高血压病患者体循环动脉重构性变化

目的探讨高血压病患者血管重构性变化及影响因素.方法检测1～2级高血压病患者主动脉、颈动脉、肱动脉及桡动脉管径、内膜中层厚度和动脉扩张性、管壁顺应性等指标;以协方差分析校正其他因素的混杂影响后,比较高血压组63例与正常对照组31例间动脉结构和功能指标的差异,并通过多元逐步回归分析,甄选影响血管重构的独立影响因素.结果和结论高血压组主动脉、颈总动脉、肱动脉和桡动脉壁内膜中层厚度和面积及其与动脉内径和管腔面积的比值显著增大,主动脉、颈动脉、肱动脉扩张性和顺应性显著降低;校正Age, Sex, BMI, HR, MAP, PP, Smoke, FPG, LDL, TG等可能影响血管重构的因素影响后显著性依然存在.动脉平均压和脉压水平是血管重构的重要影响因素,血压水平越高,内膜中层厚度越大;脉压越大,动脉扩张性和顺应性越差.其他影响高血压病血管重构的因素,特别是体重指数、吸烟及血脂水平等,在高血压病心血管重构和器官损害的防治中应加强关注.     

高血压病患者体循环动脉重构性变化

目的 探讨高血压病患者血管重构性变化及影响因素。方法 检测1-2级高血压病患者主动脉、颈动脉、肱动脉及桡动脉管径、内膜中层厚度和动脉扩张性、管壁顺应性等指标；以协方差分析校正其他因素的混杂影响后，比较高血压组63例与正常对照组31例间动脉结构和功能指标的差异，并通过多元逐步回归分析，甄选影响血管重构的独立重影响因素。结果和结论 高血压组主动脉、颈总动脉、肱动脉和桡动脉壁内膜中厚度和面积及其与动脉内径和管腔面积的比值显著增大，主动脉、颈动脉、肱动脉扩张性和顺应性显著降低；校正Age，Sex,BMI,HR,MAP,PP,Smoke，FPG，LDL，TG等可能影响血管重构的因素影响后显著性依然存在。动脉平均压和脉压水平是血管重构的重要影响因素，血压水平越高，内膜中层厚度越大；脉压越大，动脉扩张性和顺应性越差。其他影响高血压病血管重构的因素，特别是体重指数、吸烟及血脂水平等，在高血压病心血管重构和器官损害的防治中应加强关注。     

氯沙坦对高血压病病人血压、动脉顺应性及左室肥厚的影响

目的观察氯沙坦的降压效果及其对大动脉顺应性及左室肥厚(LVH)的影响.方法 54例原发性高血压(EH)伴LVH病人,服用氯沙坦12周,分别于治疗前后行诊所血压及彩色多普勒超声心动图(UCG)检测,以每搏量(SV)与脉压的比值(SV/PP)作为反映总的动脉顺应性指标.结果 氯沙坦治疗12周后诊室收缩压和舒张压与治疗前相比分别下降了(17.81±10.54)mmHg、(8.65±9.25)mmHg;总有效率为72.2%(P<0.01);服药前后SV/PP为(1.73±0.66)/(1.97±0.71)mL/mmHg);室间隔厚度(IVSdT)为(12.52±1.14)/(10.42±1.54)mm及左室后壁厚度(LVPWdT)(12.82±1.73)mm/(10.61±1.43)mm均明显变薄;左室心肌重量指数(159.9±17.57)/(138.4±18.2)g/m2显著下降,E/A比值明显升高(P<0.01).结论氯沙坦能够有效降低高血压病病人诊所血压,提高动脉顺应性并改善LVH及左心舒张功能.     

