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目的探讨隐性高血压患者肱动脉血流介导的内皮依赖性血管舒张功能(FMD)的变化及其影响因素。方法根据动态血压和诊室偶测血压将研究对象分为隐性高血压组(n=32)、原发性高血压(EH)组(n=30)和正常血压组(n=30)。所有入选者均通过超声测定肱动脉FMD和颈动脉内膜中层厚度(I MT),并测定血清生化指标及高敏C反应蛋白(hsCRP)。结果隐性高血压组(6.3±3.5)%和EH组的FMD(6.1±2.8)%均低于正常血压组(8.4±4.8)%(均P<0.05),但隐性高血压组和EH组患者FMD无显著性差异(P>0.05);隐性高血压组、EH组和正常血压组的I MT分别为(0.58±0.12)、(0.62±0.12)和(0.42±0.09)mm,3组比较,差异有统计学意义(P<0.01),隐性高血压组和EH组I MT无显著性差异(P>0.05);直线相关分析显示隐性高血压组患者FMD与I MT具有直线负相关(r=-0.59,P<0.01);多因素Logistic回归分析显示空腹血糖(OR=4.3,95%CI1.01～18.08)、hsCRP(OR=4.1,95%CI1.02～16.2)和白昼平均收缩压(dSBP)(OR=1.2,95%CI1.01～1.50)(均P<0.05)是隐性高血压患者FMD的影响因素。结论隐性高血压患者存在FMD减退和颈动脉硬化。
Objective To investigate the changes of endothelium-dependent vasodilation (FMD) induced by brachial artery blood flow and its influencing factors in patients with occlusive hypertension. Methods The subjects were divided into two groups according to ambulatory blood pressure and occasional blood pressure in clinic: normotensive group (n = 32), essential hypertension group (n = 30) and normotensive group (n = 30). All subjects were measured by ultrasound brachial artery FMD and carotid artery intima-media thickness (I MT), and serum biochemical markers and high-sensitivity C-reactive protein (hsCRP). Results The levels of FMD (6.1 ± 2.8)% in the group of Hypertension (6.3 ± 3.5)% and EH were lower than those in the group of Normal (8.4 ± 4.8)% (all P <0.05) (P> 0.05). The I MTs in the group of Hypertension, EH and normotensives were (0.58 ± 0.12), (0.62 ± 0.12) and (0.42 ± 0.09) mm, respectively, 3 (P <0.01). There was no significant difference in I MT between Hypertension group and EH group (P> 0.05). The linear correlation analysis showed that there was a straight line between FMD and I MT in Hypertension group (OR = 4.3, 95% CI1.01 ~ 18.08), hsCRP (OR = 4.1, 95% CI1.02 ~ 16.2) and negative predictive value (r = -0.59, P <0.01) Mean daytime systolic blood pressure (dSBP) (OR = 1.2, 95% CI1.01-1.50) (all P <0.05) were the influencing factors of FMD in patients with occult hypertension. Conclusions Patients with occult hypertension have decreased FMD and carotid atherosclerosis.