5-单硝酸异山梨醇酯改善高血压患者血压以及血管弹性的临床观察

目的 观察5-单硝酸异山梨醇酯(IS-5-MN)对脉压≥60mmHk高血压患者动脉弹性功能、反射波及血压的影响。方法 选取符合人选条件的30例原发性高血压患者，分两组进行单盲、安慰剂对照研究，每组15人分别给予IS-5-MN(30mg／d)或安慰剂，疗程四周。标准袖带水银血压计测量肱动脉血压，自动脉搏波速度测定仪测定颈动脉-股动脉脉搏波传导速度(CF-PWV)，DO-2020动脉功能测定仪获得大动脉和小动脉弹性指数(C1和C2)，桡动脉压力波形分析获得中心动脉压、外周反射波增压及增强指数。结果 校正安慰剂效应后，(1)患者CF-PWV明显减慢，C1显著提高，C2无明显改变。(2)反射波增压和增强指数明显下降。(3)外周和中心动脉收缩压和脉压显著降低。结论 5-单硝酸异山梨醇酯明显改善脉压≥60mmHg高血压患者的大动脉弹性，减弱外周波反射，降低了收缩压和脉压。     

Association between lumber bone mineral density and vascular stiffness as assessed by pulse wave velocity in postmenopausal women

Recent studies have showed a significant correlation between vascular calcification and bone mineral density (BMD). Therefore, an investigation was carried out on the association between arterial stiffness, lumbar BMD and bone metabolic markers in Japanese postmenopausal women. Brachial-ankle PWV (baPWV) and BMD of the lumbar spine and serum bone-specific alkaline phosphatase (BAP) levels in 143 postmenopausal women were measured, where there was a significant negative correlation between baPWV and BMD (r = −0.21; P = 0.0135). An additional analysis included the remaining 75 subjects, but excluded subjects with hypertension and obesity. Here, a more negative correlation between baPWV and BMD (r = −0.315; P = 0.006), and a positive correlation between baPWV and BAP (r = 0.248; P = 0.032) were also significant. A group analysis, where the women were age matched and stratified into three groups of different bone density, i.e., normal BMD, osteopenic and osteoporotic, were further made. This showed lower PWV values in the normal BMD group than in the other two groups. A study also showed that the tertile with the highest BAP was associated with significantly higher PWV values than the other tertiles. However, when the multiple linear regression analysis was carried out, there was no correlation between PWV and BAP values. Low BMD and arterial stiffness show some correlation, suggesting that BAP may reflect the degree of arterial stiffness present.     

动态误差分析系统对脉搏波速度测量结果的影响

目的研究不同误差状态的设置对脉搏波速度(PWV)检测结果的影响。方法和材料选择90名年龄在(18～40)岁的健康体检人群,男女各半。分别采用国际上先进的脉搏波速度测定系统Complior仪检测受检人群不同节段的PWV。颈股CF-PWV、颈桡CR-PWV、颈远端CD-PWV,分别反映主动脉、上肢动脉和下肢动脉的僵硬度。将3组受检人群检测时动态误差在分别设置为15%>误差>10%、10%>误差>5%、5%>误差三种状态下,重复测量各节段的PWV值,观察不同误差设置对检测结果的影响。结果动态误差在10%>误差>5%,5%>误差两种状态下各组人群的各节段PWV值无显著差异;而动态误差在15%>误差>10%时,与动态误差<5%组比较,各节段PWV值的差异显示出统计学意义。结论动态误差分析系统对PWV检测结果会有不同影响,选择误差较小的检测模式有利于提高检测结果的准确性。     

Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) and hypertension are independently associated with increased stiffness of large arteries that may contribute to left ventricular (LV) remodeling. We sought to investigate the impact of OSA, hypertension, and their association with arterial stiffness and heart structure. DESIGN: We studied 60 middle-aged subjects classified into four groups according to the absence or presence of severe OSA with and without hypertension. All participants were free of other comorbidities. The groups were matched for age, sex, and body mass index. MEASUREMENTS AND RESULTS: Full polysomnography, pulse-wave velocity (PWV), and transthoracic echocardiography were performed in all participants. Compared with normotensive subjects without OSA, PWV, left atrial diameter, interventricular septal thickness, LV posterior wall thickness, LV mass index, and percentage of LV hypertrophy had similar increases in normotensive OSA and patients with hypertension and no OSA (p < 0.05 for all comparisons), with a significant further increase in PWV, LV mass index, and percentage of LV hypertrophy in subjects with OSA and hypertension. Multivariate regression analysis showed that PWV was associated with systolic BP (p < 0.001) and apnea-hypopnea index (p = 0.002). The only independent variable associated with LV mass index was PWV (p < 0.0001). CONCLUSIONS: Severe OSA and hypertension are associated with arterial stiffness and heart structure abnormalities of similar magnitude, with additive effects when both conditions coexist. Increased large arterial stiffness contributes to ventricular afterload and may help to explain heart remodeling in both OSA and hypertension.     

血液透析患者颈-股动脉脉搏波速度改变及其影响因素

背景：维持性血液透析患者颈-股动脉脉搏波速度改变受多种因素影响。 目的：探讨维持性血液透析患者颈-股动脉脉搏波速度改变及其相关因素分析。 设计、时间及地点：相关性分析,交叉对照实验,于2006-01/08北京大学第三医院肾脏内科完成。 对象：北京大学第三医院临床情况稳定的66例维持性血液透析患者。 方法：收集患者一般情况、生化学指标、颈-股动脉脉搏波速度和主观综合营养状态的评估等4个方面资料。根据SGA营养评分将患者分为营养正常组49例、营养不良组17例。比较两组脉搏波速度的差异,采用单因素相关和多因素回归分析探讨脉搏波速度的相关因素。 主要观察指标：患者颈-股动脉脉搏波速度,血白蛋白和甲状旁腺激素。 结果：血液透析患者颈-股动脉脉搏波速度与年龄(r=0.284,P=0.021)、收缩压(r=0.468,P < 0.001)、脉压(r=0.451,P < 0.001)存在显著正相关,与透前血清肌酐(r=-0.347,P=0.004)、转铁蛋白(r=-0.284,P < 0.05)、血前蛋白 (r=-0.318,P < 0.05)、血浆白蛋白(r=-0.263,P < 0.05)和甲状旁腺激素(r=-0.167,P < 0.05)存在负相关。多元逐步回归分析显示脉压和甲状旁腺激素是颈-股动脉脉搏波速度的独立影响因素。采用SGA营养评估营养状态,营养不良组颈-股动脉脉搏波速度明显增快,与营养正常组比较差异有显著性意义(P < 0.05)。 结论：脉压是维持性血液透析患者颈-股动脉脉搏波速度独立的影响因素。营养不良与动脉粥样硬化是维持性血液透析常见的并发症,两者关系密切,营养不良者脉搏波速度值增高。     

新疆维吾尔族脉搏波速度与冠心病的关系

目的：了解新疆维吾尔族脉搏波速度（PWV）与冠心病的关系,为维吾尔族冠心病的早期防治提供依据.方法：经选择性冠状动脉造影确诊冠心病（冠脉狭窄程度≥50％,维吾尔族174例,汉族385例）及维吾尔族健康对照100例（冠脉无明显狭窄）,同时测定PWV,采用关联分析等对结果进行分析及评价.结果：在调整了年龄、性别、体重指数、吸烟、血压、血脂、糖尿病等因素后,维吾尔族患者PWV水平高于健康对照及汉族患者;随冠脉狭窄程度加重,PWV水平升高,且冠脉严重程度与PWV水平呈正相关;多支病变其PWV明显高于单支病变.结论：维吾尔族冠心病冠脉病变与PWV水平有密切关系,与汉族患者PWV存在差异,PWV水平高于汉族患者,从而为维吾尔族冠心病早期防治提供帮助.