高血压合并左心室肥厚患者血管内皮舒张功能与尿酸的关系

Relationship between endothelium-dependent vasodilation and uric acid in essential hypertension patients with left ventricular hypertrophy

目的探讨高血压合并左心室肥厚(LVH)患者的血流介导的内皮依赖性血管舒张功能(FMD)与尿酸的关系。方法选择2006-08-2011-02福建医科大学附属第一医院门诊轻中、度高血压患者277例(包括未降压治疗和已接受降压治疗的患者),男159例,女118例,年龄(58.5±11.0)岁。根据左心室质量指数(LVMI)≥125(男)或≥110g/m2(女)分为高血压合并LVH组(LVH组,n=83)与高血压无LVH组(non-LVH组,n=194);选择同期未服用任何药物在我院门诊初诊的体检正常的非高血压患者41例作为对照组。采用超声心动图法测定LVMI;采用高分辨超声技术测定反应性充血前后肱动脉内径的变化率,作为肱动脉FMD。采用氧化酶法测定空腹尿酸。结果与对照组比较,non-LVH组和LVH组FMD均减退[(7.3±3.5)%,(5.7±2.2)%比(9.9±3.1)%,P<0.05],高尿酸血症(HUA)发生率明显升高(39.2%,40.1%比17.1%,P<0.05)。高血压患者中,HUA与尿酸正常患者比较,FMD减弱[(6.3±2.5)%比(7.1±3.6)%,P<0.05];进一步的亚组分析发现,non-LVH组HUA与尿酸正常者比较,FMD减弱[(6.5±1.9)%比(7.7±2.6)%,P<0.05],但LVH组HUA与尿酸正常患者的FMD差异无统计学意义。相关分析显示FMD与尿酸呈负相关(r=-0.18,P<0.05)。结论尿酸与血管内皮功能相关,已有LVH的高血压患者,尿酸对血管内皮功能进一步影响不明显。

Objective To investigate the relationship between flow mediated dilation （FMD） and uric acid in essen- tial hypertensive patients with left ventricular hypertrophy （LVH） Methods Two hundred and seventy-seven outpatients [159 men, 118 women; aged （58.5 ± 11.0）years] with mild to moderate hypertension from the First Af- filiated Hospital of Fujian Medical University were enrolled between August 2006 and February 2011. The patients were divided into two groups according to left ventricular mass index （LVMI）： hypertensive patients with LVH （LVH group, n=83） and without LVH /non-LVH group, n=194）. Forty-one normotensive patients served as control group. LVH was determined by echocardiography. FMD was measured as the percentage change in bra- chial artery diameter during reactive hyperemia using high-resolution ultrasonography. Uric acid was detected by u- rease indophenol. Results Compared with control group, in both non-LVH and LVH group the FMD were signif icantly lower[（7.34±3.5）%, [5.74±2.2）% vs （9.94±3.1）%, P〈0.051, the incidence rates of hyperuricemia [HUA） were significantly higher [39.2%, 40.1 % vs 17.1%, P〈0. 051 respectively. In hypertensive patients, FMD was lower in those with HUA than in without HUA [（6.34±2.5）% vs （7.14±3.6）%, P〈0.05]. For nonLVH patients, FMD was lower in those with HUA than without HUA [（6.5 4±1.9） % vs （7.7 4±2.6）%, P〈 0. 051. For LVH patients, there was no difference in FMD no matter the presence of HUA. correlation analysis showed that FMD was negatively correlated with uric acid （r= -0.18, P〈0.05）. Conclusion Uric acid correla- ted with the endothelial function, but the correlation was not significant in essential hypertensive patients with LVH.