAU group was significantly lower than that in the NAU group; FMD in hypertension groups was significantly lower than that of the control group regardless with or without MAU（5.0%±1.4%, 6.3%±1.1%, vs control：9.1%±1.8%, both P〈0.05）. The IMT of CCA in the MAU group was significantly thicker than that of the NAU group, and the IMT of both groups was significantly thicker than that of the control group（1.0±0.2, 0.9±0. 1 vs control：0. 8±0.1 mm, both P 〈0.05）. The endothelium-dependent relaxing function negativly correlated with microalbuminuria（r=- 0. 597, P〈0. 001）, with microalbuminuria positivly correlated with the IMT of CCA（r= 0. 700, P〈0. 001）. Conclusion Microalbuminuria correlates with the decrease of endothelium-dependent relaxing function and increases in the incidence rate of atherosclerosis in CCA.