高血压病患者脂餐后血管内皮功能受损

The impaired endothelial function after a high-fat meal in essential hypertension

目的 探讨高血压病患者高脂餐后血管内皮功能变化。方法 2 0例高血压病患者和 2 0名正常对照者在禁食 12h后接受高脂餐负荷试验。分别测定餐前及餐后 2、4、5、7h血清血脂浓度。采用高分辨血管外超声法检测餐前及餐后 4h肱动脉血流介导的内皮依赖性血管舒张功能。结果 两组受试者的空腹血脂水平无显著差异 ;餐后 2、4、5h血清甘油三酯 (TG)浓度较空腹状态有显著升高。但高血压病组具有较高的餐后 4、5、7h血清TG浓度及其净增加值。两组受试者餐后内皮依赖性血管舒张功能均较空腹时显著受损。高血压病组 ,(5 38± 1 95 ) %vs(2 2 1±1 0 6 ) %;对照组 ,(9 38± 2 4 2 ) %vs(6 2 5± 2 2 3) %;P <0 0 0 1。高血压病组的空腹以及餐后内皮依赖性血管舒张功能较对照组均显著受损 (P <0 0 0 1) ,且餐后内皮依赖性血管舒张功能的受损程度显著高于对照组 [(5 8± 14) %vs(33± 17) %,P <0 0 0 1]。相关分析显示 :餐后 4h血清TG浓度净增加值与餐后内皮依赖性血管舒张功能的变化率显著正相关 (r =0 373,P <0 0 5 )。结论 高血压病患者餐后显著而持久的高甘油三酯血症可导致餐后内皮依赖性血管舒张功能严重损害。

Objective To explore the change of endothelium-dependent vasodilatation after a single high-fat meal(800 calories; 50 g fat ) in essential hypertension. Methods Twenty patients with essential hypertension and twenty healthy controls were studied. The concentrations of triglyceride, total cholesterol, LDL cholesterol (LDL-C), and HDL cholesterol (HDL-C) in fasting serum and at 2, 4, 5, 7 hours after a single high-fat meal were measured. Endothelial function, in form of flow-mediated vasodilatation, was assessed in the brachial artery by high-resolution ultrasound technique before and after 4 hours of high-fat meal. Results No significant difference in fasting lipid levels between the patients and the controls was found. The postprandial serum triglyceride levels increased significantly at 2, 4, 5 hours in all subjects. Compared to normal subjects the patients had higher serum triglyceride levels at 4, 5 and 7 hours. The fasting and postprandial endothelium-dependent vasodilatation were impaired more seriously in patients(P<0.001). The postprandial endothelial function impaired significantly after a high-fat meal in both groups(patients:5.38±1.95 % vs 2.21±1.06 %;controls:9.38±2.42 % vs 6.25±2.23 %;P<0.001). The degree of severity of postprandial endothelial function was more serious in paients than in controls(58±14 % vs 33±17 %,P<0.001). The increase in 4-hour serum triglyceride level was correlated with the degree of impairment of postprandial endothelial function(r=0.373,P<0.05). Conclusions An obvious and persistent postprandial hypertriglyceridemia in patients with essential hypertension induced significantly impairment of postprandial endothelium-dependent vasodilatation.