中青年高血压病患者动脉弹性功能与血清脂肪酸

Changes in Arterial Elasticity in Young and Middle-Aged Hypertensive Patients During 2 Years Follow up

目的观察中青年高血压病患者和健康对照者基线空腹血清游离脂肪酸(FFA)的差异和大、小动脉弹性功能2年的变化。方法社区筛选高血压病患者103例(33～60岁),并筛选128例健康非高血压者(年龄匹配),随访2年。采用CVProfilorDO-2020型动脉弹性功能测定仪检测两组2年前后大、小动脉弹性指数(C1和C2),测定基线空腹血FFA、血脂、血糖、胰岛素等。高血压组91例,非高血压组97例得到随访。结果1)高血压病患者(n=91)的C1、C2均显著低于非高血压病患者[n=97;C1,11.9±3.9比非高血压组:(14.0±4.2)mL/mmHg×10,P=0.001;C2,4.9±2.2比非高血压病组:(6.1±2.6)mL/mmHg×100,P=0.001]。2)高血压病患者2年的小动脉弹性指数变化值(ΔC2)显著低于非高血压病患者[-0.24±0.25比非高血压组:(0.75±0.31)mL/mmHg×100,P=0.014],其大动脉弹性指数变化值(ΔC1)也降低,但差异无统计学意义(P=0.458)。3)与非高血压病患者相比,高血压病患者基线空腹血清饱和脂肪酸、单不饱和脂肪酸水平均显著增高(P均<0.05),而n-3脂肪酸水平[(96.0±38.9)比非高血压病组:(123.0±36.0)μmol/L,P=0.001]、多不饱和与饱和脂肪酸比值(P/S)(1.60±0.37比非高血压病组:1.90±0.46,P=0.009)显著降低。4)logistic回归分析显示高血压病患者基线空腹血清亚麻酸(18:3n3)优势比(OR值)和95%可信区间为2.483(1.480～4.166,P=0.001),而DHA(22:6n3)的为0.329(0.195～0.554,P=0.001)。结论原发性高血压患者动脉弹性年龄相关降低过程加速,空腹血清FFA组成异常(如亚麻酸增高,DHA下降),可能是其高血压发病的危险因素之一。

Objective To investigate changes of arterial elasticity （AC） in 2 years follow up in related with baseline fasting serum free fatty acid （FFA） in young and middle-aged hypertensive patients and nonhypertensive subjects, and explore risk factors for hypertension development. Methods Fasting serum FFA were determined in community inhibitants （103 hypertensive patients, 128 nonhypertensive cases） aged between 35 and 60 years. Arterial elasticity was assessed with arterial elasticity indexes （C1 -large artery and C2-small artery） measured by CVProfilor DO-2020. Results Compared with nonhypertensive cases （ n = 97 ）, hypertensive patients （ n = 91 ） had significantly lower baseline levels of C1 and C2 （C1 ： 11.9±3. 9 vs 14.0±4. 2 mL/mm Hg×10, P〈0. 01; C2 ： 4. 9±2.2 vs 6. 1±2.6 mL/mm Hg×100, P〈0.01）, and lower levels of two-year changes in small arterial elasticity （△C2 ： -0.24±0.25 mL/mm Hg×100 vs nonhypertensives △C2 ： 0. 75-1-0.31 mL/mm Hg×100, P= 0. 014）. A baseline higher levels of saturated fatty acid and monounsaturated fatty acid （both P=0. 05） and lower levels of n-3 polyunsaturated fatty acids （96.0±38.9 vs 123.0 ±36.0 μmol/L, P= 0. 001） as well as polyunsaturated]saturated fatty acids ratio [P/S： 1.60±0.37 vs 1.90± 0.46, P=0. 009） was shown in hypertensive subjects. After adjustment for traditional risk factors of hypertensoin and baseline systolic BP in model, the odds ratio of linolenic acid was 2. 483 [95% CI： 1. 480, 4. 166, P=0. 001）, 0. 329 [95% CI：0. 195, 0. 554, P=0. 001） for DHA（22 ： 6n3） for hypertension patients indicating fasting FFA and linolenic acid and are prediposed factors for development of hypertension, while DHA appear as protective factor. Conclusion Age-related process of large arterial stiffness was accelerated in hypertensive patients, and abnormal of fasting serum FFA composition was the risk factors for development of hypertension.