家族性原发性高血压与血管紧张素原基因M235T突变关系的研究

目的：探讨血管紧张素原基因Ｍ２３５Ｔ突变与家族性原发性高血压（ＥＨ）的关系。　　方法：应用脱氧核糖核酸（ＤＮＡ）杂交和测序检定方法,对一个典型原发性高血压大家系１００名成员［分直系亲属高血压组（ｎ＝ ４５）、直系亲属正常血压组（ｎ＝ ３８）及非直系亲属正常血压组（ｎ＝ １７）］和正常血压对照家系直系亲属２１ 名（为正常对照组）成员按＜ ３５岁和≥３５岁２个年龄层的Ｍ２３５Ｔ突变进行分析。　　结果：比较４组在＜ ３５ 岁和≥３５ 岁２个年龄层的Ｍ２３５Ｔ分布。表明各年龄层中,４组间Ｍ２３５Ｔ基因型及基因频率分布未见显著不同。　　结论：血管紧张素原基因Ｍ２３５Ｔ突变与该家族性原发性高血压没有显著关联;Ｍ２３５Ｔ突变可能不是该家族性原发性高血压的遗传易感因素。     

原发性高血压超声心动图的性别差异

目的研究高血压病人超声心动图的性别差异。方法1～2级原发性高血压病人108例,其中女性病例组(PGf)52例,男性病例组(PGm)56例;正常血压者42例作对照,其中女性对照组(CGf)20例,男性对照组(CGm)22例。所有受试者用Aspen电脑声像仪行超声心动图检查。检测受试者左心房和左心室结构和功能的相关指标,测值取5个心动周期测值的平均值。指标数据以(x±s)表示,以t检验进行统计学分析。结果与PGm相比,PGf的超声心动图具有以下特点:LAID、MVa较大[(37.24±5.88vs32.14±3.80)mm,P<0.01和(84.18±12.13vs81.71±12.30)/s,P<0.05];LVMI[(119.26±22.33)g/m2vs(128.17±27.00)g/m2,P<0.05]、EF(75.13%±6.69%vs83.00%±3.68%,P<0.01)、FS(41.67%±7.99%vs49.03%±7.35%,P<0.01)、MVe[(68.28±8.66)/svs(73.73±11.46)/s,P<0.05]和MVe/a(0.83±0.08vs0.93±0.11,P<0.01)均较小。CGf和CGm之间的上述指标差别无显著性。结论高血压病人的超声心动图存在性别差异,女性高血压病人较男性更易出现心脏结构和功能损害。     

原发性高血压超声心动图的性别差异

目的研究高血压病人超声心动图的性别差异.方法1～2级原发性高血压病人108例,其中女性病例组(PGf) 52例,男性病例组(PGm)56例;正常血压者42例作对照,其中女性对照组(CGf) 20例,男性对照组(CGm)22例.所有受试者用Aspen电脑声像仪行超声心动图检查.检测受试者左心房和左心室结构和功能的相关指标,测值取5个心动周期测值的平均值.指标数据以(-x±s)表示,以t检验进行统计学分析.结果与PGm相比,PGf的超声心动图具有以下特点LAID、MVa较大[(37.24±5.88 vs 32.14±3.80)mm,P＜0.01和(84.18±12.13 vs 81.71±12.30)cm/s,P＜0.05];LV-MI[(119.26±22.33)g/m2vs(128.17±27.00)g/m2,P＜0.05]、EF(75.13%±6.69%vs 83.00%±3.68%,P＜0.01)、FS(41.67%±7.99%vs 49.03%±7.35%,P＜0.01)、MVe[(68.28±8.66)cm/s vs(73.73±11.46)cm/s,P＜0.05]和MVe/a(0.83±0.08 vs 0.93±0.11,P＜0.01)均较小.CGf和CGm之间的上述指标差别无显著性.结论高血压病人的超声心动图存在性别差异,女性高血压病人较男性更易出现心脏结构和功能损害.     