长期吸烟对高血压病患者心脏结构和功能的影响

目的通过对比吸烟和不吸烟的高血压病患者心脏结构和功能指标的差异,探讨长期吸烟对高血压病心血管重构附加的不利影响.方法以超声心动图检测89例未服药治疗的轻中度高血压病患者左右心腔及大血管内径、室壁厚度、收缩功能和舒张功能指标,并计算左室肌重量(LVM)、左室肌重量指数(LVMI)、平均室壁厚度(ALVT)、体循环血管阻力(SVR)、左室收缩末期室壁应力(ESS);其中不吸烟者57例,长年吸烟者32例.检测前2小时内不吸烟以避免吸烟的即刻效应;通过协方差分析校正年龄、性别、体重指数、收缩压、血压水平、吸烟程度、心率以及血色素等的混杂影响后,对比长期吸烟与不吸烟的高血压病患者左房、左右心室结构及功能指标的差异.结果长期吸烟的高血压病患者,平均室壁厚度、室间隔厚度、左室肌重量及指数、左房内径、右室前壁厚度、主动脉内径、主肺动脉内径以及反映左室后负荷的指标SVR及ESS较不吸烟者显著增大;左室收缩和舒张功能变化较小,而右室舒张功能有所减退.结论长期吸烟可能促进或加重轻中度高血压病患者的心血管重构.     

高血压病患者大血管顺应性变化及其对降压的反应

应用颈动脉搏动图(CPT)反应高血压(EH)病人大血管的顺应性及功能变化。结果显示:EH病人大血管阻力指数增加、顺应性下降。顺应性的改变与细胞内Na~+浓度(Na~+_1)异常有关,降压治疗可通过降低Na~+_1,改善EH的血管顺应性     

高血压病对心脏左心房结构的影响

研究探讨了高血压病人左心房结构的改变与年龄、性别、高血压程度、高血压时间和左心室收缩舒、张功能之间的关系。方法：将２４１ 例高血压病人分别按年龄、性别、高血压程度和高血压时间分组，利用心动超声测量病人左心房面积、二尖瓣 Ｅ峰、 Ａ 峰、 Ｅ／ Ａ比值及 Ｅ Ｆ值，与正常组１０６ 例 分别进行统计学比较。结果：高血压病人左心房扩大的发生与年龄密切相关，与血压高度密切相关，与二尖瓣 Ｅ峰降低， Ａ 峰升高， Ｅ／ Ａ比值倒置的发生相一致，即左心房扩大与左心室充盈功能和顺应性密切相关。同时认为高血压病左房结构的改变与性别、高血压病程和左心室射血分数相关不密切。结论：左室充盈功能和顺应性降低是高血压病早期的改变，左心房扩大是高血压心脏病的早期征象。     

高血压病患者左室重构与功能变化的关系

目的:研究高血压病患者左室重构与功能变化的关系及影响因素.方法:对89例无合并症的Ⅰ,Ⅱ期高血压病患者超声心动图心脏结构和功能测值进行多元逐步回归分析,甄选出对左室结构和功能有独立影响因素.在校正这些因素影响后,比较不同左室构型组间心脏收缩功能和舒张功能的差异,82例正常人作为对照.结果和结论:对心脏收缩功能和舒张功能有独立影响的因素不尽相同,血压水平和解剖结构是两个最重要影响因素.校正包括性别、年龄、体重指数、心率、血压等其他因素的影响后,构型不同的左室收缩功能的影响还有差异,而对左室舒张功能指标的差异则不明显 .     

高血压病患者左心室几何构型与舒张功能变化的关系

目的　研究高血压病患者左心室重构与舒张功能变化的关系及影响因素。方法　依照左心室质量指数 (L V-MI)和相对室壁厚度 (RWT)将 89例无合并症的高血压病患者分为左心室正常构型组 (17例 )、向心性重构组 (2 3例 )、向心性肥厚组 (33例 )、离心性肥厚组 (16例 )。对超声心动图心脏结构和功能测值进行多元逐步回归分析 ,筛选出对左心室舒张功能有独立影响因素。在校正这些因素影响后 ,比较不同左心室几何构型组间心脏舒张功能的差异 ,82例正常人作为对照。结果　左心室舒张功能的主要独立影响因素包括性别、年龄、心率、L VMI,部分指标还有体重指数 (BMl)和吸烟水平。不同构型组间舒张功能指标未经校正或仅经性别、年龄、心率和 BMI校正后差异虽都具有高度显著性 (P<0 .0 5 ) ,但再校正或排外血压水平的影响后 ,组间差异显著性已不复存在。结论　不同构型组间左心室舒张功能指标的差异主要是血压水平不同所致。左心室结构指标虽是舒张功能指标的独立影响因素 ,但其影响强度尚不足以达到使不同构型组间差异有统计学显著性的程度。     

