原发高血压患者脉压对血管内皮功能和大动脉缓冲功能的影响

The Effccts of Pulse Pressure on Endothelial Function and Large Artery Distensibility of Patients with Essential Hypertension

目的:探讨原发高血压(EH)患者在不同动态脉压(PP)水平大动脉缓冲功能、内皮功能损害程度。方法:选择394例EH患者将所有病例按动态脉压PP值分成三组,应用自动PWV测定仪测定颈-股动脉脉搏波速度(C-FPWV)和颈-桡动脉脉搏波速度(C-RP-WV)评价大动脉缓冲功能;应用高分辨率血管外超声分别通过对肱动脉进行血流介导的血管扩张(FMD)和硝酸甘油依赖性的血管扩张测定来评价内皮功能。结果:颈-股动脉脉搏波速度(C-FPWV)随动态脉压升高而升高,颈-桡动脉脉搏波速度(C-RPWV)组间差异无统计学意义。C-FPWV与白昼脉压(r=0.294,P<0.001)、夜间脉压(r=0.257,P<0.001)及平均脉压(r=0.289,P<0.001)均呈显著正相关,C-RPWV与脉压无显著的相关关系;血流介导的血管扩张(FMD)在3组之间差异均有显著性(P<0.01),并随PP增大,FMD逐渐减小。非内皮依赖性血管扩张(NGT-MD)在3组之间差异均无显著性(P>0.05),FMD与白昼脉压(r=-0.704,P<0.01)、夜间脉压(r=-0.615,P<0.01)及平均脉压(r=-0.641,P<0.01)呈显著性负相关。NGT-MD与脉压无显著的相关关系。结论:动态脉压增大与高血压患者内皮功能受损、大动脉缓冲能力降低关系密切。

Objective：To explore the association between ambulatory pulse pressure, and endothelial function, and large artery distensibility with essential hypertension. Methods：394 patients with essential hypertension were enrolled and divided into 3 groups based on the levels of 24h mean pulse pressure. Carotid - Femonal PWV （ CF - PWV） and Carotid - Radial PWV（ CR - PWV） were measured by automatic pulse wave velocity measuring system. The brachia] artery response to flow - mediated endothelium - dependent dilation （FMD） and nitroglycerin - mediated dilation （NTG - MD） were evaluated by the high resolution vascular ultrasound. Results： CF - PWV increased with 24h mean pulse pressure （ P 〈 0. 001 ） , whereas CR - PWV did not change significantly. CF - PWV was positively and significantly correlated with daytime pulse pressure （ r = 0. 294, P 〈 0. 001 ） , nighttime pulse pressure （ r = 0. 257, P 〈 0. 001 ） , and 24h mean pulse pressure （r = 0. 289 ,P 〈 0. 001 ）. Such relationships were not found with CR -PWV. FMD decreased with 24h mean pulse pressure （ P 〈 0. 001 ） , whereas NGT - MD did not change significantly. FMD was negatively and significantly correlated with daytime pulse pressure （r = -0. 704 ,P 〈 0.01 ）, night pulse pressure （r = -0. 615 ,P 〈 0.01 ） , and 24h mean pulse pressure （r = -0. 641, P 〈0.01 ）. Such relationships were not found with NGT- MD. Conclusions： Greater ambulatory pulse pressure was closed related to decreasing in distensibility in large artery and a reduction in endothelial function in patients with essential hypertension.