糖尿病对高血压患者血压变异性的影响及其与甲状腺功能的相关性分析

The relationship between blood pressure variability and thyroid hormone in hypertension patients with or without diabetes

目的探讨2型糖尿病合并高血压患者血压变异性(BPV)特点及与甲状腺功能的关系。方法选择200例高血压患者,其中100例高血压合并2型糖尿病患者为试验组,100例单纯高血压、血糖正常者为对照组。收集性别、年龄、体重、身高、体重指数(BMI)等一般资料。测量坐位收缩压(systolic blood pressure SBP)、舒张压(diastolic blood pressures,DBP)。测定游离甲状腺原氨酸(free thyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、促甲状腺激素(Thyrotropic hormone,TSH)、总甲状腺原氨酸(total thyronine,TT3)、总甲状腺素(total thyroxine,TT4)等甲状腺功能指标水平和糖化血红蛋白(glycolated hemoglobin A1c,HbA1c)、空腹血糖(fasting blood glucose,FBG)、餐后2 h血糖(2h-Postprandial glucose,2h PG)、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceide,TG)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoproteincholesterol,LDL-C)等糖脂代谢指标水平及同型半胱氨酸(homocysteine,HCY)水平;行24 h态血压监测。比较两组差异。结果试验组24 h舒张压变异性、24 h收缩压变异性、动脉硬化指数均高于对照组(P<0.05)。多元逐步回归分析显示:试验组收缩压变异性与TT4负相关。结论糖尿病对甲状腺功能正常的原发性高血压患者收缩压和舒张压变异性均有影响,但TT4只与收缩压变异性相关。

Objective To investigate the characteristics of blood pressure variability(BPV)in hypertension patients with or without type 2 diabetes mellitus,and to analyse the relationship between thyroid function and BPV.Methods Totally 200 hypertensive patients,with normal thyroid function,were enrolled,including 100 patients with type 2 diabetes as the experimental group,and another 100 patients without diabetes as the control group.General data such as gender,age,weight,height and body mass index(BMI)were collected,systolic blood pressure(SBP)and diastolic blood pressures(DBP)were measured.Blood samples were collected to determine thyroid functions,included free thyroxine(FT3),free thyroxine(FT4),thyrotropic hormone(TSH),total thyronine(TT3)and total thyroxine(TT4).Glycolated hemoglobin A1c(HbA1c),fasting blood glucose(FBG),postprandial glucose,total cholesterol(TC),triglyceide(TG),high density lipoprotein-cholesterol(HDL),low density lipoprotein-cholesterol(LDL-C),and homocysteine(Hcy)were measured.A 24-hour dynamic blood pressure monitoring was performed.Results The 24h diastolic blood pressure variability and 24h systolic blood pressure variability,in type 2 diabetes mellitus patients with hypertension,were higher than those in the control group(P<0.05),and the arteriosclerosis index was higher than those in the control group(P<0.05).Multiple stepwise regression analysis showed that systolic blood pressure variability was negatively correlated with TT4.Conclusion In patients with essential hypertension with normal thyroid function,diabetes changes both systolic blood pressure variability and diastolic blood pressure variability,but TT4 is only related to systolic blood pressure variability.