单纯收缩期高血压患者血管内皮功能与左心室肥厚的关系

目的探讨单纯收缩期高血压患者血流介导的血管舒张功能(FMD)与左心室肥厚(LVH)的关系。方法选择单纯收缩期高血压患者200例,根据左心室质量指数分为:LVH组73例和非LVH组127例,同期选择年龄匹配的健康体检者50例作为对照组,采用超声技术测定FMD,ELISA法检测外周血清晚期糖基化终末产物(AGEs)和内皮素1,Griess法测定外周血NO含量。结果与非LVH组和对照组比较,LVH组FMD明显降低,AGEs和内皮素1均明显升高(P0.01)。左心室质量指数与AGEs和内皮素1呈显著正相关(r=0.639,P=0.015;r=0.428,P=0.036),与FMD和NO呈显著负相关(r=-0.718,P=0.003;r=-0.337,P=0.041);FMD和AGEs为LVH的独立危险因素(P=0.027,P=0.035);随着FMD降低、AGEs增加,LVH发病的危险性明显增加。结论血管内皮功能减退和大动脉硬化是单纯收缩期高血压患者LVH的独立危险因素。

Relation between vascular endothelial function and left ventricular hypertrophy in patients with isolated systolic hypertension

Objective To investigate the correlation between flow-mediated vasodilation (FMD) and left ventricular hypertrophy (LVH) in patients with isolated systolic hypertension (ISH). Methods 250 subjects were enrolled in this study,including 73 ISH patients with LVH,127 ISH patients without LVH and 50 age-matched NTXnormotension control) subjects according to left ventricular mass index(LVMI).FMD was detected by echocardiography,and the serum concentration of advanced glycation end-products (AGEs) and endothelin-1 (ET-1) were measured by ELISA,and blood NO was measured by Griess method.Results Compared with ISH patients without LVH,the FMD and NO in ISH patients with LVH were significantly decreased,while the AGEs and ET-1 were markedly increased (P < 0.01).Correlation analysis showed that LVMI was negatively correlated with FMD and NO (r =—0.718,P= 0.003 ;r = — 0.337 ,P = 0.041), and positively correlated with AGEs and ET-1 (r = 0.639,P = 0.015;r = 0.428,P = 0.036). The logistic analysis showed that FMD and AGEs were independently associated with LVH (P = 0.027,0.035),respectively.With the decrease in FMD and increase in AGEs,the risk of morbidity of LVH was significantly increased.Conclusion Endothelium-dependent vasodilation impairment and large artery stiffness are the independent risk factors for LVH.