老年杓型与非杓型高血压患者踝臂指数变化的临床意义

Clinical significance of the changes in ankle-brachial index in elderly patients with dipper and non-dipper hypertension

目的探讨老年杓型与非杓型高血压患者踝臂指数(ankle brachial index,ABI)的异常情况及临床意义。方法选择老年原发性高血压患者79例进行24 h动态血压监测,分为非杓型组52例和杓型组27例。测定ABI、高敏C反应蛋白(high sensitive C-reactive protein,hs-CRP)、髓过氧化物酶(myeloperoxidase,MPO)水平和血管内皮功能。结果非杓型组ABI、肱动脉内皮依赖性舒张功能较杓型组明显降低,MPO、hs-CRP较杓型组明显升高,差异有统计学意义(P<0.05)。非杓型组患者ABI与hs-CRP和MPO呈负相关(r=-0.723,r=-0.71 9,P<0.01),与肱动脉内皮依赖性舒张功能呈正相关(r=0.91 7,P<0.01)。结论 ABI降低与斑块不稳定、炎性反应及血管内皮功能受损密切相关,对评价夜间老年高血压患者动脉结构、功能的损害程度、判断预后、指导合理治疗有重要的临床意义。

Objective To investigate the abnormality and clinical significance of ankle-brachial index（ABI） in elderly patients with dipper and non-dipper hypertension. Methods Seventy-nine patients with essential hypertension underwent ambulatory blood pressure monitoring, then were divided into non-dipper group （n = 52） and dipper group （n = 27）. ABI and endothelial dependent flow-mediated dilation of the brachial artery were evaluated. The levels of high sensitivity C-reactive protein（hs-CRP） and myeloperoxidase were assessed. Results ABI values in non-dipper group were significantly lower than those in dipper group （P 〈 0.05）. The levels of hs-CRP and myeloperoxidase in non-dipper group were significantly higher compared with those in dipper group （P〈0. 05）. Flow-mediated dilation values were significantly lower in non-dipper group than in dipper group （P〈0.05）. A positive correlation was observed between the ABI values and flow-mediated dilation values （r = 0. 917, P 〈0.01）, and the ABI levels were negatively correla- ted with the levels of hs-CRP and myeloperoxidase in non-dipper group （r =-0. 723,P 〈0. 1）. Conclusion Abnormal ABI values are associated with the instability of plaque,inflammatory reaction and impaired vascular endothelial function in elderly patients with nocturnal hypertension. For the elderly patients with nocturnal hypertension,abnormal ABI can early identify the damage of arterial structure and function, evaluate the prognosis, and guide rational therapy.