焦虑状态对动脉功能的影响及可能机制的初步探讨

目的以血管功能为切入点,从人群中筛查出有心因因素(紧张焦虑状态、广泛性焦虑)的亚健康人群作为研究对象,探讨焦虑状态对动脉功能的可能影响及机制。方法采用医院焦虑量表选取门诊患者为焦虑状态组(33例)和本院健康体检职工为健康对照组(15名),以握力试验进行交感神经兴奋应激试验,应激试验前后监测动脉功能、测定血浆儿茶酚胺(去甲肾上腺素、肾上腺素、多巴胺)和C反应蛋白,并进行24 h动态血压及动态动脉弹性功能监测。结果焦虑状态组患者在血压最高值及心率最慢时的系统动脉阻力(SVR)均高于健康对照组[(1 823.81±390.20)dyn·s·cm~(-5)比(1 710.10±328.81)dyn·s·cm~(-5),(1 668.90±280.78)dyn·s·cm~(-5)比(1 546.80±172.80)dyn·s·cm~(-5),均为P<0.05];焦虑状态组患者握力试验后的SVR较健康对照组升高[(1 701.29±345.51)dyn·s·cm~(-5)比(1 467.87±290.49)dyn·s·cm~(-5),P<0.05];焦虑状态组患者交感应激后体内儿茶酚胺水平各组分(去甲肾上腺素、肾上腺素、多巴胺)水平均较健康对照组升高,但差异均无统计学意义(均为P>0.05)。结论焦虑状态可能造成早期动脉功能改变,进而增加心血管病的远期发病风险。     

高血压病患者右心室结构和功能的变化及相关因素分析

本文研究高血压病患者右心室结构和功能变化、影响因素及其与左室结构和功能变化的关系。分析８９例未经治疗的Ⅰ或Ⅱ期高血压病患者与８２例正常对照者之间按超声心动图测算的右室解剖结构和功能指标的差异、相关关系及其与左室对应指标及其他影响因素的相关性。结果显示:高血压病患者右室前壁厚度增加,舒张期充盈受损,经协方差分析将年龄、性别、体重指数及心率等的影响剔除之后,差异仍存在显著性。收缩功能指标无显著性变化。右室结构和功能变化与血压水平和高血压所致的左室结构和功能变化之间有显著性相关关系。年龄、性别、体重指数及心率也是影响右室结构和功能测值的可能因素。     

Acute and subacute effects of nicorandil and isosorbide dinitrate on vessel wall properties of large arteries and hemodynamics in healthy volunteers

Summary Nicorandil (N) and isosorbide dinitrate (ISDN) are vasodilator drugs used in patients with angina. In 24 healthy male volunteers (18–32 years), the acute effect of a single oral dose (20 mg) of N and ISDN on arterial diameter (D), distensibility, and compliance of the elastic common carotid artery (CCA) and the muscular femoral (FA) and brachial (BA) arteries were investigated. The effects on systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI), and venous hemodynamics were also assessed. In addition, the subacute effects after 8 days of treatment with N (2×20 mg/day) and ISDN (3×20 mg/day) on these parameters were evaluated. After a 20 mg single oral dose, blood pressure decreased significantly more with ISDN (SBP: 6%; DBP: 14%) than with N (SBP: 2%; DBP: 6%), but after 8 days this decrease in blood pressure was not statistically different between ISDN and N. The diameter of CCA increased more with ISDN (11%) than N (5%) acutely as well as subacutely (ISDN: 12%; N: 9%). Heart rate increased only with ISDN (7% acutely, 3% subacutely). No differences between ISDN and nicorandil were found for acute and subacute effects on SVRI, venous hemodynamics, diameter of muscular arteries (FA, BA), and the distensibility and compliance of elastic (CCA) and muscular (FA, BA) arteries. Day 1 to day 8 changes in heart rate and cardiac index were small but differed between ISDN and nicorandil. These differences were due to a smaller increase in HR and CI at day 8 than at day 1 with ISDN. Data on blood pressure and heart rate are in accordance with drug tolerance seen with ISDN but not with nicorandil. However, ISDN drug tolerance was not seen for the diameter of large arteries. In conclusion, with dosages used in angina, compared to nicorandil—a drug with both a potassium channel opening property and a nitratelike action—the pure nitrate ISDN showed a more pronounced decrease in systolic and diastolic blood pressure, a slight increase in heart rate, and more vasodilation of CCA. ISDN drug tolerance was shown for blood pressure and heart rate. In contrast to the well-known venous tolerance during ISDN, there was no ISDN drug tolerance for the effects on diameter of large arteries. No drug tolerance was seen with nicorandil.     

