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- 2017
高血压前期青年血管内皮功能障碍及其影响因素
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Abstract:
摘要：目的 探讨社区高血压前期青年血管内皮功能障碍及其影响因素。方法 以373名青年作为研究对象，依据血压水平将研究对象分为高血压组(HBP组)，高血压前期组(PHT组)和正常血压组(NBP组)。以颈动脉内膜中层厚度(IMT)、血流介导的肱动脉扩张性(FMD)以及肱踝动脉脉搏波传导速度(baPWV)评估血管内皮功能。结果 PHT组的IMT、baPWV值均高于NBP组(P均<0.05)，但与HBP组间无统计学差异(P均>0.05)。PHT组的FMD水平高于HBP组(P<0.05)，但与NBP组间比较无统计学意义(P>0.05)。高血压前期青年中，舒张压(β=－0.120，P<0.05)、体质量指数(β=－0.115，P<0.05)与FMD呈独立负相关；舒张压(β=0.146，P<0.05)、餐后2h血糖(β=0.147，P<0.05)、高密度脂蛋白胆固醇(β=0.150，P<0.05)、腰臀比(β=0.126，P<0.05)与IMT呈显著正相关；收缩压(β=0.358，P<0.01)、腰围(β=0.254，P<0.05)、空腹血糖(β=0.155，P<0.05)、餐后2h血糖(β=0.152，P<0.05)、血尿酸(β=0.206，P<0.05)以及超敏C反应蛋白(β=0.099，P<0.05)与baPWV相关。结论 高血压前期青年已存在血管内皮功能障碍，多种心血管危险因素在高血压前期血管内皮功能障碍的发生发展中发挥重要作用。
ABSTRACT: Objective To investigate the endothelial dysfunction in pre-hypertension and its influencing factors. Methods A total of 373 youth were divided as the subjects into hypertension group (HBP group), pre-hypertension group (PHT group) and normal blood pressure group (NBP group). Endothelial function was assessed based on carotid intima-media thickness (IMT), brachial artery flow-mediated dilation (FMD) and brachial-ankle pulse wave velocity (baPWV). Results IMT and baPWV in PHT group were higher than those in NBP group (P<0.05), but did not reach the significant difference when compared with HBP group (P>0.05). Compared with HBP, the levels of FMD in PHT group significantly increased (P<0.05); however, no difference was observed in comparison with NBP group (P>0.05). In the early stage of hypertension, diastolic BP (β=－0.120, P<0.05) and body mass index (β=－0.115, P<0.05) were negatively correlated with FMD; diastolic BP (β=0.146, P<0.05), 2-hour glucose (β=0.147, P<0.05), high-density lipoprotein cholestrol (β=0.150, P<0.05), and waist-hip ratio (β=0.126, P<0.05) showed a positive correlation with IMT. baPWV was correlated with systolic BP (β=0.358, P<0.01), waist circumference (β=0.254, P<0.05), fasting glucose (β=0.155, P<0.05), postprandial 2h blood glucose (β=0.152, P<0.05), uric acid (β=0.206, P<0.05), and C-reactive protein (β=0.099, P<0.05). Conclusion Our study shows that endothelial dysfunction may exist in the pre-hypertensive young, and several cardiovascular risks contribute to its development in the early stage of hypertension
| [1] | CELIK T, YUKSEL UC, FICI F, et al. Vascular inflammation and aortic stiffness relate to early left ventricular diastolic dysfunction in prehypertension[J]. Blood Pressure, 2013, 22(2):94-100. |
| [2] | FALKNER B, GIDDING SS, PORTMAN R, et al. Blood pressure variability and classification of prehypertension and hypertension in adolescence[J]. Pediatrics, 2008, 122(2):238-242. |
| [3] | CHOBANIAN AV, BAKRIS GL, BLACK HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report[J]. JAMA, 2003, 289(19):2560-2571. |
| [4] | MUNKHAUGEN J, LYDERSEN S, WIDER？hE T-E, et al. Pre-hypertension, obesity, and risk of kidney disease: 20-year follow-up of the HUNT I study in Norway[J]. Am J Kidney Dis, 2009, 54(4):638-646. |
