糖脂联合负荷对高血压患者肱动脉内皮依赖性扩张功能的影响  

Impact of acute glucose and fat loading on endothelium dependent vasodilation in patients with essential hypertension

作　　者：郑小蓉[1] 柴大军[2] 彭峰[2] 徐军霞[3] 林金秀[2] 

机构地区：[1]福建省第二人民医院二化分院,福州350011 [2]福建医科大学附属第一医院心内科 [3]南京军区福州总医院心内科

出　　处：《中华心血管病杂志》2010年第12期1085-1088,共4页Chinese Journal of Cardiology

基　　金：基金项目：福建省人才创新课题（2005J040）

摘　　要：目的 探讨糖脂联合负荷对高血压患者糖脂代谢及血管内皮功能的影响.方法 98例高血压患者随机分为三组,单纯脂肪餐负荷组（n=38）,糖负荷组（n=26）,糖脂联合负荷组（n=34）,分别进行脂肪餐负荷试验,口服葡萄糖耐量试验及糖脂联合负荷试验.葡萄糖曲线下面积（GS-AUC）作为糖负荷后血糖反应水平的指标,以甘油三酯（TG）曲线下面积（TG-AUC）,TG峰浓度（TGPR）作为脂肪餐负荷后TG反应水平的指标;用血管超声测定肱动脉内皮依赖性扩张功能（FMD）作为血管内皮功能指标.结果 （1）高血压患者脂肪餐负荷后出现明显TG代谢异常,明显高于正常血压对照组（P＜0.05）,且FMD明显下降,4 h下降达高峰（下降29.2%）,8 h后恢复正常.（2）高血压患者急性糖负荷后GS-AUC及1 h血糖明显高于正常血压对照组（P＜0.05）,FMD在负荷后1 h即显著下降（下降31.4%）,2 h恢复正常.（3）糖脂联合负荷后血TG反应水平、GS-AUC及1 h血糖虽然分别与单纯脂肪餐负荷组、糖负荷组差异无统计学意义,但负荷后1 h的FMD明显低于单纯糖负荷组（5.45±1.93比9.46±3.33,P＜0.05）,4 h时的FMD也低于单纯脂肪餐负荷组（7.98±1.64比9.66±2.26,P＜0.05）.（4）相关分析显示,FMD与收缩压,GS-AUC,舒张压,TG-AUC呈负相关,γ分别为-0.46,-0.44,-0.41,-0.38（P＜0.05）.结论 糖脂联合负荷对高血压患者血管内皮损伤有协同作用.Objective To explore the influence of acute glucose and fat loading on endothelium dependent flow-mediated vasodilation （FMD） in patients with essential hypertension （EH）. Methods Patients with EH were randomly divided into three groups： oral glucose loading alone （n = 26 ）, oral standardized fat loading alone （n = 38）, combined glucose and fat loading （n = 34 ）. FMD of the brachial artery was assessed by high resolution ultrasound technique respectively. Results （ 1 ） Compared to control group, postrandial abnomal serum triglyceride metabolism was evidenced and FMD was significantly reduced and the lowest FMD occurred at 4 hours and returned to the baseline level at 8 hours post fat loading alone in EH patients. （2） GS-AUC and 1 hour glucose were significantly higher in EH patients than in controls （all P 〈0. 05）, FMD was also significant decreased （ -31.4% ） at 1 hour and returned to baseline level at 2 hours post oral glucose loading. （ 3 ） After combined glucose and fat loading, FMD at 1 hour （ 5.45 ± 1.93 vs. 9.46 ± 3.33, P 〈 0.05 ） was significantly lower than that in glucose loading alone and FMD at 4 hours （ 7. 98 ± 1. 64 vs. 9. 66 ± 2. 26, P 〈 0. 05 ）, was also lower than that in fat loading alone in EH patients.（4） FMD was negatively correlated with SBP, GS-AUC, DBP, TG-AUC （ γ= - 0. 46, - 0. 44, - 0. 41,- 0. 38,respectively, all P 〈 0. 05 ）. Conclusion Combined glucose and fat loading additively reduced FMD in hypertensive patients.

关 键 词：高血压 代谢 血管 内皮 

分 类 号：R686[医药卫生—骨科学]