原发性高血压患者血管内皮功能与左室舒张功能间关系研究

The relationship between brachial artery endothelial function and left ventricular diastolic function in patients with essential hypertension by ultrasonography

目的研究原发性高血压患者血管内皮功能与左室舒张功能之间的关系。方法超声测量50例原发性高血压患者和21例健康对照者的肱动脉充血后反应性扩张血管内径变化（DTRH）和含服硝酸甘油后血管内径变化（DTNG），多普勒组织显像技术检测其二尖瓣环的舒张早期峰值速度（Ea）、舒张晚期峰值速度（Aa）及两者之间的比值（Ea／Aa）。据二尖瓣环舒张期峰值速度将高血压病患者分为左室舒张功能正常（高血压Ea／Aa〉1组）23例，左室舒张功能异常（高血压Ea／Aa〈1组）27例。结果两组高血压病患者嘲均低于对照组（P〈0．01），且Ea／Aa〈1组患者DTRH低于Ea／Aa〉1组（P〈0．01）。DTNG在三组间无统计学差异（P〉0．05）。相关分析表明：患者DTRH与Ea／Aa和Ea呈正相关（r=0．70，P〈0．01和r=0．38，P=0．01），与Aa呈负相关（r=-0．30，P=0．04）。多元回归分析提示患者DTRH与Ea／Aa、年龄、收缩压有关联（r′=0．63，P〈0．01；r′=-0．21，P=0．04；r′=-0．21，P=0．04）。结论原发性高血压患者血管内皮功能改变与左室舒张功能的改变之间有一定的相关性，内皮功能障碍可能是左室舒张功能发生发展中的重要基础环节之一。

Objective To explore the relationship between brachial artery endothelial function and left ventricular diastolic function in patients with essential hypertension using ultrasonography. Methods Measurements of brachial artery diameter were performed by high - resolution uhrasonography during baseline, reactive hyperemia and subhngual nitroglycerin administration in 50 patients with essential hypertension and 21 healthy subjects. The percent changes in brachial artery diameter induced by reactive hyperemia （DTRH） and sublingual nitroglycerin（DTNG） were calculated. Mitral annulus velocities were detected by Doppler tissue imaging. Maximal velocity in early diastole （Ea）, and in atrial contraction （Aa） were measured and the ratio of Ea/Aa was calculated. Results The in patients was significantly less than that in healthy subjects （ P 〈 0.01 ）. While patients with abnormal Ea/Aa was significantly less than that patients with normal Ea/Aa（ P 〈 0.01）. No significant difference could be found in DTNG between patients and controls （ P 〉 0.05）. Positive correlation was found between DTRH and Ea/Aa, Ea （ r = 0.70, P 〈 0.01 ; r = 0.38, P = 0.01, respectively）. Negative correlation was found between DTRH and Aa （ r = - 0.30, P = 0.04）. A multivariate stepwise regression demonstrated that endothelial dysfunction correlated with the Ea/Aa, age and systolic blood pressure（ r＇ = 0.63, P 〈 0.01 ; r＇ = - 0.21, P = 0.04; r＇ = -0.21, P = 0.04）. Conclusion Endothelial dysfunction was related with left ventricular diastolic dysfunction in essential hypertension and it might play an important role in development and progression of left ventricular diastolic dysfunction.