原发性高血压患者血浆甲状旁腺高血压因子的变化

目的 :观察原发性高血压 (EH)患者血浆甲状旁腺高血压因子 (PHF)活性的变化。方法 :采用生物活性测定方法 ,检测了 31例 EH患者 (EH组 )和 33例正常人 (对照组 )血浆中 PHF活性。结果 :EH组血 PHF平均活性显著高于对照组 (P <0 .0 5～ 0 .0 1) ,其升压模式与自发性高血压大鼠血 PHF活性相似。结论 :检测 PHF对研究 EH病因以及采取有效治疗措施具有重要意义。     

高血压病患者动脉硬化指数增高的相关因素分析

目的观察动脉硬化指数(ASI)增高的高血压病患者,探讨其临床一般情况、血液生化指标等特点,分析临床意义。方法随机检测156例高血压病患者的动脉硬化指数、血压、脉压,并检测患者的血尿酸、血糖、血脂、肌酐、尿素氮等血液生化指标。按照患者的ASI分为两组。ASI正常组:127例,ASI值在0~70之间;ASI增高组:29例,ASI值为71或以上。结果(1)ASI增高组患者的年龄、病史、收缩压和脉压显著高于ASI正常组,其舒张压显著低于ASI正常组(均P<0.01)。(2)ASI增高组患者的血尿酸(P<0.01),尿素氮(P<0.05)水平也显著增高。结论年龄大、病史时间长、收缩压升高、舒张压降低、脉压增大、血尿酸和尿素氮水平升高均可能与ASI异常增高相关联。     

Early impairment of large artery structure and function in Type I diabetes mellitus

Aims/hypothesis. Diabetes mellitus is associated with an increased incidence of atherosclerosis. How early functional and structural alterations of large arteries that may preceed atherosclerosis occur in the course of this disease has, however, never been conclusively documented. Methods. We evaluated arterial wall distensibility in the radial artery, common carotid artery and abdominal aorta in 133 patients (aged 35.4 ± 0.9 years, means ± SEM) with Type I (insulin-dependent) diabetes mellitus and no macrovascular complications. Arterial distensibility was derived from continuous measurements of arterial diameter through echotracking techniques and use of either the Langewouters (radial artery) or the Reneman (carotid artery and aorta) formula. The same echotracking techniques enabled us to obtain radial artery and carotid artery wall thickness. Data were compared with those from 70 age-matched normotensive control subjects. Results. In diabetic patients arterial distensibility was consistently less (p < 0.01) than in control subjects, the reduction averaging 26 %, 14 % and 25 % for the radial artery, carotid artery and aorta, respectively. This was accompanied by an increase (p < 0.01) in both radial and carotid artery wall thickness. The changes were more pronounced in patients with microalbuminuria, retinopathy or neuropathy or both. They were evident also in those without microvascular complications. This was the case also when subjects in whom diabetes was associated with hypertension (n = 30) were excluded from data analysis. Carotid and aortic wall abnormalities showed a relation with the duration of disease and blood pressure whereas radial artery abnormalities showed a relation with glycated haemoglobin. Conclusion/interpretation. Type I diabetes is characterised by diffuse arterial wall stiffening and thickening which progress with the severity of the disease but can clearly be seen also in the absence of any diabetic-related complication. This suggests that in diabetes stiffening and thickening are an early marker of vascular damage. [Diabetologia (1999) 42: 987–994] Received: 11 December 1998 and in revised form: 3 March 1999     

105例高血压病患者肺通气功能的改变(附乐息平与洛汀新对其的不同影响)

