糖尿病、高血脂对高血压患者动脉僵硬度的影响
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摘要
目的探讨糖尿病、高血脂对高血压患者动脉僵硬度的影响。方法从上海市宝山区6家社区卫生中心及上海交通大学医学院附属第九人民医院入选726例高血压患者,收集相关病史信息,检测患者颈-股动脉脉搏波速度(C-F PWV),颈动脉-桡动脉脉搏波速度(C-R PWV)、颈动脉-足背动脉脉搏波速度(C-D PWV),672例患者随访1年后再次测定脉搏波传导速度,将患者分成单纯高血压组(n=357)、高血压合并高血脂组(n=108)、高血压合并糖尿病组(n=142)、高血压合并高血脂+糖尿病组(n=65)四组。结果单纯高血压组、高血压合并高血脂组、高血压合并糖尿病组、高血压合并高血脂+糖尿病组四组间PWV差异无统计学意义(P>0.05),但组间均值比较提示高血压合并高血脂+糖尿病组患者较其他3组C-F PWV和C-D PWV均值高,但组间进行两两比较差异均无统计学意义(P>0.05)。随访研究中四组的C-F PWV均有所增加,其中单纯高血压组患者前后两年C-F PWV、C-R PWV比较差异无统计学意义(P>0.05),而合并糖尿病或高血脂的患者组前后两年C-F PWV、C-R PWV比较差异有统计学意义(P<0.05);四组前后两年C-D PWV比较均无统计学差异(P>0.05)。横断面研究显示,单纯合并高血糖或高血脂的高血压患者中,其PWV值与单纯高血压组比较无统计学差异(P>0.05),而在随访研究中两组PWV的增高与单纯高血压组比较显示出统计学差异(P<0.05)。结论高血糖、高血脂相对高血压对动脉僵硬度影响较小,但可加速高血压患者动脉硬化的进程。
Objective To investigate the effect of diabetes, hyperlipoidemia on arterial stiffness in patients with hypertension. Methods 726 patients with hypertension were enrolled from 6 community health centers of Baoshan District. The related history information was collected. The carotid-femoral pulse wave velocity(C-F PWV), carotid-radial pulse wave velocity(C-R PWV), carotid artery-dorsalis pedis pulse wave velocity(C-D PWV) were measured. 672 patients were followed up for 1 years again after the determination of pulse wave velocity. All eligible patients were divided into hypertension group(n=357), hypertension and hyperlipoidemia group(n=108), hypertension with diabetes mellitus(DM) group(n=142), hypertension complicated with hyperlipoidemia + DM group(n=65). Results There was no significant difference of PMV among four groups. In the follow-up study, the C-F PWV was increased in the four groups. There was no significant difference of C-F PWV and C-R PWV in hypertension group before and after follow-up(P>0.05). The C-F PWV and C-R PWV in hypertension patients with diabetes or hyperlipidemia were significantly different before and after follow-up(P<0.05). There was no significant difference in C-D PWV between the four groups(P>0.05). The cross-sectional study showed that PWV values in hypertensive patients with hyperglycemia or hyperlipidemia were not significantly different from those in the hypertension group(P>0.05). However, in the follow-up study, the increasing of PWV in hypertensive patients with hyperglycemia or hyperlipidemia was significantly different from those in the hypertension group(P<0.05). Conclusion Hyperglycemia and hyperlipidemia have less effect on arterial stiffness than hypertension, but can accelerate the progression of arteriosclerosis in hypertensive patients.
Objective To investigate the effect of diabetes, hyperlipoidemia on arterial stiffness in patients with hypertension. Methods 726 patients with hypertension were enrolled from 6 community health centers of Baoshan District. The related history information was collected. The carotid-femoral pulse wave velocity(C-F PWV), carotid-radial pulse wave velocity(C-R PWV), carotid artery-dorsalis pedis pulse wave velocity(C-D PWV) were measured. 672 patients were followed up for 1 years again after the determination of pulse wave velocity. All eligible patients were divided into hypertension group(n=357), hypertension and hyperlipoidemia group(n=108), hypertension with diabetes mellitus(DM) group(n=142), hypertension complicated with hyperlipoidemia + DM group(n=65). Results There was no significant difference of PMV among four groups. In the follow-up study, the C-F PWV was increased in the four groups. There was no significant difference of C-F PWV and C-R PWV in hypertension group before and after follow-up(P>0.05). The C-F PWV and C-R PWV in hypertension patients with diabetes or hyperlipidemia were significantly different before and after follow-up(P<0.05). There was no significant difference in C-D PWV between the four groups(P>0.05). The cross-sectional study showed that PWV values in hypertensive patients with hyperglycemia or hyperlipidemia were not significantly different from those in the hypertension group(P>0.05). However, in the follow-up study, the increasing of PWV in hypertensive patients with hyperglycemia or hyperlipidemia was significantly different from those in the hypertension group(P<0.05). Conclusion Hyperglycemia and hyperlipidemia have less effect on arterial stiffness than hypertension, but can accelerate the progression of arteriosclerosis in hypertensive patients.
