原发性高血压患者血压水平及血压变异与血管内皮功能相关指标的关系研究

The relationship between the endothelial dysfunction with hypertension and blood pressure variability in hypertensive patients

目的探讨原发性高血压患者血压水平及血压变异与血管内皮功能相关指标的关系。方法根据《2010年中国高血压防治指南》的血压标准,筛选出104例高血压病患者,并据血压的数值分为1、2、3级高血压,以此把高血压组分为3组为实验组,并筛选出同期在我院体检中心的健康人45例为对照组,所有对象均进行无创性24 h动态血压监测,并检测血管内皮功能的标志物:ET-1及UACR的水平。结果与正常对照组比较,3组高血压组ET-1、UACR的水平明显升高(P<0.05;P<0.01),且随着高血压的分级越高,ET-1、UACR水平越高。相关性分析显示:ET-1、UACR水平与24h平均收缩压(24h SBP)、24h平均舒张压(24h DBP)、24h收缩压变异系数(24h SCV)、24h舒张压变异系数(24hdcv)呈显著正相关(ET-1:相关系数r分别为0.637,0.879,0.863,0.633;P值为0.000,0.015,0.000,0.000。UACR:相关系数r分别为0.709,0.675,0.922,0.628;P值为0.000,0.042,0.000,0.000)。结论原发性高血压患者存在血管内皮功能障碍,高血压的发生发展与血管内皮功能不全密切相关,血管内皮功能不全不仅与血压水平有关,而且与血压变异相关;可通过测定ET-1、UACR水平直接或间接评估内皮功能的改善或受损状况。

Objective： To investigate the relationship between the endothelial dysfunction with hypertension and blood pressure variability in hypertensive patients. Methods： 104 patients with hypertension and 45 normal controls were enrolled into this study. The 104 patients were diagnosed according to the 2010 Chinese standard. The 45 normal controls were selected from the physical examination center. Hypertension group was divided into three experimental groups according to the value of blood pressure. All subjects had 24 h ambulatory blood pressure monitoring. Plasma levels of endothelin-1 and UACR were measured in the next morning. Results： The levels of ET-1 and UACR were significantly increased in hypertensive group than those in control group and they increased with blood pressure increase. Correlation analysis showed that the levels of ET-1 and UACR were significantly positively correlated with 24 hours systolic blood pressure,24 diastolic blood pressure,24 hours systolic blood pressure variability and 24 hours diastolic blood pressure variability. Conclusion： There is endothelial dysfunction in hypertensive patients. Hypertension and endothelial dysfunction are closely related. Endothelial damage is associated with not only the level of blood pressure but also blood pressure variability. The endothelial dysfunction can be defined with ET-1 and UACR.