非侵入法对高血压早期血管内皮功能障碍的评价

Noninvasive Assessment of Vascular Endothelial Dysfunction with Essential Hypertension

为了评估高血压 1 2级无心血管危险因素病人是否存在内皮依赖性血管内皮功能的损害 ,并探讨高血压对内皮功能的影响 ,我们应用非侵入方法研究了高血压病人和正常人各 2 5例。用高分辨二维超声方法检测反应性充血前后肱动脉直径和血流 ,比较两组的肱动脉直径变化率、血流以及它们与血压之间的关系。结果发现 ,高血压病人血流介导的肱动脉舒张明显低于对照组 (9.8%± 6 .7%比 14 .7%± 6 .8% ,P <0 .0 1) ;血流介导的肱动脉血流亦较对照组明显减少 (5 2 9± 114mL min比 6 4 2± 16 0mL min ,P <0 .0 1) ;相关分析发现 ,血流介导的肱动脉舒张分别与收缩压 (r=- 0 .4 73,P <0 .0 1)、舒张压 (r=- 0 .30 8,P <0 .0 5 )呈负相关 ;血流介导的肱动脉血流与收缩压呈负相关 (r=- 0 .35 5 ,P <0 .0 1) ,而与舒张压无关。此结果提示 ,高血压病早期虽无明显动脉硬化 ,但已存在血管内皮功能的损伤。

Aim The purpose of this study was to evaluate whether endothelium dependent (nitric oxide mediated) dilation of the brachial artery is impaired in patients with grade 1 and 2 essential hypertension,but no other risk factors and the role of hypertension in endothelial function. Methods We studied 25 patients with hypertension and 25 control subjects. Flow mediated dilation (FMD) and hyperemia flow at rest, during reactive hyperemia were assessed in brachial artery by high resolution,two dimensional ultrasonography. Results Brachial artery FMD of hypertensive patients was significantly lower than that of controls (9.8%±6.7% vs 14.7%±6.8%,P<0.01). Hyperemia flow of hypertensive patients significantly decreased compared with that of controls (529±114 mL/min vs 642±160 mL/min,P<0.01). FMD was negatively related to systolic blood pressure and diastolic blood pressure,respectively (r=-0.473,P<0.01 and r=-0.308,P<0.05). Hyperemia flow was negatively related to systolic blood pressure besides diastolic blood pressure. Conclusions Impaired endothelial function exists in patients with early hypertension without evidence of overt atherosclerosis.