新发高血压病人游离脂肪酸与动脉弹性变化

Relationship Between Arterial Elasticity and Fasting Serum Free Fatty Acid in Incident Hypertensives and Nonhypertensives

目的观察一个人群中新发高血压病人和未发生高血压者基线空腹血清游离脂肪酸(FFA)与2年内动脉弹性的变化的相关性,探索血清FFA、动脉弹性及高血压之间的关系。方法一纵向研究。社区筛选128例健康非高血压者(年龄33～60岁),随访2年。记录新发高血压例数,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。随访期间,有12人失访。结果1)与未发生高血压者(n=97)相比,新发高血压病人(n=19)基线空腹血清饱和脂肪酸水平增高[(217±68)μmol/L比未发生高血压组:(186±46)μmol/L,P=0.04],而多不饱和与饱和脂肪酸比值(P/S)降低(1.60±0.37比未发生高血压组:1.90±0.46,P=0.009);2)与未发生高血压者相比,新发高血压者2年的收缩压和舒张压水平增高(P均<0.01),而其大、小动脉弹性指数改变值(ΔC1和ΔC2)有降低趋势(P均>0.05);3)逐步线性回归模型分析显示:全部参与者2年的ΔC1与基线空腹血清P/S正相关(标准回归系数0.201,P=0.041),独立于基线收缩压水平和经典的心血管危险因素。4)Logistic回归模型分析显示新发高血压者的基线空腹血清P/S的优势比(OR值)和95%可信区间为0.412(0.172～0.991,P=0.048)(在调整了经典的高血压危险因素后)。结论空腹血FFA组成异常是中青年非高血压人群大动脉弹性年龄相关改变和发生高血压的危险因素之一。

Objective To investigate the baseline and 2-year changes of arterial elasticity and serum free fatty acid （FFA） composition in incident hypertensives and nomotensive subjects. Methods Fasting serum FFA were determined in 128 nonbypertensive from a community inbibitants aged between 35 and 60 years. In 2-year follow-up, 19 cases of incident hypertensives were found. Arterial elasticity was assessed with arterial elasticity indexes （C1-large artery and C2-small artery） measured by CVProfilor DO-2020. Results Compared with normotensive subjects （n= 97）, incident hypertensives （n= 19） had higher baseline level of saturated fatty acid （217 ± 68 μmol/L vs 186 ± 46 μmol/L, P = 0. 04 ）, and lower level of polyunsaturated/saturated fatty acids ratio （ P/S, 1.60±0. 37 vs 1.90± 0. 46, P = 0. 009 ）. The levels of systolic BP and diastolic BP increased （P〈0. 01 for both） while the changes of large and small arterial elasticity index （△C1 and △C2 ） tended to decrease （P〉0. 05 for both） in incident hypertensives. Multivariate analysis showed △C1 remained positively associated with baseline P/S ratio （standard regression coefficient 0. 201, P= 0. 041） after adjusting for traditional risk factors and level of baseline systolic BP in all subjects. The odds ratio of P/S for incident hypertension was 0. 412 （95% confidence interval （CI） ： 0.17-0. 99, P= 0. 048 ）. Conclusion Reduced levels of fasting serum P/S is associated with age-related large arterial stiffness and development of hypertension in young and middle-aged subjects.