高血压病患者体循环动脉重构性变化

The Remodeling of Systemic Arteries in Essential Hypertensive Patients

探讨高血压病患者血管重构性变化及影响因素。方法 检测 1～ 2级高血压病患者主动脉、颈动脉、肱动脉及桡动脉管径、内膜中层厚度和动脉扩张性、管壁顺应性等指标 ;以协方差分析校正其他因素的混杂影响后 ,比较高血压组 6 3例与正常对照组 31例间动脉结构和功能指标的差异 ,并通过多元逐步回归分析 ,甄选影响血管重构的独立影响因素。结果和结论 高血压组主动脉、颈总动脉、肱动脉和桡动脉壁内膜中层厚度和面积及其与动脉内径和管腔面积的比值显著增大 ,主动脉、颈动脉、肱动脉扩张性和顺应性显著降低 ;校正Age ,Sex ,BMI ,HR ,MAP ,PP ,Smoke,FPG ,LDL ,TG等可能影响血管重构的因素影响后显著性依然存在。动脉平均压和脉压水平是血管重构的重要影响因素 ,血压水平越高 ,内膜中层厚度越大 ;脉压越大 ,动脉扩张性和顺应性越差。其他影响高血压病血管重构的因素 ,特别是体重指数、吸烟及血脂水平等 ,在高血压病心血管重构和器官损害的防治中应加强关注。

Objective To investigate the remodeling of systemic arteries and correlative factors in essential hypertensive patients. Methods The dimension, wall intimal medial thickness and functions of aortic, carotid, brachial and radial arteries were measured by vascular ultrasound technique in 63 mild to moderate hypertensive patients.\ 31 normotensive subjects were served as control. After adjusting for the confounding effects of other variables , the differences of indices of arterial structure and function were compared by covariance analysis. The independent factors of the indices of arterial remodeling were identified by method of multivariance stepwise regression analysis. Results and Conclusion The increases in the dimension and wall intimal medial thickness of aortic, carotid, brachial and radial arteries with decreased vascular distensibility and wall compliance was demonstrated in hypertensives which compared with control. The statistical significance remained after adjusting for age, sex, BMI, HR, MAP, PP, smoke, FPG, LDL, TG. The levels of MAP and PP were important factors affecting on vascular remodeling. The higher MAP is associated with increased intimal medial thickness of arterial wall, while the higher pulse pressure is usually accompanied with reduced arterial distensibility and wall compliancy. BMI,smoking and the level of blood lipids were found to be related to the vascular remodeling.