高血压病患者脂餐后甘油三酯代谢变化与血管内皮功能的关系

Essential hypertension with postprandial abnormal serum triglyceride metabolism and endothelial dysfunction

目的 本研究旨在探讨高血压病 (EH)患者脂餐后甘油三酯 (TG)变化及其与血管内皮功能之间的关系。方法 38例EH患者和 2 0例健康人禁食 10～ 12h后 ,采用高分辨率彩色血管超声、以肱动脉反应性充血前、后血管内径变化百分比反映血管内皮依赖性扩张功能。随后进行标准脂肪负荷试验 ,以TG 8h曲线下面积 (TG AUC)和TG峰反应 (TGPR)作为标准脂肪负荷后TG反应水平的指标。结果 (1)EH组的肱动脉反应性充血前、后血管内径变化百分比显著小于对照组 [(10 .36±3.43) %比 (15 .48± 4.36 ) %P <0 .0 5 ];(2 )EH组餐后TG水平的TGPR[(4 .6 8± 1.74)mmol/L比(1.84± 0 .6 7)mmol/L]及TG AUC[(2 3.5 9± 6 .48)mmol/L比 (9.49± 3.47)mmol/L]均显著大于对照组(P <0 .0 5 ) ;(3)EH合并餐后TG代谢障碍组 (n =2 6 )的肱动脉反应性充血前、后血管内径变化百分比较EH餐后TG代谢正常组 (n =12 )有明显降低 [(10 .98± 1.32 ) %比 (13.14± 1.0 9) % ,P <0 .0 5 ]。结论 6 8.4%的EH患者伴有脂餐后TG代谢障碍和消除延迟 。

Objective To determine whether patients with essential hypertension (EH) have vessel endothelial dysfunction and postprandial abnormal metabolism of serum triglyceride rich lipoprotein and to investigate the relationship between endothelial dysfunction and abnormal TG metabolism. Methods In 38 patients with EH and 20 healthy control subjects, endothelial function in the form of flow mediated vasoactivity was assessed with 7.0 MHz ultrasound in the brachial artery as percent arterial diameter change 1 minute after 5 minutes of upper arm artery occlusion. Total cholesterol, HDL cholesterol, LDL cholesterol, apoliprotein AI and apoliprotein B in fasting serum and serum triglyceride before and 2,4,6,8 hours after standardized fat loading were measured. Triglyceride peak response(TGPR) and the area under triglyceride curve (TG AUC) over 8 hours were calculated. Results The percentage of brachial arterial diameter change response to reactive hyperemia was significantly lower in the EH group than that in the control (10.36±3.43)% vs (15.48±4.36)%, P <0.05. In the EH group, the percentage of patients with normal TG metabolism and with abnormal TG metabolism was compared, and the latter percentage was lower (10.98±1.32)% vs (13.14±1.09)%, P <0.05. EH patients had higher TGPR and TG AUC(4.68±1.74)mmol/L vs (1.84±0.67)mmol/L, (23.59±6.48) mmol/L vs (9.49±3.47)mmol/L, respectively. Conclusions In patients with EH, 68.4% of hypertensive patients had postprandial abnormal serum triglyceride metabolism and a delayed fall of serum TG after fat loading. Abnormal postprandial TG metabolism can accentuate endothelial function damage.