H型高血压患者肱动脉内皮功能及颈动脉内中膜厚度的变化

Brachial artery endothelial function and carotid intima-media thickness of H-type hypertensive patients

目的 了解H型高血压患者的肱动脉内皮功能及颈动脉内中膜厚度（IMT）的变化,探讨H型高血压对动脉硬化的影响.方法 对2014年7月至2016年7月新诊断的120例1、2级原发性高血压患者,检测收缩压、舒张压及血TC、TG、LDL-C、HDL-C、空腹血糖、餐后2h血糖、同型半胱氨酸（HCY）水平、肱动脉内皮功能、颈动脉IMT等.其中58例血浆HCY＜ 10 μmol/L者为普通高血压组,62例HCY≥10 μmol/L者为H型高血压组.比较2组患者生化指标、超声下肱动脉内皮功能和颈动脉IMT;应用多元线性逐步回归分析肱动脉内皮依赖性舒张功能（EDD）、颈动脉IMT的影响因素.结果 与普通高血压组比较,H型高血压组患者的肱动脉EDD明显下降[（6.85±0.77）％比（5.98±0.85）％],差异有统计学意义（t=2.552,P=0.041）,颈动脉IMT明显升高[（0.90±0.13）mm比（1.01 ±0.17）mm],差异有统计学意义（t=2.426,P=0.048）.多元线性逐步回归分析结果显示,EDD与收缩压、舒张压、空腹血糖、餐后2h血糖、HCY呈明显负相关（r值分别为-0.685、-0.654、-0.571、-0.627、-0.529,均P＜0.05）;IMT与收缩压、舒张压、TC、TG、LDL-C、HCY呈明显正相关（r值分别为0.596、0.584、0.652、0.665、0.673、0.541,均P＜0.05）.结论 H型高血压较普通高血压对动脉硬化的危害更大,可能与高HCY有关.

Objective To investigate brachial artery endothelial function and carotid intima-media thickness （IMT） in patients with H-type hypertension.Methods One hundred and twenty patients with newly-diagnosed mild to moderate hypertension were enrolled in the study,including 58 cases with normal homocysteine （HCY） level （〈 10 μmnol/L,non H-type group） and 62 cases with high HCY （≥10 μ moL/L,H-type group）.Systolic pressure,diastolic pressure,blood lipid （TC,TG,LDL-C,HDL-C）,fasting plasma glucose and two hours postprandial plasma glucose were measured in all patients.Brachial artery endothelial function and carotid IMT were determined with ultrasonography and compare between two groups.The factors related to brachial artery endothelium-dependent dilation （EDD） and carotid IMT were analyzed with multiple linear stepwise regression.Results Compared with non H-type group,the brachial artery EDD was reduced [（6.85 ± 0.77） % vs.（5.98 ± 0.85） %,t =2.552,P =0.041] and carotid IMT was increased [（0.90±0.13）mm vs.（1.01 ±0.17）mm,t =2.426,P=0.048] in H-type group.The multiple linear stepwise regression analysis showed that EDD was negatively correlated to systolic pressure,diastolic pressure,fasting plasma glucose,two hours postprandial plasma glucose and HCY （r =-0.685,-0.654,-0.571,-0.627,-0.529,respectively,all P 〈 0.05）.IMT was positively related to systolic pressure,diastolic pressure,TC,TG,LDL-C and HCY （r =0.596,0.584,0.652,0.665,0.673,0.541,respectively,all P 〈 0.05）.Conclusion Patients with H-type hypertension are at a higher risk to arteriosclerosis than those with non H-type hypertension,which may be related to high HCY levels.