高血压病患者血压变异性对动脉僵硬度与左室肥厚的影响
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摘要
目的：探讨原发性高血压患者血压变异性（blood pressure variability，BPV）对动脉僵硬度和左室肥厚的影响及三者的相关性。
方法：1、收集原发性高血压患者120例。2、使用无创携带式动态血压监测仪（ambulatoryblood pressure monitoring，ABPM）检测出研究对象24小时血压；计算24小时收缩压变异（24hBPVs）、24小时舒张压变异（24hBPVd），以此将研究对象分组：（1）根据收缩压变异值分：24hBPVs<15组，24hBPVs15~20组，24hBPVs>20组；（2）根据舒张压变异值分：24hBPVd<15组，24hBPVd15~20组，24hBPVd>20组。3、用VP-1000动脉弹性检测仪测定臂踝脉搏波传导速度（brachial-ankle Pulse Wave Velocity，ba-PWV），采用高分辨率超声检测肱动脉血流介导的内皮依赖性舒张功能（Flow-MediatedDilatation，FMD），以评价动脉僵硬度。4、采用心脏彩色多普勒超声，测定左心室舒张末期内径（left ventricle end diastolic diameter，LVDd），左心室后壁厚度(posteriorwall thickness，PWT)和室间隔厚度(interventricular septal thickness，IVST)等，计算出左室质量指数（left ventricular mass index，LVMI），以此评价左室肥厚程度。5、数据用单因素直线相关分析和多元逐步回归法分析ba-PWV、FMD、LVMI的影响因素。
结果：1、在不同血压变异性分组的原发性高血压患者，血压变异性越大的组别，其ba-PWV、LVMI值越大，而FMD值越小，差异有统计学意义（P<0.05），其中收缩压变异性分组中各组的FMD、ba-PWV、LVMI比较差异性较舒张压变异性分组的显著（P<0.01）。2、在所有受试者中，单因素相关分析显示，24hBPVs、24hBPVd均与ba-PWV、LVMI呈正相关，均与FMD呈负相关；ba-PWV与FMD呈负相关，ba-PWV与LVMI呈正相关，FMD与LVMI呈负相关。3、多元逐步回归分析显示，24hBPVs是FMD、ba-PWV、LVMI的独立影响因素，FMD和ba-PWV亦是LVMI的影响因素。
结论：1、BPV是动脉僵硬度的独立影响因素，其机制可能是通过损伤血管内皮功能促进动脉硬化性病变的发生发展。2、BPV是左室肥厚的独立影响因素，其机制可能与血管内皮损伤、AngII系统激活及动脉僵硬度增加有关。3、在原发性高血压患者中，随着BPV的增大，动脉僵硬度和左室肥厚程度增加，BPV的大小对评估高血压性心脏、血管损害程度有一定的价值。
Objective: To explore the blood pressure variability's influence on artery stiffness and leftventricular hypertrophy in patients with essential hypertension.
Methods: Blood pressure variability(blood pressure variability，BPV) were monitoredin 120 hypertensive paitents by ambulatory blood pressure monitoring. Brachial-anklewave velocity (brachial-ankle Pulse Wave Velocity，ba-PWV) and Flow-mediated dilation(Flow-Mediated Dilatation，FMD) were examined as artery stiffness (ba-PWV was measuredby VP-1000 automated analyzer, FMD of brachial artery was measured by high resolutionultralsound assessment of the brachial artery diameter). Left ventricular mass index(leftventricular mass index，LVMI) was measured by echocardiography to evaluate the level ofleft ventricular hypertrophy. The data are analyzed by univariate correlation analysis andmultivariate stepwise regression to discuss the factors influencing ba-PWV, FMD and LVMI.
Results: On the increase of blood pressure variability, ba-PWV and LVMI became higherand higher (P<0.05), FMD became lower and lower (P<0.05). Univariate correlation analysisdemonstrated that there was a significant relationship between BPV and ba-PWV, BPV and FMD,BPV and LVMI, ba-PWV and FMD, ba-PWV and LVMI, FMD and LVMI. In all recruitedsubjects，multivariate stepwise regression analysis demonstrated that 24hBPVs was significantand independent factors for ba-PWV and FMD and LVMI , also, ba-PWV and FMD wassignificant and independent factors for LVMI.
