代谢综合征对高血压病患者血管功能影响
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摘要
目的探讨代谢综合征(MS)对高血压病患者动脉功能的影响,为高血压合并代谢综合征患者早期干预,逆转亚临床血管病变提供依据。
对象和方法根据代谢综合征(MS)的诊断标准把64例门诊高血压病病人分为高血压合并MS的患者32例和32例单纯高血压病患者,31例健康受试者作为对照组,用VP1000和CVprofiler-2020动脉功能检测仪分别检测受检者的肱-踝动脉的脉搏波传导速度(BaPWV)及大动脉弹性(C1)和小动脉弹性(C2),同时检测其身高、体重、血压、血糖、血脂水平,并计算体重指数(BMI)。比较三组受试者BaPWV、C1及C2变化,统计分析动脉功能与各危险因素的相关性。
结果1.与对照组相比,高血压合并MS和单纯高血压病患者,BaPWV均显著增高,(1916.50±318.04,1757.59±313.90比1517.93±314.97cm/s, P分别为<0.01和<0.05);高血压合并MS患者BaPWV高于单纯高血压病(P<0.05)。
2.三组受试者C1和C2高低依次为:正常对照组>单纯高血压病组>高血压合并MS组, (C1:11.32±4.62> 9.11±3.50> 6.66±3.11ml/mmHg×10, P<0.01 ;C2:5.05±2.44>3.55±1.95>2.53±1.16 ml/mmHg×100,P<0.05)。
3.Peasion相关分析显示: BaPWV与年龄(Age)(r=0.586)、收缩压(SBP) (r=0.424)、脉压(PP)(r=0.529)、三酰甘油(TG)(r=0.301)呈显著正相关(P<0.01),与高密度脂蛋白胆固醇(HDL-C)(r=-0.401)呈显著负相关(P<0.01);C1与HDL-C(r=0.241)呈正相关(P<0.05);与Age(r=-0.310)、SBP(r=-0.539)、PP(r=-0.588)、TG(r=-0.322)呈负相关(P均<0.01);C2与HDL-C(r=0.392)呈正相关(P<0.01),与Age(r=-0.288)、SBP(r=-0.480)、PP(r=-0.486)、TG(r=-0.302)呈负相关(P均<0.01)。
结论代谢综合征加重高血压病人动脉功能的减退。
Objective: To evaluate the effects of metabolic syndrome(MS) on the arterial function in essential hypertensive(EH) patients, support some valuable evidences to intervent earlier and reversal subclinical vascular disease in essential hypertensive with MS.
Methods : 64 patients with hypertension were assigned into two groups: EH with MS group(EH+MS,n=32), EH without MS group(EH+nonMS,n=32). 31 healthy subjects was normal control(NC).Brachial-Ankle Pulse Wave Velocity (BaPWV) was measured using an automatic device (VP1000), Arterial elastic index(C1-large artery and C2-small artery )were measured by the CVProfiler-2020 pulse wave analysis instrument.
Results:1. BaPWV in EH+MS and EH+nonMS was higher than that in NC. (1916.50±318.04,1757.59±313.90 VS 1517.93±314.97 cm/s, P<0.01 and <0.05);BaPWV in EH+MS was higher than that in EH+nonMS(P<0.05).
2. The magnitude of C1 and C2 among three groups were: NC > EH+nonMS > EH+MS, (C1:11.32±4.62> 9.11±3.50> 6.66±3.11ml/mmHg×10, P <0.01;C2:5.05±2.44>3.55±1.95>2.53±1.16 ml/mmHg×100,P<0.05).
3. Pearson Correlation show that BaPWV was significantly positive related with age(r=0.586)、SBP(r=0.424)、PP(r=0.529)、TG(r=0.301)(P<0.01)and signifycantly negatively related with HDL-C(r=-0.401) (P<0.01);C1 was significantly positive related with HDL-C(r=0.241)(P<0.05 ) and significantly negatively related with age(r=-0.310)、SBP(r=-0.539)、PP(r=-0.588)、TG(r=-0.322) (P<0.01); C2 was significantly positive related with HDL-C(r=0.392)(P<0.01)and significantly negatively related with age(r=-0.288)、SBP(r=-0.480)、PP(r=-0.486)、TG(r=-0.302)(P<0.01).
Conclusion:Metabolic syndrome may aggravate the dysfunction of artery in essential hypertensive patients.
