高血压患者血管超负荷指数与颈动脉内膜中层厚度的相关性

The relationship between vascular overload index and intima media thickness of carotid artery in hypertensive patients

目的探讨高血压患者血管超负荷指数(VOI)与颈动脉内膜中层厚度(CA-IMT)的关系。方法入选原发性高血压(EH)患者646例(男386例,女260例,包括未降压和已降压治疗者),年龄(62.2±12.3)岁。以内膜中层厚度(IMT)≥1.0mm为切点,分为IMT<1.0mm组(n=376)和IMT≥1.0mm组(n=270)。选择同期未服用任何药物的门诊体检的正常血压者98人为对照组。测量身高、体质量、收缩压和舒张压。VOI=1.33×收缩压-0.33×舒张压-133.3mm Hg。清晨空腹测定血糖、血脂、肝肾功能、血常规和纤维蛋白原。采用高分辨率血管彩色多普勒超声心动图技术测定反应性充血前后肱动脉内径的变化率,作为血管内皮舒张功能(FMD)。测定双侧CA-IMT,当任何一侧颈动脉有斑块形成时,CA-IMT记为1.5mm。同时检查超声心动图,计算左心室质量指数(LVMI)。结果高血压患者FMD随着VOI、LVMI和左心室质量/身高2.7(LVM/H2.7)增加而减弱。与IMT<1.0mm组比较,IMT≥1.0mm组VOI、LVMI和LVM/H2.7增加,而FMD减弱(均P<0.05)。多元逐步回归分析显示,VOI是所有对象CA-IMT的影响因素,VOI每升高10mm Hg,CA-IMT增厚0.05mm。分层分析显示,无论哪个年龄段和性别,以及合并危险因素的多少,VOI都是EH患者CA-IMT的影响因素。结论 VOI是EH患者CA-IMT的重要影响因素。

Objective To investigate the relationship between vascular overload index （VOI） and intima media thickness of carotid artery （CA-IMT） in hypertensive patients. Methods A total of 646 patients （386 men and 260 women） with essential hypertension （EH） aged （62.2±12.3） years were enrolled. Based on the cut-point of inti- ma media thickness （IMT）, E H patients were divided into the low IMT（IMT〈1. 0 mm, n= 376） and the high IMT group （IMT≥1. 0 ram, n= 270 ）. Meanwhile, 98 subjects with normal blood pressure and without any drug ad- ministration were selected as controls. Body height and weight, systolic and diastolic blood pressure （SBP and DBP） were recorded. VOI was calculated as （1.33XSBP--0.33XDBP--133.3） in mm Hg. Fasting blood glu- cose, blood lipid profiles, liver and renal functions, routine blood test and fibrinogen were determined. Flow medi- ated dilation （FMD} of brachial artery induced by reactive hyperemia was examined by high-resolution vascular ultra- sound. The bilateral CA-IMT was recorded and defined as 1.5 mm when plaque presented on either side of the ca- rotid artery. Left ventricular mass index （LVMI） was calculated based on the results of echocardiographic exami- nation. Results FMD was attenuated with the increases of VOI, LVMI and left ventricular mass/height2,7 （LVM/ H2,7 ） in hypertensive patients. The VOI,LVMI and LVM/H2,7 were increased, while FMD decreased in high IMT group compared to low IMT group （all P〈0.05）. Stepwise multiple regression analysis revealed that VOI was as- sociated with CA-IMT in all study subjects. CA-IMT increased by 0.05 mm as each 10 mm Hg-increasing of VOI. VOI was found to be a persistent influencing factor for CA-IMT in hypertensives,irrespective of age, sex and num- bers of risk factors. Conclusion VOI was an important influencing factor for CA-IMT in EH patients.