腹主动脉内膜中层厚度在高血压病患者中的特征及其临床意义

目的 探讨腹主动脉内膜中层厚度（IMT）在原发性高血压病（PH）患者中的特征及其临床意义,为PH主动脉病变的防治提供依据.方法 采用随机抽样方法选取≥30周岁的2级PH患者194例（高血压组）,行腹主动脉内膜中层厚度检测,对于IMT≥3.0 mm,主动脉管径≥3.0 cm的4例患者,行人工血管转换术并进行病理检查,并与203例非高血压健康体检者（正常对照组）进行对照.结果 高血压组IMT为（2.46±0.34） mm,正常对照组为（1.70±0.30）mm,高血压组高于正常对照组（t=23.833,P＜0.01）.其中,高血压组男性IMT为（2.41±0.36） mm,正常对照组为（1.68±0.29） mm,组间比较差异有统计学意义（t=14.520,P＜0.01）;高血压组女性IMT为（2.53±0.27） mm,正常对照组为（1.72±0.31）mm,组间比较差异有统计学意义（t=22.660,P＜0.01）.两组IMT偏度值比较差异无统计学意义（P＞0.05）,而高血压组峰度值明显高于正常对照组,差异有统计学意义（P＜0.01）.IMT频数在高血压组呈正偏态分布,在正常对照组呈负偏态分布;增厚的动脉多数伴有动脉粥样硬化样改变,如内膜呈现黄色脂点或黄色脂肪条纹,内膜增生的结缔组织含有脂质的平滑肌细胞、巨噬细胞,其中央基底部变性、坏死,与脂质混合形成粥样物质,为粥样斑块或粥样瘤.结论 PH患者,不论男性或者女性,其IMT平均值高于正常对照组,IMT频数在高血压患者呈正偏态分布,在正常健康者呈负偏态分布,增厚的动脉内膜中层多数伴有动脉粥样硬化样改变.

Characteristics of abdominal aortic intima-media thickness of hypertension patients and its clinical significance

Objeetlve To explore the characteristics of abdominal aortic intima-media thickness （IMT） of patients with primary hypertension （PH） and its clinical significance, so as to provide basis for prevention and treatment of aortic lesions of PH.Methods 194 patients with stage 11 hypertension,who aged 30 or above,were selected as the hypertension group by random sampling method.They underwent IMT detection, and 4 cases with IMT≥3.0 mm and aortic diameters ≥13.0 cm among them underwent switch operation of artificial blood vessel and pathological examination.And the hypertension group were compared with 203 cases without hypertension （ control group） proved by physical examination.Results IMT of the hyperten- sion group was （ 2.46＋ 0.34） ram, obviously higher than that （ 1.70± 0.30 ） mm of the control group （ t = 23.833, P〈 0. 01 ）. I MT of male patients in the hypertension group was （2.41 ＋0.36） ram, but IMT of males in the control group was only（ 1.68± 0.29） mm, so the difference was statistically significant （t = 14.520, P〈 0. 01 ）.IMT of females in the hypertension group was （2.53＋0.27） mm ,but IMT of females in the control group was （1.72±0.31） mm, so the difference was also statistically significant（t=22.660,P〈0. 01）.There was no significant statistical difference in IMT skewness of two groups（P〉0. 05）, but kurtosis of the hypertension group was significantly higher than that of the control group and the difference was statistically significant（P〈0. 01）.IMT frequency was in positive skew distribution in the hypertension group,while it showed a negative skewness distribution in the control group;most thickened artery showed changes of atherosclerosis, such as yellow fat point and yellow fat streaks.Connective tissue with intimal hyperplasia contained lipidic smooth muscle cells, macrophages, and the central base became degenerated and necrosis mixing with lipid becoming atherosclerosis material-atherosclerotic plaque or atherosclerosis.C