老年收缩期高血压不同糖耐量水平时的大动脉僵硬度

Impact of Glucose Intolerance and Diabetes Mellitus on Arterial Stiffness in Systolic Hypertension

目的探讨老年收缩期高血压病人糖代谢异常时对大动脉僵硬度是否有叠加作用。方法老年收缩期高血压病人132例进行口服葡萄糖耐量试验,按WHO标准分为糖耐量正常组(NGT),糖耐量/空腹血糖受损(IGT/IFG)组,糖尿病(DM)组。同期21例健康老年人为对照组。彩色超声仪检测颈总动脉内膜中膜厚度(IMT),收缩期内径(Ds),舒张期内径(Dd),计算弹性内径(ΔD=Ds-Dd),动脉弹性系数(DC),动脉顺应性系数(CC),僵硬指数(SI),弹性模量(EP)。结果收缩期高血压病人IMT,Ds,Dd显著高于健康对照组。由NGT组向IGT/IFG及DM发展,IMT、SI、EP逐渐增加,而DC,CC逐渐下降。多元逐步回归证明在无血糖紊乱的老年单纯收缩期高血压病人中,脉压与年龄是大动脉僵硬度增加的主要决定因素,而伴有糖耐量异常,糖尿病时,则餐后2h血糖与糖化血红蛋白也成了危险因素。结论在收缩期高血压病人伴随糖代谢异常时,动脉弹性进一步下降,动脉僵硬度明显增加,顺应性下降,在治疗高血压的同时,应当加强对血糖控制。

Objective To investigate the impact of glucose tolerance and diabetes mellitus on arterial stiffness in systolic hypertension. Methods One hundred and thirty two elderly patients with isolatel systolic hypertension were enrolled and were classified by the severity of impairment of glucose metabolism into three groups： group Ⅰ normal glucose tolerance（NGT）; group Ⅱ impaired glucose tolerance/impaired fasting glucose（IGT/ IFG） and group Ⅲ： diabetes mellitus（DM）. Age and gender matched normotensive elderlys served as control. Carotid intimal-medial thickness（IMT）, systolic diameter（DS） and diastolic diameter（Dd） were measured by ultrasonics. Arterial elasticity indexes were calculated as： arterial distensibility coefficient（DC）, compliance coefficient（CC）, stiffness index（SI）, pressure-strain elastic modulus（EP）. Results IMT, Ds and Dd in the systolic hypertension patients significantly higher than normotensive control group. IMT, SI and EP were increased commensurately with the order from NGT to IGT/IFG to DM. Whereas DC and CC were decreased. Multiple linear regression analysis showed pulse pressure and aging contributed arterial stiffness in isolated systolic hypertension with NGT, however, post prandial 2 h hyperglycemia and HbA1c were included as the determinants for arterial stiffness in IGT/IFG and DM patients. Conclusions In the systolic hypertension with impaired glucose metabolism, DC and CC were significantly decreased but SI was significantly increased. Tightly control glucose metabolism in patients with isolated hypertension is strongly advocated.