原发性高血压患者合并代谢综合征加重血管内皮功能损害

Metabolic Syndrome Enhanced the Arteriosclerotic Development in Patients with Essential Hypertension

目的观察代谢综合征对原发性高血压患者颈动脉内膜中膜厚度(IMT)、肱动脉的舒张功能和高敏C反应蛋白(hsCRP)的影响。方法 EH 患者148例根据是否合并 MS,分为 EH+非 MS 组(79例)和 EH+MS 组(69例),选择同期健康体检者30例为正常对照(对照组),超声测定颈动脉 IMT、肱动脉内皮依赖性血管舒张功能(FMD)和非内皮依赖性血管舒张功能(NMD),激光散射比浊法测定 hsCRP。结果与 EH+非 MS 组患者比较,EH+MS 组患者的 IMT[(1.0±0.3)vs(0.8±0.2)mm,P<0.01]和 hsCRP[(0.9±0.4)vs(0.7±0.3)mg/L,P<0.01]显著增高,FMD[(5.5±4.0)%vs(8.9±3.5)%,P<0.05]和 NMD[(13.5±4.1)%vs(20.1±3.9)%vs(26.7±3.3)%,P<0.01]显著降低。多元回归分析研究显示,IMT 与收缩压、低密度脂蛋白胆固醇、空腹血糖和hsCRP 相关(P<0.05或 P<0.01)。结论 EH 和 MS 可损害内皮细胞及动脉的舒张功能,促进颈动脉内膜增厚和动脉硬化的发生发展。

Objective To investigate the effects of metabolic syndrome（MS） on the structure and function of artery in patients with essential hypertension（EH）. Methods One hundred forty-eight patients with EH were classified as EH with MS （EH＋MS） or EH alone and healthy subjects（n=30） as control. Carotid intima-media thickness（IMT）, brachial artery flow-mediated vasodilation（FMD） and non-flow-mediated vasodilation （NMD） were measured by Dopple uhrasonography. Results Carotid IMT{EH＋MS： 1.0±0. 3 vs EH： 0. 8±0. 2 vs control： 0. 5±0. 1 mm）and hsCRP（EHWMS： 0.9±0.4 vs EH： 0. 7±0. 3 vs control： 0. 4±0. 2 mg/L） were significantly higher in EHW MS patients than that in EHW nonMS patients and control subjects（P all〈0. 01 ）. Brachial artery FMD（EH＋MS： 5.5%＋4.0% vs EH.. 8.9%±3.5% vs control： 11.3%±2.5%, P〈0.05 ） and NMD （EH＋ MS： 13. 5%±4. 1% vs EH： 20. 1%±3. 9% vs control： 26. 7%±3. 3%, P〈0. 01） were significantly lower in EH ＋MS patients than that in EH＋nonMS patients and control subjects. IMT is positively related with SBP, BMI, WHR, LDL-C, TG, FPG, hsCRP, negatively with HDL-C（P〈0.01）. Conclusion Metabolic syndrome accentuated the vascular endothelial impairment and arteriosclerotic change with concomitantly increases in hsCRP in patients with essential hypertension.