高血压病患者盐敏感性与高胰岛素血症之间的关系

目的：探讨高胰岛素血症（ＨＩＳ）与盐敏感性高血压病肾脏排钠障碍间的关系。方法：根据盐敏感性（盐负荷试验Ｓｕｌｉｖａｎ标准），将５３例高血压病患者分为２组：盐敏感型（ＳＳ）组２２例、盐不敏感型（ＳＲ）组３１例。测定患者在盐负荷试验中血糖和血胰岛素浓度变化，计算胰岛素抵抗。结果：ＳＳ组与ＳＲ组相比较，基础状态、盐负荷和服呋喃苯胺酸（速尿）后各时点血糖及血胰岛素变化明显（血糖：５．１２±１．２５、５．９７±１．５９、５．２１±１．２８ｍｍｏｌ／Ｌ比４．９６±１．１４、５．４８±１．３８、５．０７±１．２３ｍｍｏｌ／Ｌ，Ｐ＞０．０５；血胰岛素：１２．４６±４．１４、３１．６８±１２．２１、１４．３５±４．４５ｍＵ／Ｌ比１０．１５±３．６２、２２．１４±８．６４、１０．８９±３．９１ｍＵ／Ｌ，Ｐ＜０．０１），ＳＳ组中胰岛素抵抗发生率显著高于ＳＲ组（６３．６％比３２．３％，Ｐ＜０．０５）。结论：ＳＳ高血压病肾脏排钠障碍与高胰岛素血症有关。     

原发性高血压患者饮食结构与心血管病危险因素

研究背景饮食治疗和生活方式的改善始终是临床预防和干预的基础。目的通过对北京地区原发性高血压患者饮食结构的调查研究,探讨不同膳食结构对原发性高血压患者心血管病危险因素的影响。方法应用膳食调查问卷形式连续收集了424例北京地区原发性高血压患者的饮食结构,测量患者的身高、体质量、腰围,并清晨空腹取静脉血检测各项生化指标。根据调查结果采用病例对照研究的方法对患者进行分组:素食为主组(素食组,n=95)、肉食为主组(肉食组,n=133)和荤素平衡组(平衡组,n=196),分别比较组间临床和生化指标。以膳食结构和传统心血管危险因素为自变量做 logistic 回归分析。结果 1)肉食组患者发生肥胖的比例(46.6%)明显高于素食组(21.7%)和平衡组(30.0%),P 均<0.01;肉食组超重加肥胖患者所占的总比例(90.5%)也显著高于素食组(61.4%)和平衡组(72.9%),P 均<0.01。2)与素食组比较,肉食组和平衡组患者的体质量指数(BMI)、腰围、血清肌酐和尿酸水平均呈显著增高(P<0.01和 P<0.05);而平衡组患者的 BMI、腰围、血清肌酐和尿酸水平均显著低于肉食组(P<0.01)。3)与素食组...     