对象和方法根据代谢综合征(MS)的诊断标准把64例门诊高血压病病人分为高血压合并MS的患者32例和32例单纯高血压病患者,31例健康受试者作为对照组,用VP1000和CVprofiler-2020动脉功能检测仪分别检测受检者的肱-踝动脉的脉搏波传导速度(BaPWV)及大动脉弹性(C1)和小动脉弹性(C2),同时检测其身高、体重、血压、血糖、血脂水平,并计算体重指数(BMI)。比较三组受试者BaPWV、C1及C2变化,统计分析动脉功能与各危险因素的相关性。
结果1.与对照组相比,高血压合并MS和单纯高血压病患者,BaPWV均显著增高,(1916.50±318.04,1757.59±313.90比1517.93±314.97cm/s, P分别为<0.01和<0.05);高血压合并MS患者BaPWV高于单纯高血压病(P<0.05)。
2.三组受试者C1和C2高低依次为:正常对照组>单纯高血压病组>高血压合并MS组, (C1:11.32±4.62> 9.11±3.50> 6.66±3.11ml/mmHg×10, P<0.01 ;C2:5.05±2.44>3.55±1.95>2.53±1.16 ml/mmHg×100,P<0.05)。
3.Peasion相关分析显示: BaPWV与年龄(Age)(r=0.586)、收缩压(SBP) (r=0.424)、脉压(PP)(r=0.529)、三酰甘油(TG)(r=0.301)呈显著正相关(P<0.01),与高密度脂蛋白胆固醇(HDL-C)(r=-0.401)呈显著负相关(P<0.01);C1与HDL-C(r=0.241)呈正相关(P<0.05);与Age(r=-0.310)、SBP(r=-0.539)、PP(r=-0.588)、TG(r=-0.322)呈负相关(P均<0.01);C2与HDL-C(r=0.392)呈正相关(P<0.01),与Age(r=-0.288)、SBP(r=-0.480)、PP(r=-0.486)、TG(r=-0.302)呈负相关(P均<0.01)。
结论代谢综合征加重高血压病人动脉功能的减退。
Objective: To evaluate the effects of metabolic syndrome(MS) on the arterial function in essential hypertensive(EH) patients, support some valuable evidences to intervent earlier and reversal subclinical vascular disease in essential hypertensive with MS.
Methods : 64 patients with hypertension were assigned into two groups: EH with MS group(EH+MS,n=32), EH without MS group(EH+nonMS,n=32). 31 healthy subjects was normal control(NC).Brachial-Ankle Pulse Wave Velocity (BaPWV) was measured using an automatic device (VP1000), Arterial elastic index(C1-large artery and C2-small artery )were measured by the CVProfiler-2020 pulse wave analysis instrument.
Results:1. BaPWV in EH+MS and EH+nonMS was higher than that in NC. (1916.50±318.04,1757.59±313.90 VS 1517.93±314.97 cm/s, P<0.01 and <0.05);BaPWV in EH+MS was higher than that in EH+nonMS(P<0.05).
2. The magnitude of C1 and C2 among three groups were: NC > EH+nonMS > EH+MS, (C1:11.32±4.62> 9.11±3.50> 6.66±3.11ml/mmHg×10, P <0.01;C2:5.05±2.44>3.55±1.95>2.53±1.16 ml/mmHg×100,P<0.05).
3. Pearson Correlation show that BaPWV was significantly positive related with age(r=0.586)、SBP(r=0.424)、PP(r=0.529)、TG(r=0.301)(P<0.01)and signifycantly negatively related with HDL-C(r=-0.401) (P<0.01);C1 was significantly positive related with HDL-C(r=0.241)(P<0.05 ) and significantly negatively related with age(r=-0.310)、SBP(r=-0.539)、PP(r=-0.588)、TG(r=-0.322) (P<0.01); C2 was significantly positive related with HDL-C(r=0.392)(P<0.01)and significantly negatively related with age(r=-0.288)、SBP(r=-0.480)、PP(r=-0.486)、TG(r=-0.302)(P<0.01).
Conclusion:Metabolic syndrome may aggravate the dysfunction of artery in essential hypertensive patients.
引文
1.Grey E, Bratteli C, Glasser SP, et al. Reduced small artery but not large artery elasticity is an independent risk marker for cardiovascular events. Am J Hypertens, 2003,16:265-269.
2.Boutouyrie P, Tropeano AI, Asmar R, et al. Aortic stiffness is an indep- endent predictor of primary coronary events in hypertensive patients: a longitudinal study .Hypertension, 2002,39(1):10-15.
3.陶军,靳亚非,王礼春,等.年龄对血管弹性和内皮细胞功能的影响.中华心血管病杂志,2003 ,31:250-253.
4.Safar M,Thuilliez C, Richard V, et al. Pressure-independent contribution of sodium to large artery structure and function in hypertension. Cardiovasc Res,2000,46(2):269-276.
5.刘斌,张晋霞,陈桂华,等.脑梗死患者颈动脉颅外段狭窄危险因素分析.脑与神经疾病杂志,2004,6:404-406.
6.蒲里津,陆林,沈卫峰,等.晚期糖基化终末产物致动脉粥样硬化的机制.国际心血管病杂志,2006,33(2):98-100.