引文
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[15]刘国玲.糖尿病周围神经病变患者颈动脉内-中膜厚度、颈动脉僵硬度与糖化血红蛋白的相关性研究[J].中国糖尿病杂志,2015,23(7):617-20.
[16]梁丽艳,陈曦,张源明,等.伴糖耐量异常的原发性高血压患者血尿酸与颈动脉硬化、动脉僵硬度的相关性研究[J].疑难病杂志,2015,14(3):223-6.
[17]杨红霞,米树华,贾淑杰,等.代谢综合征对老年原发性高血压病患者脉搏波传导速度的影响[J].中国全科医学,2013,16(39):3903-5.
[18]王宏宇,刘金波,赵红薇,等.高血压患者动脉僵硬度与血脂的相关性研究[J].中国全科医学,2014,17(18):2070-3.
[19]孙旭晖,何正飞,余健.瑞舒伐他汀对急性心肌梗死患者MMP-9、炎症因子、血脂水平及心功能的影响[J].中国生化药物杂志,2016,36(5):66-8.
[2]李曦,胡荣,芦燕玲,等.体检人群脉搏波传导速度与动态血压监测指标的相关性研究[J].心肺血管病杂志,2013,32(4):452-5.
[3]Ohkuma T,Tomiyama H,Ninomiya T,et al.Proposed Cutoff Value of Brachial-Ankle Pulse Wave Velocity for the Management of Hypertension[J].Circ J,2017,81(10):1540-2.
[4]李谷来,王金华,李秀娟.糖耐量异常患者血糖、血脂、胰岛素水平变化与颈动脉血管壁弹性的相关性研究[J].河北医药,2017,39(17):2647-9.(上接564页)
[5]王君玓,商广芸,何为,等.2型糖尿病病人大动脉僵硬度相关危险因素研究[J].首都医科大学学报,2017,38(5):740-3.
[6]王松鹤,何胜虎.动脉僵硬度与影响高血压预后的心血管危险因素相关性的研究进展[J].中国循环杂志,2015,30(2):196-8.
[7]邱萌,朱昀,张福春.老年高血压患者动脉僵硬度与血压变异性的关系[J].中国循环杂志,2015,30,30(2):136-9.
[8]Moczulska B,Kubiak M,Bryczkowska A,et al.[Pulse wave velocity as an early marker of diastolic heart failure in patients with hypertension][J].Pol Merkur Lekarski,2017,42(250):142-4.
[9]Wang Y,Zhang J,Qain Y,et al.Association of Brachial-Ankle Pulse Wave Velocity with Asymptomatic Intracranial Arterial Stenosis in Hypertension Patients[J].J Stroke Cerebrovasc Dis,2016,25(8):1922-8.
[10]林铮,王振华,吴玉塘.臂踝脉搏波传导速度及踝臂指数对高血压患者早期动脉硬化的诊断价值[J].中国动脉硬化杂志,2015,23(11):1149-52.
[11]Tentolouris A,Eleftheriadou I,Grigoropoulou P,et al.The association between pulse wave velocity and peripheral neuropathy in patients with type 2 diabetes mellitus[J].J Diabetes Complications,2017,31(11):1624-9.
[12]杨蕾,李蓉,李启富,等.臂-踝脉搏波传导速度与2型糖尿病周围神经病变的相关性研究[J].解放军医学杂志,2014,39(11):882-7.
[13]Kisliak OA,Starodubova AV.Pulse wave velocity and pulse pressure in patients with arterial hypertension[J].Kardiologiia,2014,54(5):34-8.
[14]王燚,赵存瑞,徐鲲,等.高血压病和冠心病患者脉搏波传导速度分析[J].中国动脉硬化杂志,2015,23(10):1026-30.
[15]刘国玲.糖尿病周围神经病变患者颈动脉内-中膜厚度、颈动脉僵硬度与糖化血红蛋白的相关性研究[J].中国糖尿病杂志,2015,23(7):617-20.
[16]梁丽艳,陈曦,张源明,等.伴糖耐量异常的原发性高血压患者血尿酸与颈动脉硬化、动脉僵硬度的相关性研究[J].疑难病杂志,2015,14(3):223-6.
[17]杨红霞,米树华,贾淑杰,等.代谢综合征对老年原发性高血压病患者脉搏波传导速度的影响[J].中国全科医学,2013,16(39):3903-5.
[18]王宏宇,刘金波,赵红薇,等.高血压患者动脉僵硬度与血脂的相关性研究[J].中国全科医学,2014,17(18):2070-3.
[19]孙旭晖,何正飞,余健.瑞舒伐他汀对急性心肌梗死患者MMP-9、炎症因子、血脂水平及心功能的影响[J].中国生化药物杂志,2016,36(5):66-8.