原发性高血压患者饮食结构与心血管病危险因素

研究背景 饮食治疗和生活方式的改善始终是临床预防和干预的基础.目的 通过对北京地区原发性高血压患者饮食结构的调查研究,探讨不同膳食结构对原发性高血压患者心血管病危险因素的影响.方法 应用膳食调查问卷形式连续收集了424例北京地区原发性高血压患者的饮食结构,测量患者的身高、体质量、腰围,并清晨空腹取静脉血检测各项生化指标.根据调查结果采用病例对照研究的方法对患者进行分组:素食为主组(素食组,n＝95)、肉食为主组(肉食组,n＝133)和荤素平衡组(平衡组,n＝196),分别比较组问临床和生化指标.以膳食结构和传统心血管危险因素为自变量做logistic回归分析.结果 1)肉食组患者发生肥胖的比例(46.6%)明显高于素食组(21.7%)和平衡组(30.0%),P均＜0.01;肉食组超重加肥胖患者所占的总比例(90.5%)也显著高于素食组(61.4%)和平衡组(72.9%),P均＜0.01.2)与素食组比较,肉食组和平衡组患者的体质量指数(BMI)、腰围、血清肌酐和尿酸水平均呈显著增高(P＜0.01和P＜0.05);而平衡组患者的BMI,腰围、血清肌酐和尿酸水平均显著低于肉食组(P＜0.01).3)与素食组和平衡组比较,肉食组患者的肱动脉脉压、血清丙氨酸氨基转移酶和三酰甘油水平均显著增高(P＜0.01),高密度脂蛋白胆固醇(HDL-C)水平显著降低(P＜0.01);而这些指标在素食组和平衡组之间未见显著差异.4)肉食组患者代谢综合征(MS)的患病率(74.3%)明显高于素食组(53.7%,P＜0.01)和平衡组(62.4%,P＜0.05),而素食组和平衡组患者之间MS的患病率未呈现显著差异.5)Logistic回归分析显示,膳食结构是原发性高血压患者HDL-C(OR＝2.118,P＝0.008)和腰围(OR＝5.376,P＝0.017)的独立相关因素.结论 1)不同膳食结构与北京地区原发性高血压患者超重和肥胖的患病率显著相关;2)富于蔬菜、水果和碳水化合物的膳食可能改善原发性高血压患者HDL-C和腰围的水平,降低代谢综合征的患病率.     

Structural Changes in the Cardiovascular System of Untreated Essential Hypertensives

Arterial hypertension is associated with structural changes in the cardiovascular system. This study has examined the effect of hypertension on the carotid artery wall and examined the relation between changes in the structure of carotid artery wall and left ventricle in untreated hypertensives. The carotid artery wall was visualized using a high resolution ultrasound technique in 37 untreated hypertensive patients (25 males, 12 females) and 37 age and sex matched normotensive individuals and carotid intima-media thickness (IMT) and carotid artery diameter measured. IMT and intima-media cross sectional area was significantly greater in the hypertensive group compared with the normotensive group, though the carotid artery diameter did not differ significantly. There was a significant association between age and IMT in both groups. In the hypertensive group there was also a significant association between left ventricular mass index, ventricular septal or posterior wall thickness and IMT. This study indicates that there is an association between cardiac and carotid arterial structure in hypertension. Such a relationship may be important in understanding the associated risks of high blood pressure.     

血管紧张素原基因M235T分子变异与原发性高血压的关系

目的：探讨血管紧张素原（ＡＧＴ）基因Ｍ２３５Ｔ分子变异与中国人原发性高血压的关系。　　方法：对８９ 例原发性高血压（原发性高血压组）及９１ 例正常者（正常对照组）用多聚酶链式反应法及限制性片段长度多态性技术对ＡＧＴ基因Ｍ２３５Ｔ多态性进行了检测。　　结果：原发性高血压组Ｔ等位基因频率０．８０,ＴＴ基因型频率０．６７,与正常对照组（０．６６,０．４３）比较有显著性差异,（Ｐ＝ ０．０２３,Ｐ＝ ０．００４）;ＴＴ基因型较ＭＴ＋ ＭＭ 基因型对原发性高血压的比值比为２．７６（９５％ 可信区间为１．５０～５．０６,Ｐ＝ ０．００１）。　　结论：ＡＧＴ基因ＴＴ基因型可能与中国人群原发性高血压发病有关联。     

中老年原发性高血压患者血清胰岛素水平变化的研究

本文根据WHO标准对84例老年及老年前期原发性高血压患者和36例健康人进行口服葡萄糖耐量试验。结果表明:随着增龄高血压患者和健康人糖耐量异常发生率增加,口服75g葡萄糖后1h和2h血清胰岛素水平亦升高,但显著高于同龄健康对照组。多因子逐步回归表明,在高血压病中,以收缩压为因变量时,自变量选了血清胰岛素曲线下面积及2h血清胰岛素。本文还探讨了老年与老年前期原发性高血压病患者血清胰岛素变化规律及其在发病机制中的作用。     