7.刘金来,郝宝顺,朱承明,等.高分辨率超声检测代谢综合征患者血管内皮功能.中国动脉硬化杂志,2004,12(1):90-92.
8.严孙杰,张松菁,杨立勇,等.糖尿病不同时期血管内皮依赖性舒张功能变化.高血压杂志,2005,13:142-144.
9.涂昌,陶军,杨震,等.糖尿病患者动脉弹性功能的变化与监测.新医学,2005, 36(2):80-81.
10.冯海波,庄惠君,孙宁玲,等.不同血糖水平糖尿病患者动脉弹性指数的变化.中华高血压杂志,2007,15(7):575-578.
11.Nakanishi N, Suzuki K, Tatara K.Clustered features of the metabolic syndrome and the risk for increased aortic pulse wave velocity in middle-aged Japanese men. Angiology,2003 54(5):551-559.
12.Safar ME, Thomas F, Blacher J,et al. Metabolic syndrome and age-related progression of aortic stiffness. J Am Coll Cardiol, 2006 3;47(1):72-75.
1.祝之明,代谢综合征的病因探索与临床实践.北京:人民军医出版,2005.7-8.
2.中华医学会糖尿病分会代谢综合征研究协作组.中华医学会糖尿病分会关于MS的建议。中华糖尿病杂志,2004,12(3): 156-161.
3.张毅,李玲,厉平,等.不同代谢综合征诊断标准在沈阳地区人群中的比较.中国医科大学学报,2007,36(1):86-88.
4. Eckel RH, WassefM, Chait A, et al. Prevention Conference VI: Diabetes and Cardiovascular Disease1 Writing groupⅡ: pathogenesis of atherosclero- sis in diabetes1. Circulation, 2002,105(18):138-143.
5. Ulrich P, CeramiA. Protein glycation, diabetes, and aging. Recent Prog Horm Res, 2001,56(2):1-21.
6.涂昌,陶军,杨震,等。糖尿病患者动脉弹性功能的变化与监测.新医学,2005, 36(2):80-81.
7.严孙杰,张松菁,杨立勇,等.糖尿病不同时期血管内皮依赖性舒张功能变化.高血压杂志,2005,13:142-144.
8. Henry RM, Kostense PJ , Spijkerman AM, et al.Arterial stiffness increases with deteriorating glucose tolerance status : the Hoorn study.Circulation, 2003,107(16): 2089-2095.
9.刘金来,郝宝顺,朱承明,等.高分辨率超声检测代谢综合征患者血管内皮功能.中国动脉硬化杂志, 2004,12(1):90-92.
10.Cullen P. Evidence that triglycerides are an independent coronary heart diseaserisk factor. Am J Cardiol,2000,86: 943-949.
11 . Leeson CP, Whincup PH,Cook DG,et al. Cholesterol and Arterial Distensibility in the First Decade of Life. Circulation. 2000,101: 1533-1538.
12.Leibovitz E, Hazanov N, Zimlichman R, et al. Treatment with atorvastatin improves small artery compliance in patients with severe hypercholesterolemia. Am J Hypertens,2001 14(1):1096-1098.
13.刘斌,张晋霞,陈桂华,等.脑梗死患者颈动脉颅外段狭窄危险因素分析.脑与神经疾病杂志,2004,6:404-406.
14.黄芸,戴闺柱,冯宗忱,等.高甘油三酯血症对血管内皮功能的影响.中华心血管杂志,2003 ,31(6):421-423.
15.谭静,华琦,闻静,等.高血压病患者大动脉弹性功能的临床研究.心肺血管病杂志, 2006,25(3):143-146.
16.张延斌,黄宗明,吴兰芬,等.高血压病患者血管内皮依赖性舒张功能的无创评价.高血压杂志,2000 ,8 :295-296.
17.谭静,华琦,闻静,等。代谢综合征与动脉僵硬度的关系.中国动脉硬化杂志,2006年第14卷第2期167-169.
18.Kem PA, Ranganathan S,Li C, et al. Adipose tissue tumor necrosis factor and inter-Leukin-6 expression in human obesity and insulin resistance. Am J Physiol, 2001, 280: E745-E751.
19.Pradhan AD, Manson JE, Rifai N, et al. CRP, interleukin-6, and risk of developing type 2 dibetes mellitus. JAMA, 2001, 286: 327-334.
2.Boutouyrie P, Tropeano AI, Asmar R, et al. Aortic stiffness is an indep- endent predictor of primary coronary events in hypertensive patients: a longitudinal study .Hypertension, 2002,39(1):10-15.
3.陶军,靳亚非,王礼春,等.年龄对血管弹性和内皮细胞功能的影响.中华心血管病杂志,2003 ,31:250-253.
