血压正常的胰岛素依赖型糖尿病患者动态血压的改变

为观察胰岛素依赖型糖尿病（ＩＤＤＭ）患者动态血压的改变及其与尿白蛋白排泄率（ＵＡＥ）和自主神经病变的关系，我们对血压正常的ＩＤＤＭ患者２４例进行了２４小时动态血压监测（ＤＢＰＭ），并与糖耐量正常（ＮＧＴ）者进行了比较。结果发现，ＩＤＤＭ患者无白天血压和２４小时血压的明显改变，但夜间血压升高，昼夜血压差值明显降低，该改变与自主神经功能计分、ＵＡＥ、偶测ＳＢＰ、夜间ＳＢＰ和夜间ＤＢＰ呈显著负相关。     

糖耐量低减患者进行动态血压及尿白蛋白检测的临床意义

应用动态血压监测（ＡＢＰＭ）技术进行了５４例血压正常的糖耐量低减（ＩＧＴ）患者动态血压与尿白蛋白检测，并与３０例正常人进行对照，结果显示：ＩＧＴ患者在未出现高血压之前，已有动态血压改变，部分ＩＧＴ存在阵发性高血压，尤其是收缩压（ＳＢＰ）升高显著，舒张压有增高趋势。ＩＧＴ患者尿白蛋白排出率（ＵＡＥＲ）较正常人升高（Ｐ〈０．０１），血压升高者尿白蛋白（ＵＡＥ）增高多见。因此，预防糖尿病并发症，干预应从     

糖耐量低减患者的尿白蛋白排出率观察

测定了７７２例ＩＧＴ患者尿白蛋白排出率（ＵＡＥ），并与７８７例正常对照者作了比较。结果显示ＩＧＴ患者ＵＡＥ和微量白蛋白尿发生率明显高于正常对照组。此外，ＩＧＴ患者的血压、ＢＭＩ、血清Ｃｈ、Ｔｇ、Ｃｒ也明显增高，而ＨＤＬ－Ｃｈ则明显低于正常对照组。ＩＧＴ伴高血压者的ＵＡＥ高于正常血压者。正常血压组中肥胖者的ＵＡＥ高于非肥胖者。多元逐步回归分析显示ＩＧＴ和正常人的ＵＡＥ与ＢＭＩ、ＭＢＰ、服糖后２小时血     

动态血压负荷值与高血压病左室肥厚的关系探讨

对７８ 例高血压病患者进行了２４ 小时动态血压监测,并分析其２４ 小时、白昼和夜间血压负荷值。结果Ａ组（单纯高血压组）血压负荷值明显高于正常,但夜间血压负荷值较白昼明显降低。Ｂ组（高血压左室肥厚组）血压负荷值较Ａ组明显增高,尤其是夜间血压负荷值明显增高（Ｐ＜ ０．０５、０．０１）。提示动态血压负荷值增高对高血压左室肥厚（ＬＶＨ）的发生起重要作用。     

缓释维拉帕米在高血压治疗中对血栓素,前列环素的影响

目的研究维拉帕米治疗高血压时血清ＴＸＡ２和ＰＧＩ２的变化。方法２５例原发性高血压病人应用缓释维拉帕米治疗１２周，治疗前后进行２４ｈ动态血压监（ＭＡＢＰ）及ＴＸＡ２，ＰＧＩ２测定。结果治疗后全天ＭＡＢＰ平均下降２４％，ＡＢＰ平均均Ｔ／Ｐ〉５０％，ＴＸＡ２明显下降，ＰＧＩ２显著增加，ＴＸＡ２／ＰＧＩ２下降。结论ＴＸＡ２下降，ＰＧＩ２增高及ＴＸＡ２／ＰＧＩ２降低，可能是维拉帕米降压的一种机制。在血压下降     

起搏综合征患者的24小时动态血压监测(摘要)

应用２４小时动态血压监测（ＡＢＰＭ）术,可观察起搏器安置术前后患者动态血压变化,探讨起搏综合征的发生机制。一、对象与方法１．病例选择：欲行ＶＶＩ起搏器安置术的患者１１例,女５例,男６例。年龄２３～６２岁,平均（４９．８±１４．５）岁。病窦综合征７例。完全性房室传导阻滞４例。排除高血压病史及有明显心肝肾功能损害的患者。检查前停服心血管活性药物３天。２．ＡＢＰＭ采用ＴＭ２４２０型携带式动态血压监测仪,扫常规方法对患者进行２４小时动态血压监测,分析下列参数：（１）２４小时平均收缩压（２４ｈＳＢＰ）和２…     

正常人与高血压患者24小时动态血压监测观察及初步分析(摘要)

正常人与高血压患者２４小时动态血压监测观察及初步分析（摘要）蔡楚丹，李玉光，陈仰理本文对６０例其中２５例正常血压者及３５例高血压患者２４小时动态血压（简称ＡＢＰＭ）观察，分析血压波动的变化规律，阐明ＡＢＰＭ对诊断及治疗的意义．对象和方法门诊及住院病人...     