Decreased Core-to-Skin Heat Transfer in Mild Essential Hypertensives Exercising in the Heat

In previous reports (1,2) we examined the physiological responses of normotensive and essentially hypertensive men to steady state leg exercise (at 40% V02max) in a warm (38°C dry-bulb, 28°C wet-bulb) environment. Those results are reviewed. Additionally, in this paper we report relative core-to-skin heat transfer (HT) characteristics of these two groups, matched for age, aerobic fitness, and body composition, but differing in resting blood pressure. Forearm skin blood flow (as measured from changes in total forearm blood flow) was relatively reduced in the hypertensives. This resulted in a similar (but slightly compensated) reduction in HT, e.g., at minute 30, the hypertensives had 81% less skin blood flow and 56% less HT than their normotensive counterparts. This finding has important implications for unmedicated mild hypertensives exercising or working in hot environments.     

Effect of Plasma from Essential Hypertensives on Tension of Aortic Strips

The effect of fractions of plasma from essential hypertensive (n=27) and normotensive subjects (n=26) on the tension of aortic strips (n=27) from normotensive rats was examined. The fractions obtained from hypertensive patients had been shown to increase blood pressure, when injected intravenously in a normotensive rat. In aortic strips the hypertensive fractions elicited a translent relaxation of variable amplitude and subsequently a sustained contraction. The normotensive fractions did not alter tension of the strips significantly. In Ca²⁺ free medium and after addition of nifedipine hypertensive plasma fractions did not induce a contraction, whereas in Na⁺ free medium the contraction was not abolished. It is concluded that in the fraction of hypertensive plasma containing substances with a molecular weight in the range of 1000 - 1500 Da a vasopressor agent with direct actions on arterial smooth muscle is present. The substance probably acts by increasing Ca²⁺ influx in vascular smooth muscle.     

间隙连接蛋白40基因多态性与原发性高血压病的相关性研究

目的：探讨间隙连接蛋白40基因（44和＋71位点）多态性与原发性高血压（EH）的相关性。方法运用聚合酶链反应PCR技术对210例原发性高血压病住院患者,对照组158例体检正常人的 Cx40基因的44和＋71位点基因多态性、基因型、等位基因分布频率等进行统计学分析。结果病例组三酰甘油、钙、高密度脂蛋白（HDL）与对照组有统计学意义（P〈0.05）,CX40基因44位点基因型病例组和对照组构成比总体及男性均存在统计学意义（P〈0.05）,＋71位点无统计学意义（P〉0.05）。Logistic回归提示44位点 AA基因型、三酰甘油、钙的OR值分别是4.458、4.1330、0.195,P分别是0.039、0.001、0.014。结论 Cx40基因启动子区域44位点 AA基因型可能是男性高血压人群的危险因素,高三酰甘油为危险因素,高钙为保护因素。     

Characterization of a Group of Essential Hypertensives with Impaired Regulation of Aldosterone

The pattern of aldosterone excretion during high sodium intake in 100 patients with essential hypertension allowed the differentiation of two groups: in the majority of patients (group A, n = 64) aldosterone excretion was suppressed below 6 μg/day similar to the normotensive control group. In a second group (group B, n = 36), aldosterone remained above the control range despite forced sodium loading. In group B, serum potassium was significantly lower than in patients of group A (3.81 ± 0.44 meq/1 vs. 4.26 ± 0.57 meq/1, p< 0.001). The blood pressure lowering effect of spironolactone (200 mg/d) was more pronounced among patients in group B. Plasma renin values tended to be lower in group B compared to patients with suppressed aldosterone. Infusion of Angiotensin II (0.1 - 2 μg/kg/min) led to a similar relative rise of plasma aldosterone levels in both groups despite higher baseline values in group B. The exact mechanism of the impaired regulation of aldosterone in a subgroup of patients with essential hypertension remains to be elucidated.     