4.Safar M,Thuilliez C, Richard V, et al. Pressure-independent contribution of sodium to large artery structure and function in hypertension. Cardiovasc Res,2000,46(2):269-276.
5.刘斌,张晋霞,陈桂华,等.脑梗死患者颈动脉颅外段狭窄危险因素分析.脑与神经疾病杂志,2004,6:404-406.
6.蒲里津,陆林,沈卫峰,等.晚期糖基化终末产物致动脉粥样硬化的机制.国际心血管病杂志,2006,33(2):98-100.
7.刘金来,郝宝顺,朱承明,等.高分辨率超声检测代谢综合征患者血管内皮功能.中国动脉硬化杂志,2004,12(1):90-92.
8.严孙杰,张松菁,杨立勇,等.糖尿病不同时期血管内皮依赖性舒张功能变化.高血压杂志,2005,13:142-144.
9.涂昌,陶军,杨震,等.糖尿病患者动脉弹性功能的变化与监测.新医学,2005, 36(2):80-81.
10.冯海波,庄惠君,孙宁玲,等.不同血糖水平糖尿病患者动脉弹性指数的变化.中华高血压杂志,2007,15(7):575-578.
11.Nakanishi N, Suzuki K, Tatara K.Clustered features of the metabolic syndrome and the risk for increased aortic pulse wave velocity in middle-aged Japanese men. Angiology,2003 54(5):551-559.
12.Safar ME, Thomas F, Blacher J,et al. Metabolic syndrome and age-related progression of aortic stiffness. J Am Coll Cardiol, 2006 3;47(1):72-75.
1.祝之明,代谢综合征的病因探索与临床实践.北京:人民军医出版,2005.7-8.
2.中华医学会糖尿病分会代谢综合征研究协作组.中华医学会糖尿病分会关于MS的建议。中华糖尿病杂志,2004,12(3): 156-161.
3.张毅,李玲,厉平,等.不同代谢综合征诊断标准在沈阳地区人群中的比较.中国医科大学学报,2007,36(1):86-88.
4. Eckel RH, WassefM, Chait A, et al. Prevention Conference VI: Diabetes and Cardiovascular Disease1 Writing groupⅡ: pathogenesis of atherosclero- sis in diabetes1. Circulation, 2002,105(18):138-143.
5. Ulrich P, CeramiA. Protein glycation, diabetes, and aging. Recent Prog Horm Res, 2001,56(2):1-21.
6.涂昌,陶军,杨震,等。糖尿病患者动脉弹性功能的变化与监测.新医学,2005, 36(2):80-81.
7.严孙杰,张松菁,杨立勇,等.糖尿病不同时期血管内皮依赖性舒张功能变化.高血压杂志,2005,13:142-144.
8. Henry RM, Kostense PJ , Spijkerman AM, et al.Arterial stiffness increases with deteriorating glucose tolerance status : the Hoorn study.Circulation, 2003,107(16): 2089-2095.
9.刘金来,郝宝顺,朱承明,等.高分辨率超声检测代谢综合征患者血管内皮功能.中国动脉硬化杂志, 2004,12(1):90-92.
10.Cullen P. Evidence that triglycerides are an independent coronary heart diseaserisk factor. Am J Cardiol,2000,86: 943-949.
11 . Leeson CP, Whincup PH,Cook DG,et al. Cholesterol and Arterial Distensibility in the First Decade of Life. Circulation. 2000,101: 1533-1538.
12.Leibovitz E, Hazanov N, Zimlichman R, et al. Treatment with atorvastatin improves small artery compliance in patients with severe hypercholesterolemia. Am J Hypertens,2001 14(1):1096-1098.
13.刘斌,张晋霞,陈桂华,等.脑梗死患者颈动脉颅外段狭窄危险因素分析.脑与神经疾病杂志,2004,6:404-406.
14.黄芸,戴闺柱,冯宗忱,等.高甘油三酯血症对血管内皮功能的影响.中华心血管杂志,2003 ,31(6):421-423.
15.谭静,华琦,闻静,等.高血压病患者大动脉弹性功能的临床研究.心肺血管病杂志, 2006,25(3):143-146.
16.张延斌,黄宗明,吴兰芬,等.高血压病患者血管内皮依赖性舒张功能的无创评价.高血压杂志,2000 ,8 :295-296.
17.谭静,华琦,闻静,等。代谢综合征与动脉僵硬度的关系.中国动脉硬化杂志,2006年第14卷第2期167-169.
18.Kem PA, Ranganathan S,Li C, et al. Adipose tissue tumor necrosis factor and inter-Leukin-6 expression in human obesity and insulin resistance. Am J Physiol, 2001, 280: E745-E751.
19.Pradhan AD, Manson JE, Rifai N, et al. CRP, interleukin-6, and risk of developing type 2 dibetes mellitus. JAMA, 2001, 286: 327-334.