血管内皮舒张功能与原发性高血压危险性分层的关系

目的采用高频超声技术检测原发性高血压(EH)病人血管内皮依赖性舒张功能(EDD)和血管内皮非依赖性舒张功能(EIDD),探讨血管内皮舒张功能与原发性高血压危险性分层的关系。方法将80例EH病人分为低危组、中危组、高危组、极高危组,并选20例正常人作为对照。利用高频超声检测EH病人和正常对照组在静息状态下、加压充血后和服用硝酸甘油后的肱动脉内径和血流量的变化,并计算充血后肱动脉内径变化率(FMD)和服用硝酸甘油后肱动脉内径变化率(GNT-MD),以FMD、GNT-MD代表EDD和EIDD。结果高血压各组FMD均低于对照组(F=7.35,q=3.21～4.43,P<0.05);高危组与极高危组FMD低于低危组和中危组(q=3.02～4.03,P<0.05)。极高危组和高危组GNT-MD与对照组、低危组及中危组比较差异有显著性(F=6.18,q=3.02～4.43,P<0.05)。结论EDD和EIDD可反映高血压的危险性,可作为高血压危险性分层的评价指标之一。超声是检测血管内皮舒张功能的简便、无创、可靠的方法。

RELATIONSHIP BETWEEN ENDOTHELIAL VASODILATION FUNCTION AND RISK DEGREES IN ESSENTIAL HYPERTENTION

Objective To study the relationship between vascular endothelial dilation function and the risk in essential hypertension (EH). Methods Eighty patients with EH were randomly divided into four groups: low-, moderate-, high- and very-high-risk groups; 20 healthy subjects were served as controls. Brachial artery internal diameter and the variation of blood flow were measured by high resolution vascular ultrasound in patients with EH and subjects at resting condition, after taking sublingual nitroglycerin (GNT-MD)and under reactive hyperemia (FMD). FMD and GNT-MD represented EDD and EIDD, respectively. Results Flow-mediated vasodilation (FMD) of EH group decreased dramatically compared with the control group (F=7.35,q=3.21-4.43,P<0.05); FMD in high-risk group and very-high-risk group was lower than that of low-risk and moderate-risk (q=3.02-4.03,P<0.05). The differences of GNT-MD between the control, low-risk or moderate-risk were significant (F=6.18, q=3.02-4.43,P<0.05). Conclusion EDD and EIDD can reflect the risk of patients with EH and can be regarded as an index for estimation of this problem. Ultrasound is simple, noninvasive and reliable to measure the vascular endothelial dilation.