高血压左室肥厚与血清ACE水平及动态血压的关系

目的左室肥厚（ＬＶＨ）是心血管疾病的独立危险因子。观察高血压左室肥厚与血清ＡＣＥ水平及动态血压的关系，探讨ＬＶＨ的影响因素。方法１０４例原发性高血压患者采用超声心动图检测有无ＬＶＨ，同时作２４小时动态血压监测（ＡＢＰＭ），血清ＡＣＥ水平用人工合成的马尿酰甘氨酰甘氨酸作为底物，比色法测定。结果（１）ＡＢＰＭ显示高血压左室肥厚与左室正常两组仅夜间收缩压及夜间平均动脉压有统计学差异，余ＡＢＰＭ指标差异无显著性；（２）血清ＡＣＥ水平两组差异无显著性。结论高血压左室肥厚与２４小时动态血压间关系不十分密切，仅夜间收缩压及夜间平均动脉压与之有关，血清ＡＣＥ水平与ＬＶＨ无明显关系，可能是血清ＡＣＥ水平并不能反映组织ＡＣＥ水平所致，有待进一步研究。     

肥胖症患者和新诊断的2型糖尿病患者真胰岛素和前胰岛素的改变

目的 了解真胰岛素（ｔｒｕｅ ｉｎｓｕｌｉｎ，ＴＩ）和前胰岛素（ｐｒｏｉｎｓｕｌｉｎ，ＰＩ）在肥胖症和２型糖尿病患者中的改变，了解免疫活性胰岛素（ｉｍｍｕｎｏｒｅａｃｔｉｖｅ ｉｎｓｕｌｉｎ，ＩＲＩ）能否准确反映ＴＩ。方法 ３３例糖耐量正常（ＮＧＴ），２４例糖耐量减低（ＩＧＴ）和５３例新诊断的２型糖尿病患者行口服葡萄糖耐量实验，并根据体重指数（ＢＭＩ）分为肥胖和非肥胖组；采用ＥＬＩＳＡ方法（其单克     

高血压病血压昼夜节律与左室肥厚的关系

目的：观察高血压病血压昼夜节律与左室肥厚（ＬＶＨ）的关系。方法：５２例高血压病患者均经２４小时动态血压监测（ＡＢＰＭ）来观察昼夜节律,并用超声心动图检测左室重量指数（ＬＶＭＩ）。根据血压昼夜节律变化而分组,结果：血压昼夜节律消失１５例,ＬＶＨ７例,占４６．６％,血压昼夜节律正常３７例,ＬＶＨ８例,占２１．６％。结论：血压昼夜节律消失组室左室肥厚检出率显著高于血压昼夜节律正常组;而夜间收缩压（ＳＢＰ     

高龄高血压病患者动态血压及昼夜节律与胰岛素抵抗相关性的临床研究

目的探讨高龄高血压病患者血压昼夜节律与胰岛素抵抗之间的关系。方法对89例高龄原发性高血压病患者行动态血压监测（ABPM）和葡萄糖耐量实验（OGTT）及糖化血红蛋白含量的测定，根据糖负荷后2h血糖（2hPG）水平分为糖耐量正常（NGT）、糖耐量减低（IGT）和新发现2型糖尿病（NDM）三组，对三组间动态血压参数和糖代谢指标进行统计学分析。结果IGT组24h舒张压负荷显著低于NGT和NDM组（P〈0．05），24hDBP和nDBP显著低于NGT和NDM组（P〈0．05）。NDM组非杓型和反杓型的血压节律发生率明显高于NGT组（P〈0．01）。NGT组的杓型和超杓型血压发生率分别为21．21％和9．09％，明显高于NDM组。NDM组胰岛素抵抗指数（IRI）、糖化血红蛋白含量显著高于NGTIGT组（P〈0．05）。Logistic回归分析显示，脉压增大与餐后血糖和糖化血红蛋白显著相关，非杓型血压与胰岛素抵抗（IR）显著相关。结论血压昼夜节律紊乱与糖化血红蛋白含量及胰岛素抵抗密切相关。     