目的　研究高血压患者肺通气功能变化及降压药物对其的影响。方法　对 1 0 5例未经正规治疗的原发性高血压病 ( EH)患者和 80例正常血压者的临床肺通气功能指标进行对照研究 ,并观察乐息平及洛汀新治疗高血压前后肺通气功能各项指标的变化。结果　 EH组在反映肺通气功能的多项指标 (用力肺活量、第一秒时间肺活量、最大呼气中段流速、最大通气量、呼气峰值流速 )均较对照组降低 ( P<0 .0 5～ 0 .0 0 1 ) ,并随高血压程度的加重而改变。经钙拮抗剂 (乐息平 )的正规降压治疗后 ,上述指标均较治疗前有所恢复 ( P<0 .0 5～ 0 .0 0 1 ) ,而洛汀新组上述指标无明显变化。结论　 EH组患者肺通气功能受到损害 ,其改变的程度与高血压程度相关 ,乐息平有助于高血压患者受损的肺通气功能部分恢复 ,洛汀新对高血压患者的肺通气功能无明显影响。     

Effects of long-term nicardipine treatment on hemodynamics of large arteries in essential hypertension

Summary The effects of the calcium-entry blocker nicardipine on brachial hemodynamics were studied in 22 patients (18 male, 4 female) with essential hypertension, who were treated with 20 mg tid for 1 year. Compliance, characteristic impedance, vascular resistances, and tangential tension were measured before treatment and after 1, 3, and 12 months of treatment by an automatic recording from a B-mode, high-resolution, real-time scanner and pulsed Doppler velocimetry for the calculation of the flow volume. We observed statistically significant variations in compliance and impedance after 1 month (3.21±0.59 dyn^–1 cm⁴ 10^–7 vs. 1.26±0.16 dyn^–1 cm⁴ 10^–7 and 50.6±4.7 dyn s cm^–510² vs. 91.4 ±7.3 dyn s cm^–5 10², respectively; mean±SEM; p<0.001), while tangential tension was significantly reduced after only 3 months (23.2±2.2 mmHg vs. 25.4±2.3 mmHg cm; p<0.05). The correlation between variations in mean blood pressure and in the hemodynamic parameters studied remained statistically significant throughout the study. Nicardipine improved the parameters of large-artery hemodynamics that favor a normal systolic pulse.     

降压治疗对原发性高血压患者血清肾上腺髓质素水平的影响

目的研究降压治疗对原发性高血压患者血清肾上腺髓质素（ADM）水平的影响及其临床意义。方法选取2010年7-12月福建医科大学附属第一医院心内科原发性单纯高血压住院患者68例为高血压组,50名门诊健康体检者设定为对照组。对住院患者采集病史,收集相关实验室检查结果,进行心脏彩色多普勒超声检查＋左心功能测定、双侧颈动脉彩超等检查,并采用ELISA法定量测定人血清中ADM含量。高血压组患者经过降压治疗2周后再次测定血清中ADM含量进行比较。结果高血压组患者血清ADM水平明显高于对照组[（45．79±6．84）ng／L比（19．85±3．22）ng／L,P〈0．01]。降压药物干预前高血压组的ADM、收缩压和舒张压分别为（45．79±6．84）ng／L、（150．89±14．53）mmHg和（83．07±12．10）mmHg,干预后ADM、收缩压、舒张压分别为（32．44±6．68）ng／L、（124．11±10．67）mmHg和（72．01±6．91）mmHg。将高血压组药物干预前后ADM、血压进行配对t检验,提示两者差别具有统计学意义（P〈0．01）,且相关性分析显示,ADM差值与收缩压差、舒张压差、平均动脉压差成正相关（r=0．841,P〈0．01;r=0．371,P〈0．05;r=0．783,P〈0．01）。结论血清肾上腺髓质素水平与血压水平具有明显正相关。     

不同年龄高血压患者大动脉扩张性的临床研究

目的　探讨不同年龄段高血压患者大动脉弹性的改变及其影响因素。方法　应用脉搏波传导速度 (pulsewavevelocity ,PWV)自动测量系统测定颈动脉 股动脉PWV作为反映大动脉扩张性的参数。对 1392例高血压患者进行了PWV检测 ,其中男 95 4例 ,女 438例 ,年龄 14～ 85岁 ,平均 (5 2 .0 9± 12 .37)岁。结果　 1392例高血压患者的研究结果显示PWV随年龄增大 (不论男性还是女性 )而增加 (P<0 .0 0 0 1)。多元逐步回归分析结果表明年龄、收缩压和心率是与反映大动脉弹性的PWV关系最为密切的参数 (P<0 .0 0 1)。结论　长期高血压将导致大动脉扩张性降低 ,这种改变随年龄增大而加重。年龄、收缩压、心率与高血压患者大动脉扩张性变化关系密切。