高血压患者颈动脉内膜中层厚度、内皮功能与糖脂代谢的相关性分析

目的 探究高血压患者颈动脉内膜中层厚度（carotid intima-media thickness，cIMT）、内皮功能与糖脂代谢的相关性。方法 以2019年10月-2021年10月上海交通大学医学院附属新华医院崇明分院初次诊断为原发性高血压137例患者为研究对象。收集患者一般资料，根据cIMT、内皮功能进行分组，分析高血压患者cIMT、内皮功能与糖脂代谢的相关性，并探究高血压患者cIMT、内皮功能的影响因素。结果 cIMT增厚组舒张压、收缩压、体质量指数（BMI）、空腹血糖、糖化血红蛋白（glycosylated hemoglobin,bA1c）、总胆固醇、三酰甘油、低密度脂蛋白胆固醇（low density lipoprotein cholesterol,LDL-C）、血肌酐、同型半胱氨酸（homocysteine,Hcy）均高于cIMT正常组，反应性充血指数（reactive hyperemia index,RHI）降低组收缩压、空腹血糖、HbA1c、LDL-C高于RHI正常组（P<0.05）。多因素Logistic回归分析结果显示，收缩压、三酰甘油、LDL-C、Hcy升高为高血压患者cIMT增厚的危险因素（P<0.05）。多因素Logistic回归分析结果显示，收缩压、空腹血糖、HbA1c、LDL-C升高为高血压患者RHI降低的危险因素（P<0.05）。Pearson 相关分析结果显示，高血压患者收缩压、空腹血糖、HbA1c、LDL-C均与RHI呈负相关（P<0.05），高血压患者收缩压、三酰甘油、总胆固醇、LDL-C、Hcy均与cIMT呈正相关（P<0.05）。结论 高血压患者糖脂代谢异常可增加cIMT、内皮功能障碍，且cIMT、内皮功能障碍具有相互促进作用。

Correlation between carotid intima-media thickness, endothelial function, and glucose and lipid metabolism in patients with hypertension

Objective To explore the correlation between carotid intima-media thickness (cIMT), endothelial function, and glucose and lipid metabolism in patients with hypertension. Methods 137 patients with primary hypertension first diagnosed in our hospital from October 2019 to October 2021 were studied. The general data of patients were collected and grouped according to cIMT and endothelial function. The correlation between cIMT, endothelial function, and glucose and lipid metabolism in patients with hypertension was analyzed, and the influencing factors of cIMT and endothelial function were analyzed by Multivariate logistic regression. Results Systolic and diastolic blood pressure, systolic blood pressure, body mass index (BMI), fasting blood glucose, glycosylated hemoglobin (HbA1c), total cholesterol, triglyceride, low density lipoprotein cholesterol (LDL-C), serum creatinine, and homocysteine (Hcy) in the cIMT thickening group were higher than those in the normal cIMT group. Systolic blood pressure, fasting blood glucose, HbA1c LDL-C in the reactivity hyperemia index (RHI) reduction group were higher than those in RHI normal group (P<0.05). Multivariate Logistic regression analysis showed that the systolic blood pressure, triacylglycerol, LDL-C and Hcy were the risk factors of cIMT thickening in patients with hypertension (P<0.05). Multivariate logistic regression analysis showed that the systolic blood pressure, fasting blood glucose, HbA1c and LDL-C were the risk factors for the decrease of RHI in patients with hypertension (P<0.05). Pearson correlation analysis showed that systolic blood pressure, fasting blood glucose, HbA1c and LDL-C were negatively correlated with RHI (P<0.05), and systolic blood pressure, triacylglycerol, total cholesterol, LDL-C and Hcy were positively correlated with cIMT (P<0.05). Conclusion Abnormal glucose and lipid metabolism in patients with hypertension can increase cIMT and endothelial dysfunction, and cIMT and endothelial dysfunction promoted each other.