代谢综合征对原发性高血压患者颈动脉硬化的影响研究

Effect of metabolic syndrome on carotid atherosclerosis in patients with essential hypertension

目的探讨代谢综合征(MS)对原发性高血压(EH)患者颈动脉内膜中层厚度(IMT)及动脉硬化程度的影响。方法入选EH患者66例,分为MS组(EH+MS,31例)和单纯EH组(35例),另选取健康体检中心对照30名,测定体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)、IMT以及动脉硬化程度,分别将3组患者的一般临床数据,IMT以及动脉硬化程度进行对比。结果3组研究者之间在年龄和性别上差异无统计学意义(P>0.05)。3组间SBP、DBP、BMI、FBG、TG、TC差异有统计学意义(P<0.01),3组间HDL-C,LDL-C的差异无统计学意义(P>0.05)。MS组BMI、FBG、TG、TC均明显比单纯EH组要高(P<0.01),2组患者在年龄大小、性别、高血压病程和血压水平差异无统计学意义;MS组BMI、WC、FPG、TC、TG、LDL-C明显高于非MS组,而HDL-C明显低于非MS组(P<0.05);3组间IMT的差异有统计学意义,MS合并高血压组的IMT颈动脉硬化发生率明显比单纯EH组要高(P<0.01);Spearman相关分析结果显示,IMT与年龄(r=0.598,P<0.01)、SBP(r=0.450,P<0.01)、TG(r=0.554,P<0.01)、FBG(r=0.522,P<0.01)呈正相关,与HDLC呈负相关(r=-0.218,P<0.05);多元线性回归分析结果显示,TG、年龄、SBP、HDL-C是IMT的独立影响因素(P<0.05)。结论MS对EH患者IMT以及动脉硬化程度影响较为明显。为了减少发生心血管并发症的风险,一方面要重视血压控制,与此同时,运用调脂、降糖以及减肥等综合干预及个体化治疗。

Objective To investigate the effect of metabolic syndrome(MS)on intima-media thickness(IMT)and arteriosclerosis degree in patients with essential hypertension(EH).Methods Sixty-six EH patients were included in the study and divided into the MS group(EH+MS,n=31)and EH group(n=35).At the same time,30 healthy subjects were included in the control group.The body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FPG),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein(LDL-C),IMT and arteriosclerosis degree were measured.The general clinical data,IMT and arteriosclerosis degree in the three groups were compared,respectively.Results There were no statistically significant differences in age and gender among the three groups(P>0.05).There were significant differences in the levels of SBP,DBP,BMI,FBG,TG and TC among the three group(P<0.01),whereas there were no statistically significant differences in levels of HDL-C and LDL-C among the three group(P>0.05).The LSD method was used to test BMI,FBG,TG,TC in the MS+hypertension group,and the results showed that the leves were significantly higher than those in the simple hypertension group(all P<0.01).There were no differences in age,gender,duration of hypertension and level of blood pressure between the two groups.The levels of BMI,WC,FPG,TC,TG and LDL-C in the MS group were significantly higher than those in the non-MS group,while the HDL-C level was significantly lower than that in the non-MS group(all P<0.05).There was statistically significant difference in IMT among the three groups.Compared with the simple EH group,the IMT(1.09±0.22 mm vs.0.90±0.18 mm)and the incidence of carotid arteriosclerosis(61.3%vs.29.4%)in the MS+hypertension group were significantly higher(P<0.01).The results of Spearman correlation analysis showed that IMT was positively correlated with age(r=0.598,P<0.01),SBP(r=0.450,P<0.01),TG(r=0.554,P<0.01),FBG(r=0.522,P<0.01)and negatively correlated with HDLC(r=-0.218,all P<0.05).The results of multiple Regression analysis showed that TG,age,blood pressure and HDL-C were independent influencing factors of IMT(all P<0.05).Conclusion MS shows significant effect on IMT and arteriosclerosis degree in EH patients.Besides the control of blood pressure,comprehensive intervention and individual treatment such as lipid regulation,reducing blood glucose and weight loss should be used to reduce the risk of cardiovascular complications.