原发性高血压患者颈动脉结构与功能的改变

STRUCTURE AND FUNCTION ALTERATIONS OF COMMON CAROTID ARTERYIN HYPERTENSION

目的：观察原发性高血压患者颈动脉结构与功能的变化及其相关性。方法：将４７例原发性高血压患者按病期分为高血压Ⅰ期组和高血压Ⅱ期组，采用彩色多普勒超声检测技术观察颈动脉的结构、血流动力学及血管的扩张性和顺应性变化，并与正常对照组比较。结果：两组高血压病人的血管内膜中层厚度（ＩＭＴ）增加，血管收缩、舒张内径扩大，并随着高血压病期增加而增加。高血压病人的血管扩张性和顺应性都下降，但在两组高血压病人间无差异。血管的扩张性与年龄、脉压呈反比（ｒ分别为－０．４３２和－０．４７，Ｐ＜０．０１），与舒张压呈正比（ｒ＝０．４７，Ｐ＜０．０１），血管的顺应性与收缩压呈反比（ｒ＝－０．４４，Ｐ＜０．０１），与收缩内径呈正比（ｒ＝０．４３，Ｐ＜０．０１），顺应性、扩张性与血管内膜中层厚度增厚无关。结论：大动脉僵硬度的改变主要是由血压变化引起的，而非结构变化所致。

Objective: To observe the alterations of the structure and function of the common carotid artery and their correlation. Methods: The 47 essential hypertension patients including 31 Ⅰstage hypertension patients (group 1), 16 Ⅱstage hypertension patients (group 2), and 35 normal controls were measured by duplex ultrasonic Doppler technique with ultrahigh frequency (7.5 MHz) probe. Results: The intimamedial thickness (IMT), systolic diameter(SD), and diastolic diameter(DD) of carotid artery showed an increase and were increased with the severity of hypertension. The distensibility and compliance of the carotid artery showed a significant decrease in hypertension patients in comparison with control subjects, but there was no difference between group 1 and group 2. The distensibility was negatively correlated to age, pulse pressure (r=-0.43, r=-0.47,P<0.01) and positively to diastolic pressure (r=0.47, P<0.01), the compliance was negatively correlated to systolic pressure (r=-0.44, P<0.01) and positively to systolic diameter (r=0.43, P<0.01). Conclusion: The change of blood pressure is the main cause of the alteration of large artery stiffness.