增殖抑制基因单核苷酸多态性与原发性高血压的相关性

目的 探讨增殖抑制基因第二内含子7个单核苷酸多态性位点与原发性高血压的相关性.方法 筛选正常血压人群500名和原发性高血压患者930名,提取血中白细胞基因组DNA后设计特定的单核苷酸多态性引物进行定量多聚酶链反应,通过荧光定量方法确定该基因是否存在着某种特定的多态性位点.结果 7个不同的单核苷酸多态性中有3种即rs873457、rs2336384和rs4846085的基因型频率在正常血压组和原发性高血压组之间存在明显的差别(P<0.05),分别为TT:TC:CC=21.8%:46.6%:31.6%/22.5%:53.0%:24.5%、CC:CA:AA=21.8%:46.8%:31.4%/22.8%:52.6%:24.6%及TT:TC:CC=22.6%:46.4%:31.0%/23.4%:51.8%:24.7%,等位基因频率在正常血压组与原发性高血压组之间也存在明显差别(P<0.05),分别为T:C=45.1%:51.0%/49.0%:51.0%、C:A=45.2%:54.8%/49.1%:50.9%及T:C=45.8%:54.2%/49.1%:50.6%,其余4个单核苷酸多态性位点在正常血压组和原发性高血压组之间不存在明显的差别.对不同性别进行分析后发现在男性正常血压组与原发性高血压组的7个单核苷酸多态性位点之间均存在着明显的差别(P<0.05或P<0.01),而在女性正常血压组与原发性高血压组之间没有明显差别(P>0.05).相关性分析发现体质指数、年龄和基因型与血压之间存在着明显的相关性 (P<0.05).在进行了年龄和性别调整后,回归分析发现体质指数和rs873457与血压密切相关.单倍体型分析发现C-G-A-A-A-C-C(以 rs873457、rs2336384、rs1474868、rs4846065、rs4240897、rsrs2236055和 rs873458为序)无论在总体人群、男性还是女性人群中,均存在着明显的差别(P<0.01).结论 增殖抑制基因的基因多态性与高血压尤其是男性高血压之间存在着明显的差别.     

内皮型一氧化氮合酶基因多态性与原发性高血压的相关关系

目的 探讨内皮型一氧化氮合酶(eNOS)基因27bp数目可变的串联重复序列(VNTR)多态性与中国汉族人原发性高血压(EH)的相关性。方法 (1)聚合酶链反应(PCR)及琼脂糖凝胶电泳检测334例EH患者的基因型，同时进行基因测序。(2)硝酸还原酶法测定空腹血清一氧化氮代谢物(NOx)水平，用放射免疫法测定内皮素(ET)的水平。结果(1) EH组aa ab基因型和a等位基因频率显著高于对照组；(2)EH组内ab ab基因型空腹血清NOx、NOx／ET比明显低于bb基因型。结论 eNOS基因27bpVNTR的a等位基因与中国汉族人EH的发生相关，a等位基因携带者可能通过减少内皮：NO的释放、损害内皮功能参与EH发病。     

内皮型一氧化氮合酶基因多态性与原发性高血压的相关关系

目的探讨内皮型一氧化氮合酶(eNOS)基因27 bp数目可变的串联重复序列(VNTR)多态性与中国汉族人原发性高血压(EH)的相关性.方法 (1)聚合酶链反应(PCR)及琼脂糖凝胶电泳检测334例EH患者的基因型,同时进行基因测序.(2)硝酸还原酶法测定空腹血清一氧化氮代谢物 (NOx)水平,用放射免疫法测定内皮素(ET)的水平.结果 (1)EH组aa+ab基因型和a等位基因频率显著高于对照组;(2)EH组内ab+ab基因型空腹血清NOx、NOx/ET比明显低于bb基因型.结论 eNOS基因27 bp VNTR的a等位基因与中国汉族人EH的发生相关,a等位基因携带者可能通过减少内皮NO的释放、损害内皮功能参与EH发病.     