Conclusion: In the hypertensive patients, the increase of BPV can lead to an increase in arterialstiffness and left ventricular hypertrophy. BPV play an important role in hypertensive targetorgan’s damage.
方法：1、收集原发性高血压患者120例。2、使用无创携带式动态血压监测仪（ambulatoryblood pressure monitoring，ABPM）检测出研究对象24小时血压；计算24小时收缩压变异（24hBPVs）、24小时舒张压变异（24hBPVd），以此将研究对象分组：（1）根据收缩压变异值分：24hBPVs<15组，24hBPVs15~20组，24hBPVs>20组；（2）根据舒张压变异值分：24hBPVd<15组，24hBPVd15~20组，24hBPVd>20组。3、用VP-1000动脉弹性检测仪测定臂踝脉搏波传导速度（brachial-ankle Pulse Wave Velocity，ba-PWV），采用高分辨率超声检测肱动脉血流介导的内皮依赖性舒张功能（Flow-MediatedDilatation，FMD），以评价动脉僵硬度。4、采用心脏彩色多普勒超声，测定左心室舒张末期内径（left ventricle end diastolic diameter，LVDd），左心室后壁厚度(posteriorwall thickness，PWT)和室间隔厚度(interventricular septal thickness，IVST)等，计算出左室质量指数（left ventricular mass index，LVMI），以此评价左室肥厚程度。5、数据用单因素直线相关分析和多元逐步回归法分析ba-PWV、FMD、LVMI的影响因素。
结果：1、在不同血压变异性分组的原发性高血压患者，血压变异性越大的组别，其ba-PWV、LVMI值越大，而FMD值越小，差异有统计学意义（P<0.05），其中收缩压变异性分组中各组的FMD、ba-PWV、LVMI比较差异性较舒张压变异性分组的显著（P<0.01）。2、在所有受试者中，单因素相关分析显示，24hBPVs、24hBPVd均与ba-PWV、LVMI呈正相关，均与FMD呈负相关；ba-PWV与FMD呈负相关，ba-PWV与LVMI呈正相关，FMD与LVMI呈负相关。3、多元逐步回归分析显示，24hBPVs是FMD、ba-PWV、LVMI的独立影响因素，FMD和ba-PWV亦是LVMI的影响因素。
结论：1、BPV是动脉僵硬度的独立影响因素，其机制可能是通过损伤血管内皮功能促进动脉硬化性病变的发生发展。2、BPV是左室肥厚的独立影响因素，其机制可能与血管内皮损伤、AngII系统激活及动脉僵硬度增加有关。3、在原发性高血压患者中，随着BPV的增大，动脉僵硬度和左室肥厚程度增加，BPV的大小对评估高血压性心脏、血管损害程度有一定的价值。
Objective: To explore the blood pressure variability's influence on artery stiffness and leftventricular hypertrophy in patients with essential hypertension.
Methods: Blood pressure variability(blood pressure variability，BPV) were monitoredin 120 hypertensive paitents by ambulatory blood pressure monitoring. Brachial-anklewave velocity (brachial-ankle Pulse Wave Velocity，ba-PWV) and Flow-mediated dilation(Flow-Mediated Dilatation，FMD) were examined as artery stiffness (ba-PWV was measuredby VP-1000 automated analyzer, FMD of brachial artery was measured by high resolutionultralsound assessment of the brachial artery diameter). Left ventricular mass index(leftventricular mass index，LVMI) was measured by echocardiography to evaluate the level ofleft ventricular hypertrophy. The data are analyzed by univariate correlation analysis andmultivariate stepwise regression to discuss the factors influencing ba-PWV, FMD and LVMI.
Results: On the increase of blood pressure variability, ba-PWV and LVMI became higherand higher (P<0.05), FMD became lower and lower (P<0.05). Univariate correlation analysisdemonstrated that there was a significant relationship between BPV and ba-PWV, BPV and FMD,BPV and LVMI, ba-PWV and FMD, ba-PWV and LVMI, FMD and LVMI. In all recruitedsubjects，multivariate stepwise regression analysis demonstrated that 24hBPVs was significantand independent factors for ba-PWV and FMD and LVMI , also, ba-PWV and FMD wassignificant and independent factors for LVMI.
Conclusion: In the hypertensive patients, the increase of BPV can lead to an increase in arterialstiffness and left ventricular hypertrophy. BPV play an important role in hypertensive targetorgan’s damage.
引文
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