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目的探讨高血压合并代谢综合征对血管内皮功能及靶器官损害的影响。方法根据代谢综合征的诊断标准将156例高血压病患者分为高血压合并代谢综合征(EH+MS 组,n=61例)、高血压非代谢综合征(EH+nonMS 组,n=95例)两组,31例健康体检者作为对照组(NC 组),用彩色多普勒超声测定反应性充血前后肱动脉内径、血流量及阻力变化,并测定颈动脉粥样斑块及左室重量指数。结果 (1)除空腹血糖(FBG)、体重指数(BMI)、甘油三酯(TG)外,EH+MS 组的收缩压、舒张压、TC、HDL-C、LDL-C、Fib、年龄、性别比、吸烟习惯等指标与 EH+nonMS 组均衡可比。(2)内皮依赖性血管舒张功能(FMD%):EH+MS 组明显低于 EH+nonMS 组组及 NC[(7.08±3.21)%比(8.18±1.74)%和(10.41±4.52)%,P 分别<0.05和0.01],EH+nonMS 组也低于 NC 组(P<0.05)。(3)EH+MS 组反应性充血后血流量变化率(%)明显低于 EH+nonMS 组及 NC 组[(154.19±78.94)%比(196.44±64.22)%和(221.81±89.64)%,P 值分别<0.05和0.01],但 EH+nonMS组与 NC 组间差异无统计学意义。(4)前臂血管扩张能力的高低顺序为 NC 组(3.21±0.90)>EH+nonMS 组(2.89±0.73)>EH+MS 组(2.58±0.76)。(5)颈动脉粥样斑块发生率分别为17/61(27.9%)、19/95(20.2%)及1/31(3.2%),P<0.05。(6)左室肥厚发生率从高到低排列分别为EH+MS 组(59%)>EH+nonMS 组(37.9%)>NC 组(9.7%)。(7)FMD 与年龄、性别、吸烟、收缩压、舒张压、TG、血浆纤维蛋白原有相关性;颈动脉内膜中层厚度与年龄、吸烟、收缩压、舒张压、BMI、TG、血浆纤维蛋白原呈正相关;左室重量指数与年龄、吸烟、SBP、DBP、BMI、TG 呈正相关;FMD 与颈动脉内膜中层厚度、左室重量指数呈负相关。结论代谢综合征明显加重了高血压病患者血管功能和靶器官损害。
Objective To investigate the effect of hypertension complicated with metabolic syndrome on vascular endothelial function and target organ damage. Methods According to the diagnostic criteria of metabolic syndrome, 156 patients with hypertension were divided into metabolic syndrome (EH + MS group, n = 61), hypertensive non-metabolic syndrome (EH + nonMS group, n = 95 Cases) and 31 healthy controls as control group (NC group). The changes of internal diameter, blood flow and resistance of brachial artery before and after reactive hyperemia were measured by color Doppler sonography. The carotid atherosclerotic plaque and left ventricular Weight index. Results (1) The systolic blood pressure, diastolic blood pressure, TC, HDL-C, LDL-C, Fib, age, body mass index Sex ratio, smoking habits and other indicators and EH + nonMS balanced group comparable. (2) Endothelium-dependent vasodilation (FMD%): The EH + MS group was significantly lower than that of the EH + nonMS group and the NC group (8.18 ± 3.21% vs 8.18 ± 1.21% vs 10.41 ± 4.52% P <0.05 and 0.01 respectively], and also lower in EH + nonMS group than in NC group (P <0.05). (3) The rate of change of blood flow (%) after reactive hyperemia in EH + MS group was significantly lower than that in EH + nonMS group and NC group [(154.19 ± 78.94)% vs (196.44 ± 64.22)% and (221.81 ± 89.64)%, P value respectively <0.05 and 0.01], but there was no significant difference between EH + nonMS group and NC group. (4) The order of vasodilatation of forearm was NC group (3.21 ± 0.90)> EH + nonMS group (2.89 ± 0.73)> EH + MS group (2.58 ± 0.76). (5) The incidence of carotid artery plaque was 17/61 (27.9%), 19/95 (20.2%) and 1/31 (3.2%) respectively, P <0.05. (6) The incidence of left ventricular hypertrophy was from high to low in EH + MS group (59%), EH + nonMS group (37.9%) and NC group (9.7%). (7) The correlation between FMD and age, sex, smoking, systolic blood pressure, diastolic blood pressure, TG and plasma fibrinogen; carotid artery intima-media thickness and age, smoking, systolic blood pressure, diastolic blood pressure, BMI, TG, (P <0.05). The left ventricular mass index was positively correlated with age, smoking, SBP, DBP, BMI and TG. FMD was negatively correlated with carotid intima-media thickness and left ventricular mass index. Conclusion Metabolic syndrome significantly aggravates vascular function and target organ damage in patients with essential hypertension.