Active and Inactive Renin During Acute Reduction of Renal Perfusion Pressure in Essential Hypertensives

Arterial and renal venous active and inactive renin were studied in 5 patients with long established moderate hypertension following unilateral acute reductions of renal perfusion pressure (15% and 70% of control) by inflating a balloon catheter introduced into the right renal artery. This procedure failed to induce the expected release of active renin; total and inactive renin levels were also unchanged. on the contrary in a single normotensive patient smaller reductions of the renal perfusion pressure (-15% and -30%) were able to acutely increase the release of active renin with a concurrent conversion of inactive renin but without inducing blood pressure changes.

These findings show that the renin pattern typical of unilateral renovascular hypertension, including the intrarenal activation of inactive renin, could be reproduced acutely in a normotensive subject. Moreover, a complete reversal of the above mentioned active and inactive renin pattern was observed in a recent onset renovascular hypertensive patient within 30 min from successful percutaneous trans-luminal dilation. The negative results observed in our hypertensive patients suggest that structural changes induced by the long duration of hypertension might have reduced the sensitivity of the baroceptors involved in renin release.     

Baroreceptor Reflex in Elderly Essential Hypertensives: Effect of Chronic Inhibition of Angiotensin Converting Enzyme

Baroreflex function and plasma angiotensin II (Ang II) were examined in five elderly and five young or middle-aged essential hypertensive patients before and after enalapril treatment. Baroreflex sensitivity (BS) during blood pressure (BP) elevation by phenylephrine (PE) but not during BP reduction by sodium nitroprusside (SNP) was significantly attenuated in the elderly compared with the younger group, while plasma Ang II concentration was not different between the two groups. Enalapril treatment reduced BP without significant changes in heart rate and plasma norepinephrine in both groups, suggesting a leftward shift of barofunction curve. It also increased the BS in some cases in each group. However, plasma Ang II was not significantly reduced during enalapril treatment. The changes in BS did not correlate with changes in plasma Ang II. These results suggest that BS may be attenuated with increasing age independent of plasma Ang II and that ACE inhibitor influences the set point of the barofunction curve and BS by different mechanisms.     

β3肾上腺素能受体基因Trp64Arg多态性与蒙古族原发性高血压病相关性分析

目的检测蒙古族原发性高血压人群中β3肾上腺素能受体基因Trp64Arg多态性,探讨其与蒙古族人群原发性高血压病(EH)和其他心血管病危险因素的关系。方法应用PCR技术检测原发性高血压病患者102例,健康体检者93例。比较两组Trp64Arg突变基因型和临床特征。结果高血压病组与对照组β3-AR基因突变频率两者差异无统计学意义(P>0.05),基因Trp64Arg突变者的体质量指数显著高于正常基因型(P<0.05),突变者在三酰甘油、血糖、胰岛素、尿酸方面差异有统计学意义(P<0.05)。结论 Trp64Arg基因突变可能不是蒙古族原发性高血压病发生的决定因素,但该基因变异可能与肥胖、脂代谢、糖代谢等危险因素有关。     

多巴胺受体D1基因多态性与原发性高血压的相关性研究

目的:探讨多巴胺受体D1(DRD1)基因(-48A／G)多态性与原发性高血压的相关性。方法:采用多聚酶链式反应结合限制性内切酶片段长度多态性分析方法检测330例原发性高血压患者(高血压组) 和195例健康人(对照组)DRD1基因(-48A／G)多态性,并对两组人群的血压及各项临床指标进行测定。结果:高血压患者中,DRD1基因(-48A／G)多态性各基因型之间的收缩压、舒张压及平均动脉压有显著差异。其中, AG基因型的诊室舒张压、24h舒张压及24h平均动脉压显著高于AA基因型(P<0．05);GG基因型的诊室收缩压、诊室舒张压、诊室平均动脉压及24h舒张压、24h平均动脉压均显著高于AA基因型(P<0．05);AG基因型与GG基因型之间的收缩压、舒张压及平均动脉压均无显著差异(P>0．05)。结论:北京地区汉族人群中DRD1基因(-48A／G)多态性与原发性高血压明显相关。