藏汉两族人群血管内皮功能的差异比较(英文)

Differences of vascular endothelial function between Tibetan and Han nationality populations

背景:近年来研究认为内皮功能是动脉粥样硬化性疾病的新的独立危险因子,但藏汉两族人群内皮功能的差异尚未得到充分研究。目的:比较藏汉两族人群内皮功能的差异,同时比较血脂及肥胖相关指标。设计:对比分析。单位:解放军总医院心内科和解放军西藏军区总医院心内科。对象:选择272名藏族男性代表藏族人群,年龄(43±9)岁,均为拉萨本地居民。选择580名青藏铁路建设工人代表汉族人群,均为男性,年龄(42±11)岁;均来自四川省;且在拉萨市居住1年以上,同样生活在同一高原地区(拉萨市海拔3658m)。所有参试者均为2006-02/05在解放军西藏军区总医院进行常规健康体检者,且对检测项目知情同意。方法:①测量身高、体质量、腰围、臀围、收缩压、舒张压,计算体质量指数(体质量/身高2)。②肱动脉舒张功能检查:采用GE公司Vivid7超声仪、10MHz高频探头扫描右臂肱动脉。先记录肱动脉基础直径,之后将袖带充气至高于受试者收缩压50mm Hg(1mm Hg=0.133kPa)以阻断动脉血流,并保持4min。在充气状态下及放气后2min时分别测量肱动脉直径。袖带放气后,血管反应性充血,此时血流量增加以适应前臂阻力血管的扩张。使用计算机辅助软件计算肱动脉直径。肱动脉内皮功能绝对变化和相对变化由Vivid 7超声仪本身附带软件自动计算得出。③生化检查:禁食12h后,采用日立7600型全自动生化分析仪测定血总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平。④计量资料比较采用方差分析,计数资料采用卡方检验。主要观察指标:比较两组之间的体质量指数、腰臀比、血压、血脂、基础肱动脉直径和肱动脉直径变化。结果:藏族人272名和汉族人580名均进入结果分析。①肱动脉舒张功能:藏族人群基础肱动脉直径明显大于汉族人群[(4.28±0.06),(4.03±0.04)mm,t=71.9156,P<0.01],肱动脉绝对及相对变化分别为(0.124±0.005)mm,(2.934±0.204)%,明显小于汉族[(0.141±0.006)mm,(3.587±0.152)%,t=40.5820,52.1732,P<0.01]。②体格检查结果:藏族人群体质量指数、腰臀比分别为(30.1±2.5)kg/m2,0.92±0.07,明显大于汉族人群[(26.5±3.4)kg/m2]。③血清三酰甘油和低密度脂蛋白胆固醇水平:藏族人群分别为(2.31±1.31),(3.49±0.91)mmol/L,明显高于汉族人群[(1.97±1.44),(3.07±0.86)mmol/L,t=3.4200,6.5223,P<0.01]。结论:①藏族人群肱动脉舒张功能较汉族人群差,即血管反应性差。②藏族人群腹型肥胖较汉族严重,血脂也较高。

BACKGROUND： Recently, it is thought that endothelial function is a new independent risk factor of atherosclerotic disease. However, the differences in endothelial function between Tibetan and Han nationality populations have not been fully investigated. OBJECTIVE： To investigate the differences in endothelial function between Tibetan and Han nationality population. DESIGN ： Controlled analysis. SETTING： Department of Cardiology, General Hospital; Department of Cardiology, Tibet General Hospital of Chinese PLA. PARTICIPANTS： Totally 272 Tibetan male subjects, aged （43±9） years, were enrolled in this study to stand for Tibetan nationality populations. All of them were native residents in Lhasa city. And 580 Qinghai-Tibetan railway constructers with Han nationality, aged （42±11） years, were enrolled in this study to stand for Hart nationality populations. All of them were male subjects from Sichuan province and lived in Lhasa city for at least 1 year. All the participants received regular physical examination between February and May 2006 in the General Hospital of Tibet Military Area Command of Chinese PLA. All the subjects lived in the same high-altitude area （the altitude of Lhasa is 3 658 m）. informed consents were obtained from all the participants. METHODS： ①Height, body mass, waist circumference, hip circumference, systolic blood pressure（SBP） and diastolic blood pressure （DBP） were measured. Body mass index （BMI） was measured as body mass/height. ② Measurement of brachial artery flow-mediated dilation （FMD）： All the participants, who were in the fasting state, were examined in supine position following 20-minute rest. The room temperature was about 20 ℃. In the right arm, a sphygmomanometer cuff was positioned 5 cm below the antecubital fossa. A 10-MHz transducer （Vivid 7, GE Corporation, USA） was used to image the right brachial artery. After obtaining the baseline imaging, the blood pressure cuff was inflated 50 mm Hg （1 mm Hg=0.133 kPa） above the participant＇s SBP to occlude the brachial artery for 4 minutes. The brachial artery was then imaged during cuff inflation and 2 minutes after cuff release. After the cuff was released and reactive hyperaemia occurred, that was, flow in the brachial artery increased to accommodate the dilated resistance vessels in the forearm. In order to ensure the reliability of the data, the cuff placement and image record were performed by two designated performers. Computer-assisted analysis software was used to calculate brachial artery diameters. The absolute and relative changes of brachial artery FMD were automatically calculated out with the attached software of Vivid 7 ultrasonic diagnosis instrument. ③Biochemical study： The biochemical parameters were obtained after an overnight fasting for 12 hours. Venous blood was sampled for the measurement of total cholesterol, triglyceride （TG）, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol （LDL-C）. ④ Analysis of variance was used to evaluate the measurement data. Chi-square statistic was used to compare enumeration data. MAIN OUTCOME MEASURES： Comparison of change in BMI, waist-hip ratio, blood pressure, blood lipid, baseline brachia diameter and brachial diameter between 2 groups. RESULTS： Totally 272 Tibetan nationality populations and 583 Han nationality populations participated in the final analysis. ① Brachial artery FMD： The baseline brachial artery diameter of Tibetan nationality populations was significantly larger than that of Han nationality population [（4.28±0.06） mm vs. （4.03±0.04） mm, t =71.915 6, P 〈 0.01）; The absolute and relative changes of brachial artery of Tibetan nationality populations were significantly smaller than those of Han nationality populations, respectively [（0.124±0.005）mm vs. （0.141±0.006） mm; （2.934±0.204）% vs. （3.587±0.152）%, t = 40.582 0,52.173 2, P 〈 0.01]. ②Physical study results： BMI and waist-hip ratio of Tibetan nationality populations were significantly larger than those of Han nationality populations [（30.1±2.5） kg/m^2 vs. （26.5± 3.4） kg/m^2, 0.92±0.07 vs. 0.88±0.05, t =15.595 1, 9.525 4, P 〈 0.01]. ③TG and LDL-C levels of Tibetan nationality population were （2.31±1.31） mmol/L and （3.49±0.91） mmol/L, respectively, which were significantly higler than those of Han nationality population [（1.97±1.44） mmol/L and （3.07±0.86） mmol/L, t =3.420 0, 6.522 3, P 〈 0.01]. CONCLUSION ： ① Brachial artery FMD of Tibetan nationality population is poorer than that of Han nationality population, i.e. poor vascular reactivity. ② Tibetan nationality populations have severe abdominal obesity and higher level of blood lipid as compared with Han nationality populations.