Relationship between blood pressure and glucose tolerance in acromegaly

BACKGROUND: Hypertension represents a well-known risk factor for cardiovascular diseases. The pathogenesis of hypertension in acromegaly is commonly viewed as multifactorial, but the possible influence of metabolic disorders on blood pressure (BP) in affected patients is largely unknown. OBJECTIVE: The aim of the present study was to evaluate the impact of glucose metabolism abnormalities on BP values in a series of patients with active acromegaly. DESIGN: An open multicentre prospective study. PATIENTS: Sixty-eight patients with active disease, aged 47.5 +/- 11.7 years, have been studied. Thirty-nine had normal glucose tolerance (NGT), 16 impaired glucose tolerance (IGT) and 13 suffered from diabetes mellitus (DM). MEASUREMENTS: Mean clinical BP values were calculated as the mean of BP values obtained by sphygmomanometric measurement in three separate occasions and mean 24-h, diurnal and nocturnal systolic (SBP) and diastolic (DBP) values were obtained by 24-h ambulatory blood pressure monitoring (ABPM). RESULTS: Patient's age and the degree of glucose tolerance abnormalities were found to significantly and independently influence BP values. All clinical and ABPM SBP and DBP values significantly increased with age by linear regression (P < 0.02 for all BP values, 0.30 < or = R < or = 0.43), and the independent influence of this parameter on BP values was confirmed by mutivariate analysis. Similarly, the independent influence of glucose tolerance abnormalities on BP values was confirmed when introducing age as a covariable in a multivariate analysis, and patients with DM presented significantly higher clinical SBP and 24-h, diurnal and nocturnal SBP and DBP than patients with NGT (P < 0.02 for clinical SBP, P < 0.015 for all ABPM values, respectively). In addition, patients with DM showed significantly higher 24-h, diurnal and nocturnal DBP than those with IGT (P < 0.05 in all cases). In contrast, no significant difference was found between NGT and IGT patients. No significant influence of disease duration, BMI, GH, IGF-I, or fasting and 2-h post glucose load insulinaemia on BP values was observed. CONCLUSIONS: Abnormalities of glucose metabolism significantly contribute to increase systolic blood pressure and especially diastolic blood pressure in acromegalic patients. Careful control of blood pressure and of risk factors for developing systemic hypertension, with special reference to glucose tolerance, is mandatory to decrease cardiovascular morbidity and mortality in such patients.     

对中高危高血压患者葡萄糖耐量试验异常的干预研究

目的观察对葡萄糖耐量试验异常的中高危高血压患者进行干预12个月后血压及糖代谢的情况。方法对213例葡萄糖耐量减低（IGT）的高血压患者随机分为生活方式控制组（LC）、生活方式控制加二甲双胍组（LC＋M）、生活方式控制加阿卡波糖组（LC＋A）三组,分析干预12个月后各组IGT转化为正常葡萄糖耐量（NGT）和新发糖尿病（DM）的发生率以及血压与IGT、NGT、DM之间的关系。结果三组干预12个月后,2hPG均明显降低（P〈0．01）,与LC组比,LC＋M组和LC＋A组转为NGT的人数均明显增多（P〈0．01）,LC＋M组和LC＋A组相比,在转为NGT和DM的人数方面差异无统计学意义（P〉0．05）,且血压越达标,糖尿病发生率越低。结论对糖耐量异常的高血压患者,积极的进行干预,可以减少糖尿病的发生,生活方式控制加药物治疗优于单纯生活方式控制。     

Impact of abnormal glucose tolerance, hypertension and other risk factors on coronary artery disease.

BACKGROUND: The degree to which abnormal glucose tolerance contributes to the development of coronary artery disease (CAD) has not been clarified in Japanese. The relationship between abnormal glucose tolerance and severity of coronary artery stenosis, as well as the contributions of hypertension, diabetes and other risk factors for CAD to recurrence of the disease, were investigated in the present study. METHODS AND RESULTS: The subjects were 474 consecutive patients (mean age: 63.8+/-11.3 years) with suspected CAD who were admitted to Sapporo Medical University Hospital during April 1, 1997 to March 31, 2004. The coronary index and stenosis score were higher in subjects with diabetes mellitus (DM) and in subjects with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) than in subjects with normal glucose tolerance (NGT). Ischemic episodes recurred during the observation period (mean 2.5 years) in 61 of 341 patients diagnosed as having CAD. In the follow-up subjects, systolic blood pressure (SBP) was significantly higher in the recurrence group than in the non-recurrence group, and SBP was a significant variable in logistic regression analysis after adjustment for age, gender, hemoglobin A1c, total cholesterol, body mass index, smoking history, family history and stenosis score. The relative risk of recurrence became 1.7-fold higher with a rise in SBP of 10 mmHg (95% confidence interval: 1.252-2.250). Analysis of the relationship between glucose tolerance and recurrence showed that the rate of recurrence was higher in patients with IFG+IGT+DM than in those with NGT. CONCLUSIONS: CAD progresses not only in patients with DM but also in those with IGT. The rate of recurrence of ischemic episodes increases in individuals with IGT or DM, and suggesting that hypertension is a risk factor for recurrence of ischemic episodes. Management of glucose tolerance and blood pressure is therefore important for prevention of CAD in Japanese.     

