不同危险分层的原发性高血压患者球结膜微循环的改变

Alterations of bulbar conjunctival microcirculation in essential hypertension patients with different risk stratification

目的：研究高血压病不同危险分层对原发性高血压患者球结膜微循环形态及功能的影响。方法根据血压水平（1、2、3级）、其他心血管危险因素（年龄、吸烟、血胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、早发心血管家族史、体质量指数、高敏C反应蛋白等）、靶器官损害及并发症的情况，对118例高血压病患者进行分层，研究不同危险分层的高血压病患者和同期20例健康志愿者球结膜微循环的变化。结果与健康对照组比较，低危组高血压病患者球结膜微循环改变主要表现为稀疏网格结构、微血管数目减少及细静脉管径变细，两者差异有统计学意义（P＜0.05）。中危以上（含中危）组高血压病患者球结膜微循环出现形态、流态和袢周状态的明显改变。其形态改变主要为视野清晰度下降、微血管数减少、细动脉及细静脉管径变细、微血管粗细不均增多，并出现网格结构、微血管瘤、囊状扩张及缺血区。其流态改变主要为微血管内血流速度减慢、红细胞聚集。其管周渗出增加、含铁血黄素沉着增多。随着高血压危险分层的增加，球结膜微血管密网格结构比例逐渐增多、微血管数逐渐减少、微血管内血流速度逐渐减慢、红细胞聚集程度逐渐加重，差异有统计学意义（P＜0.05）。结论高血压病患者出现与危险分层相关的球结膜微循环改变。

ObjectiveTodetermine the effect ofessential hypertension（EH）with different risk stratificationon the morphology and function of bulbar conjunctival microcirculation in EH patients.MethodsBlood pressure （grades 1, 2, and3）, other cardiovascular risk factors （age, smoking, blood cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, family history of premature cardiovascular diseases, body mass index,andhigh sensitivity C reactive protein）,andtarget organ damage and complications were used tostratify 118EHpatientsadmitted in the hypertension clinic of our hospital from April 2014 to February 2015. Bulbar conjunctival microcirculation was monitored and analyzed in the patients and20 healthy volunteers in the same period.Results Compared with the healthy volunteers,thelow-riskpatientshad statistically sparser grid structure,lessmicrovessels, and thinner venules （P〈0.05）.While themoderate-, high-, and very high-riskpatientsdisplayed obviouschanges in morphology, blood flow in microvessles, and surrounding loop state. The morphological changes were mainly characterized byblurred vision, reduced microvessels, thinner arterioles and venules,moremicrovessels ofunevendiameters,grid structureand microaneurysm, cystic dilation and ischemic area.Theyalso showed slowed blood flow velocity, increased erythrocyte aggregation and exudation, and hemosiderin deposition in surrounding loop. With the increase in risk stratification,there weregraduallymoregrid structure density, decreased number ofmicrovessels, reduced blood flow velocity,and enhancederythrocyte aggregation （P〈0.05）.Conclusion EH patients with different risk stratification show different alterationsin bulbar conjunctival microcirculation.