老年H型高血压患者踝臂指数变化的临床意义

Clinical implications of ankle brachial index in elderly patients with H type hypertension

目的探讨老年H型高血压患者踝臂指数(ABI)的异常情况及临床意义。方法选择127例患者,根据血浆高同型半胱氨酸和诊室血压水平分为H型高血压组(HH组)65例、非H型高血压组(NHH组)32例和正常血压组(NT组)30例。测定ABI、高敏C反应蛋白(hs-CRP)、髓过氧化物酶(MPO)水平和血管内皮功能。结果与NT组比较,HH组和NHH组ABI明显降低(P<0.05,P<0.01);与NHH组比较,HH组ABI明显降低(P<0.05)。与NT组比较,HH组MPO、hs-CRP明显升高,内皮依赖性舒张功能(FMD)明显降低(P<0.05,P<0.01);与NHH组比较,HH组FMD明显降低(P<0.05)。相关分析显示,HH组ABI与hs-CRP和MPO呈负相关(r=-0.739、r=-0.723,P<0.01),与FMD呈正相关(r=0.927,P<0.01)。结论 ABI降低与炎性反应及血管内皮功能受损密切相关,对评估老年H型高血压患者动脉功能损害及识别高危患者有重要的临床意义。

Objective To study the clinical implications of ankle brachial index （ABI） in elderly pa- tients with H type hypertension. Methods One hundred and twenty-seven elderly patients were divided into H type hypertention （HH） group （n= 65）,non-H type hypertension （NHH） group （n=32） and normotension （NT） group （n=30）. Their ABI,serum hs-CRP and MPO levels,endo- thelial dependent flow-mediated dilation（FMD）were measured. Results The ABI was significant- ly lower in HH group and NHH group than in NT group （P〈0. 05,P〈0.01） and in HH group than in NHH group （P〈0.05）. The serum MPO and hs-CRP levels were significantly higher in HH group than in NT group （P〈0.05）while the endothelial dependent FMD was significantly lower in HH group than in NHH group （P〈0.05）. The ABI was negatively related with the ser- um MPO and hs-CRP levels and positively related with the endothelial dependent FMD in HH group （r= --0. 739,r=-0. 723,P〈0.01;r=0. 927,P〈0.01）. Conclusion Reduced ABI is closely related with inflammatory reactions and vascular endothelial function impairment, and plays an important role in diagnosis of artery function impairment and high risk of H type hyper- tension in elderly hypertensive patients.