急性冠脉综合征并糖耐量异常临床特征及冠脉病变特点

急性冠脉综合征(acute coronary syndrome,ACS)包括不稳定型心绞痛、非ST段抬高性心肌梗死和ST段抬高性心肌梗死,是老年人中的常见病。流行病学资料表明,美国>65岁老年人占总人口的12·6%,但是,占急性心肌梗死住院病人的60%以上,其病死者中80%以上为>65岁老年人[1]。增龄是急性     

糖耐量低减的老年非ST段抬高急性冠状动脉综合征临床分析

目的:探讨糖耐量低减(IGT)的老年急性冠状动脉综合征(ACS)非ST段抬高病人临床特点。方法:96例ACS患者根据血糖和口服葡萄糖耐量试验(OGTT)被分为:糖尿病(DM)组(32例).糖耐量减低(IGT)组(32例)和糖耐量正常(NGT)组(32例)。所有病人检测血糖,血脂,心电图和作冠状动脉(冠脉)造影,并进行各组间相互比较。结果:DM组和IGT组的血糖、甘油三酯水平比NGT组高(P<0.05～<0.01),而。DM组的血糖水平比IGT组升高更为明显(P<0.05～<0.01)。DM组和IGT组的心电图缺血和冠状动脉造影显示的狭窄比NGT 组重。P<0.01。结论:IGT组和DM组的血脂代谢异常,心肌缺血和血管狭窄程度均明显较NGT组重。故对IGT 的老年病人应警惕冠心病病变。     

老年冠心病合并糖耐量减低患者不同血糖水平与冠状动脉病变的研究

目的探讨老年冠心病合并糖耐量减低患者不同血糖水平与冠状动脉病变的相关性。方法回顾分析经冠状动脉造影确诊冠心病的老年患者212例临床资料,根据口服葡萄糖耐量试验结果分为糖耐量正常(NGT)组64例,糖耐量减低(IGT)患者148例,又根据餐后2h血糖水平分为IGT1组50例,IGT2组58例和IGT3组40例,比较各组的冠状动脉病变支数、弥漫性病变状况以及冠状动脉病变Gensini总积分。结果与NGT组比较,IGT1组、IGT2组、IGT3组LDL-C水平、弥漫性病变比例、Gensini积分明显升高(P<0.05);IGT1组、IGT3组双支病变比例明显升高,IGT2组双支病变比例明显下降(P<0.05)。冠状动脉Gensini积分与餐后2h血糖呈正相关(r=0.512,P<0.05)。结论 IGT加重了冠状动脉病变程度。餐后2h血糖升高的患者是动脉粥样硬化的高危人群,对于此类人群应及时早期干预、治疗。     

高血糖是高血压的独立危险因素？

作者分析糖耐量低减者（ＩＧＴ）２５０例及正常糖耐量者（ＮＧＴ）１７５例的资料。ＩＧＴ者中高血压所占比例明显高于ＮＧＴ者（分别为３０．１４％、１３．１７％，Ｐ＜０．００１）；Ｐｅｒｓｏｎ相关分析中，收缩压、舒张压、平均血压均与体重指数，空腹及服糖后２小时血糖和胰岛素呈显著正相关；应用多因素回归分析，在调整年龄、性别、体重指数、血浆总胆固醇、空腹胰岛素等因素后，收缩压、舒张压、平均血压仍与服糖后２小时血糖呈独立正相关。提示高血糖可能为高血压的独立危险因素。     

高血压患者胰岛素抵抗与凝血系统功能的关系

目的:研究高血压(EH)患者胰岛素抵抗(IR)与凝血系统功能的关系。方法:按75g葡萄糖口服负荷法(OGTT)结果,69例EH患者被分为糖耐量正常(NGT)组(43例)例和糖耐量异常(IGT)组(26例)。另正常对照组31例。测定各组纤维蛋白原(Pg)、纤溶酶原激活物抑制因子(PAI-1)含量,同时作血胰岛素(INS)测定, 用HOMA指数作为胰岛素抵抗指标。结果:高血压两组与正常对照组相比HOMA指数、Fg、PAI-1水平明显异常(P<0.05～<0.01).高血压IGT组的这些指标较高血压NGT组更恶化(P<0.05～<0.01)。HOMA与PAI-1、Fg 之间具有正相关性,其r分别为0.635,0.832。结论:高血压病人存在胰岛素抵抗和凝血异常,当高血压合并IGT时, 胰岛素抵抗更严重,血液促凝血状态加重。