高血压合并代谢综合征患者血管功能及靶器官损害的变化

目的探讨高血压合并代谢综合征对血管内皮功能及靶器官损害的影响。方法根据代谢综合征的诊断标准将156例高血压病患者分为高血压合并代谢综合征（EH＋MS组,n=61例）、高血压非代谢综合征（EH＋nonMS组,n=95例）两组,31例健康体检者作为对照组（NC组）,用彩色多普勒超声测定反应性充血前后肱动脉内径、血流量及阻力变化,并测定颈动脉粥样斑块及左室重量指数。结果（1）除空腹血糖（FBG）、体重指数（BMI）、甘油三酯（TG）外,EH＋MS组的收缩压、舒张压、TC、HDL-C、LDL-C、Fib、年龄、性别比、吸烟习惯等指标与EH＋nonMS组均衡可比。（2）内皮依赖性血管舒张功能（FMD％）：EH＋MS组明显低于EH＋nonMS组组及NC（7．08±3．21）％比（8．18±1．74）％和（10．41±4．52）％,P分别〈0．05和0．01],EH＋nonMS组也低于NC组（P〈0．05）。（3）EH＋MS组反应性充血后血流量变化率（％）明显低于EH＋nonMS组及NC组（154．19±78．94）％比（196．44±64．22）％和（221．81±89．64）％,P值分别〈0．05和0．01],但EH＋nonMS组与NC组间差异无统计学意义。（4）前臂血管扩张能力的高低顺序为NC组（3．21±0．90）〉EH＋nonMS组（2．89±0．73）〉EH＋MS组（2．58±0．76）。（5）颈动脉粥样斑块发生率分别为17／61（27．9％）、19／95（20．2％）及1／31（3．2％）,P〈0．05。（6）左室肥厚发生率从高到低排列分别为EH＋MS组（59％）〉EH＋nonMS组（37．9％）〉NC组（9．7％）。（7）FMD与年龄、性别、吸烟、收缩压、舒张压、TG、血浆纤维蛋白原有相关性;颈动脉内膜中层厚度与年龄、吸烟、收缩压、舒张压、BMI、TG、血浆纤维蛋白原呈正相关;左室重量指数与年龄、吸烟、SBP、DBP、BMI、TG呈正相关;FMD与颈动脉内膜中层厚度、左室重量指数呈负相关。结论代谢综合征明显加重了高血压病患者血管功能和靶器官损害。

Endothelial dysfunction and target organ damage in hypertensive patients complicating with or without metabolic syndrome

OBJECTIVE: To investigate the impacts of metabolic syndrome (MS) on endothelial function and target organ damage in hypertensive patients. METHODS: Patients with essential hypertension (EH) were divided into two groups: hypertension and metabolic syndrome (EH + MS, n = 61), hypertension without metabolic syndrome (EH + nonMS, n = 95) and 31 healthy subjects served as normal control (NC). The change of brachial artery vascular diameter, blood flow volume and vascular resistance after reactive hyperemia were measured by color Doppler ultrasonography. RESULTS: (1) Triglyceride (TG), fasting blood glucose (FBG), body mass index (BMI) were higher in EH + MS group than that in EH + nonMS group (P < 0.05). (2) Endothelium-dependent Dilatation (FMD%) and rate of flow volume of reactive hyperemia were significantly lower in EH + MS group than that in EH + nonMS and NC group (7.08 +/- 3.21)% vs. (8.18 +/- 1.74)% and (10.41 +/- 4.52)%, P < 0.05 and 0.01 respectively; (154.19 +/- 78.94)% vs. (196.44 +/- 64.22)% and (221.81 +/- 89.64)%, P < 0.05 and 0.01 respectively], while these parameters were similar between EH + nonMS and NC groups (P > 0.05). (3) The high sequence of forearm dilatation capability was also significantly reduced in EH + MS group compared to other groups. (4) The incidences of carotid atherosclerotic plaque and left ventricular hypertrophy (LVH) were significantly increased in EH + MS group compared to EH + nonMS group and NC group. (5) FMD was correlated with age, gender, smoking, SBP, DBP, TG, Fib respectively (P < 0.05). Intima-media thickness (IMT) of carotid artery was positively related with age, smoking, SBP, DBP, BMI, TG, Fib respectively. The left ventricular mass index (LVMI) was positively related with age, smoking, SBP, DBP, BMI, TG respectively. FMD was negatively related with IMT and LVMI respectively (P < 0.01). CONCLUSION: Metabolic syndrome further aggravated endothelial dysfunction and target organ damage in patients with essential hypertension.