老年高血压前期患者糖耐量减低与内皮功能及颈动脉粥样硬化的关系

The relationship among the degree of carotid artery atherosclerosis,vascular endothelial function and impaired glucose tolerance in elder patients with prehypertension

目的:探讨老年高血压前期患者糖耐量减低与内皮功能及颈动脉粥样硬化的关系。方法:225例患者分为正常对照组(NC组)57例、单纯高血压前期组(PH组)55例、单纯糖耐量异常组(IGT组)55例及高血压前期合并糖耐量异常组(PH+IGT组)58例。高分辨超声检测肱动脉血流介导的内皮依赖性血管舒张功能(FMD)及颈动脉内中层厚度(IMT)并进行比较。结果:FMD在PH组、IGT组、PH+IGT组均低于NC组[(8.56±2.54)%、(8.59±2.29)%、(5.91±2.11)%︰(13.28±2.91)%,均P<0.05],且PH+IGT组较PH组、IGT组也明显降低(P<0.05),但PH组与IGT组间差异无统计学意义;IMT在PH组、IGT组、PH+IGT组均高于NC组[(0.79±0.12)mm、(0.77±0.14)mm、(0.98±0.18)mm︰(0.68±0.13)mm,均P<0.05],且PH+IGT组较PH组、IGT组也明显升高(P<0.01),但PH组与IGT组间比较差异无统计学意义。多元逐步回归分析显示,收缩压(SBP)、餐后2h血糖(2hPG)、舒张压(DBP)是影响FMD的独立危险因素(P<0.05);SBP、2hPG是影响IMT的独立危险因素(P<0.05)。结论:老年高血压前期患者血管内皮功能明显受损,在高血压前期基础上糖耐量减低将进一步使血管内皮功能受损和动脉粥样硬化加剧。

Objective：To investigate the relationship among the degree of carotid artery atherosclerosis, vascu- lar endothelial function assessed by flow mediated dilation （FMD）and impaired glucose tolerance in elder patients with prehypertension . Method：Two hundred and twenty-five patients were divided into four groups： normal con- trol group （NC group, n= 57 ）, prehypertension group （PH group, n=55）, impaired glucose tolerance group （IGT, n= 55 ）, prehypertension and impaired glucose tolerance group （PH＋IGT group, n= 58）. The FMD and carotid artery intima-media thickness （IMT） were determined in four groups by high resolution ultrasonography. Result：FMD was significantly decreased in PH, IGT and PH＋IGT group than that in NC group [（8.56± 2.54）%, （8.59±2.29）% and（5. 91±2.11）% vs （13.28±2.91）%,all P〈O. 05], which was significantly lower in PH＋IGT group than that in PH or IGT group. IMT was significantly increased in PH, IGT and PHq-IGT group than that inNCgroup [（0.79±0.12） mm,（0.77±0.14） mm and（0.98 ±0.18） mm vs （0.68±0.13） mm,all P〈0.05], which was significantly high in PHq-IGT group than in PH or IGT group. Multiple stepwise regression analysis showed that SBP,2hPG and DBP were the independent factors influencing FMD SBP and 2h PG were the independent factors influencing IMT. Conclusion： Vascular endothelium function is obviously impaired in elder patients with prehypertension. The endothelial injury and the degree of atherosclerosis are exacerbated by IGT in these patients.