老年高血压昼夜节律与左心功能及血管内皮功能的关系  

Association between plasma endothelin ET,NO levels,LVMI,brachial artery endothelial function and circadian rhythm of blood pressure in elderly patients with hypertension

作　　者：印小荣[1] 李蓬[1] 

机构地区：[1]南京市市级机关医院,江苏省南京市210018

出　　处：《实用老年医学》2005年第6期298-299,320,共3页Practical Geriatrics

基　　金：南京市医学科技发展项目(YKK0467)

摘　　要：目的探讨老年高血压血压昼夜节律与左室肥厚(LVH)、肱动脉扩张性、循环中一氧化氮(NO)、内皮素(ET)的关系。方法选择400例老年高血压患者,最后符合入选本研究的293例。根据动态血压(ABPM)将其分为血压昼夜节律正常组及血压昼夜节律消失组。用高分辨率超声测心脏结构,肱动脉内皮功能。用放射免疫法测定血浆ET,用镀铜镉还原法测定血浆NO,进行统计分析。结果血压昼夜节律消失组室间隔厚度(IVSd)、左室质量指数(LVMI)、相对室壁厚度、ET均增高,而E/A有下降趋势,肱动脉内皮依赖性扩张(FMD)及药物依赖性扩张(GTN-ID)均减弱。NO,NO/ET明显下降,夜间血压下降率与FMD、GTN-ID、NO、NO/ET呈显著正相关,而与ET、IVSd、左室后壁厚度、LVMI呈显著负相关。结论老年EH患者血压昼夜节律消失可促进或加重LVH、削弱血管扩张性及NO和ET合成释放失衡。Objective To investgate the relationship between plasma endothelin ET, NO levels, LVMI, brachial artery endothelial function and rhythm of blood pressure in elderly patients with hypertension. Methods According to ambulatory blood pressure, 293 elderly patiens with essential hypertension were classified prospectively into 2 groups, dipper group（n = 142） and nondipper group（n = 151 ）. High-resolution ultrasound was used to measure cardiac dimensions, and brachial artery endothelial function. Results The groups were matched for age, body size, and serum cholesterol levels. Nondipper groupe tended to have increased indicates left ventricular mass-index （LVMI） , left ventricular diameter in diastole （ LVDd）, septum in diastole （ IVSd）, relative wall thickness, and decreased early （E） and late （A） mitral flow peak velocities （E/A-ratio）, and decreased flow-mediated dilatation （FMD） and nitrate-mediated dilatation （GTN-ID）. Increased ET levels and decreased NO levels. FMD, GTN-ID, NO, NO/ET were significantly positive correlated to nocturnal blood pressure fall, ET, IVSd, LVPWd, LVMI were significantly negative correlated to nocturnal blood pressure fall. Conclusions Disapperance of rhythm of blood pressure in elderly patients with essential hypertension can aggravate LVH, weaken artery dilation and induce imballance of ET and NO levels.

关 键 词：血压 昼夜节律 心室功能 左 一氧化氮 内皮缩血管肽类 老年人 

分 类 号：R544.1[医药卫生—心血管疾病]