糖代谢异常对原发性高血压患者血管内皮损伤的影响

目的：探讨糖代谢异常对原发性高血压（EH）患者血管内皮损伤的影响。方法：对46例单纯EH患者（EH组）与33例EH合并2型糖尿病（T2DM）患者（EH＋T2DM组）的血糖、血脂、体质指数（BMI）及血清同型半胱氨酸（Hcy）、尿微量白蛋白浓度进行测定、比较，同时分析血清Hcy及尿微量白蛋白浓度与血糖、血脂及BMI之间的相关性。结果：与EH组相比，EH＋T2DM组的BMI、血糖[空腹血糖（FBG）、餐后2h血糖（2hPBG）、糖化血红蛋白（HbAlc），血脂[甘油三酯（TG）、低密度脂蛋白胆固醇（LDL．C）及载脂蛋白B（ApoB）]水平均显著升高（P〈0．05或〈0．01），而且血清Hcy[（12．78±2．51）μmol／L比（16．26±2．91）μmol／L]及尿微量白蛋白水平[（19．45±5．24）mg／L比（33．65±10．70）mg／L]升高更加显著（P〈0．01）；Pearson相关分析显示，在EH＋T2DM组患者，血清Hcy水平分别与BMI、FBG、HbAlc、LDL．C、ApoB及尿微量白蛋白水平显著正相关（r=0．667～0．906，P均〈0．01），而尿微量白蛋白水平则分别与BMI、HbAlc、LDL-C、ApoB及血清Hcy水平显著正相关（r=0．566～0．685，P均〈0．01）。结论：糖代谢异常可加重原发性高血压患者的血管内皮及肾微血管损伤，而且这与血糖代谢异常程度密切相关；控制血糖水平可减轻血管损伤，进而延缓心血管疾病及肾脏并发症的病理进展。

Influence of abnormal glucose metabolism on vascular endothelial injury in patients with essential hypertension

Objective： To explore influence of abnormal glucose metabolism on vascular endothelial injury in patients with essential hypertension （EH）. Methods： A total of 46 pure EH patients （EH group） and 33 EH patients compli- cated type 2 diabetes mellitus （T2DM, EH＋T2DM group） were enrolled. Blood glucose, blood lipid, body mass in- dex （BMI）, serum concentrations of homocysteine （Hcy） and urine microalbumin were measured and compared be- tween two groups. Relationship among serum Hcy, urine microalbumin concentrations and blood glucose, blood lip- ids, BMI were analyzed. Results： Compared with EH group, there were significant increase in levels of BMI, fast- ing blood glucose （FBG）, 2h postprandial blood glucose （2hPBG）, glycosylated hemoglobin （HbAlc）, triglyceride （TG）, low density lipoprotein-cholesterol （LDL-C） and apolipoprotein B （ApoB）, （P〈0.05 or 〈0.01）, and even more significant increase in serum levels of Hcy [ （12.78±2.51） μmol/L vs. （16.26±2.91） μmol/L] and urine mi- croalbumin [（19.45±5.24） mg/L vs. （33.65＋10.70） mg/L] in EH＋T2DM group, P〈0.01 both; Pearson corre- lation analysis indicated that in EH patients with DM, serum Hey level was positively correlated with BMI, FBG, HbAle, LDL-C, ApoB and urine mieroalbumin （r=0. 667-0. 906, P〈0.01 all）, while urine microalbumin level was positively correlated with BMI, HbAlc, LDL-C, ApoB and serum Hcy （r = 0. 566-0. 685, P〈0.01 all）. Con- clusion： Abnormal glucose metabolism can aggravate both vascular endothelial injury and renal mierovascular injury in patients with essential hypertension, and these are closely related with degree of abnormal glucose metabolism. Therefore, controlling blood glucose level can relieve vascular injury, further relieve pathological development of cardiovascular diseases as well as renal complications.