| [5] | PADWAL RS, HEMMELGARN BR, KHAN NA, et al. The 2008 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1-blood pressure measurement, diagnosis and assessment of risk[J]. CJC, 2008, 24(6):455-463. |
| [6] | ISHIKAWA Y, ISHIKAWA J, ISHIKAWA S, et al. Prevalence and determinants of prehypertension in a Japanese general population: The Jichi Medical School Cohort Study[J]. Hypertens Res, 2008, 31(7):1323-1330. |
| [7] | SITIA S, TOMASONI L, ATZENI F, et al. From endothelial dysfunction to atherosclerosis[J]. Autoimmun Rev, 2010, 9(12):830-834. |
| [8] | 金楠，李革，李会 ，等. 中国大陆地区成年人高血压前期发生率及危险因素的meta分析[J]. 南方医科大学学报, 2013, 33(12):1738-1743. |
| [9] | RUBINSHTEIN R, KUVIN JT, SOFFLER M, et al. Assessment of endothelial function by non-invasive peripheral arterial tonometry predicts late cardiovascular adverse events[J]. Eur Heart J, 2010, 31(9):1142-1148. |
| [10] | 李丽，赵清，朱伟，等. 血管功能的无创检测方法进展[J]. 国际心血管病杂志, 2013, 40(5):302-304. |
| [11] | 刘力生. 中国高血压防治指南2010[J]. 中华高血压杂志, 2011, 19(8):701-708. |
| [12] | CELERMAJER S, SORENSEN KE, GOOCH VM, et al.Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis[J]. Lancet, 1992, 340(7):1111-1115. |
| [13] | WU S, HUANG Z, YANG X, et al. Cardiovascular events in a prehypertensive Chinese population: Four-year follow-up study[J]. Int J Cardiol, 2013, 167(5):2196-2199. |
| [14] | WAKABAYASHI I. Stronger associations of obesity with prehypertension and hypertension in young women than in young men[J]. J Hypertens, 2012, 30(7):1423-1429. |
| [15] | ASMAR R, BENETOS A, TOPOUCHIAN J, et al. Assessment of arterial distensibility by automatic pulse wave velocity measurement validation and clinical application studies[J]. Hypertension, 1995, 26(3):485-490. |
| [16] | KAWAI T, OHISHI M, ONISHI M, et al. Cut-off value of brachial-ankle pulse wave velocity to predict cardiovascular disease in hypertensive patients: A cohort study[J]. J Atheroscler Thromb, 2012, 20(4):391-400. |
| [17] | KOTSIS VT, PITIRIGA VC, STABOULI SV, et al. Carotid artery intima-media thickness could predict the presence of coronary artery lesions[J]. Am J Hypertens, 2005, 18(5):601-606. |
| [18] | INABA Y, CHEN JA, BERGMANN SR. Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: A meta-analysis[J]. Atherosclerosis, 2012, 220(1):128-133. |
| [19] | LUSHCHER TF. Imbalance of endothelium derived relaxing and contracting factors: A new concept in hypertension[J]. Am J Hypertens, 1990, 3(4):317-330. |
| [20] | GHIADONI L, TADDEI S, VIRDIS A. Hypertension and endothelial dysfunction: Therapeutic approach[J]. Curr Vasc Pharmacol, 2012, 10(1):42-60. |
| [21] | HU Y, LU Y, ZHANG Y. The evaluation of arterial early damage in high-normal blood pressure population[J]. Heart, 2011, 97(Suppl 3):A194-A195. |
| [22] | MARUYAMA Y, SAITO T, MAEHARA K. Coronary circulation in the failing heart[J]. Jpn Heart J, 1997, 38(6):755-767. |
| [23] | HIRASE T, NODE K. Endothelial dysfunction as a cellular mechanism for vascular failure[J]. Am J Physiol Heart Circ Physiol, 2012, 302(3): H499-H505. |
