H型高血压患者颈动脉结构和功能变化及与亚临床炎症的相关性  

Structural and functional changes of the carotid artery and their relationship with subclinical inflammation in patients with H-type hypertension

作　　者：胡兆霆[1] 侯庆臻[1] 赵素玲[2] 梁燕琼[1] 沈安娜[1] 

机构地区：[1]南方医科大学第三附属医院心内科,广东广州510630 [2]南方医科大学第三附属医院超声科,广东广州510630

出　　处：《南方医科大学学报》2012年第8期1175-1178,共4页Journal of Southern Medical University

基　　金：广东省医学科学技术研究基金(wstJJ20091118);南方医科大学第三附属医院院长基金(B201011)

摘　　要：目的探讨H型高血压患者颈动脉结构与功能的变化,及其与亚临床炎症的相关性。方法选择H型高血压患者60例(A组),非H型高血压患者49例(B组),与在南方医科大学第三附属医院体检的健康者作为正常对照组20例(C组),对3组人群均行彩色超声检查;同时进行超敏C反应蛋白(hs-CRP)、纤维蛋白原(FIB)、肿瘤坏死因子-α(TNF-α)的水平进行测定,比较3组之间颈动脉超声参数及炎性标志物的水平,观察H型高血压患者颈动脉结构与功能的变化,及其与亚临床炎症的相关性。结果 H型高血压组与非H型高血压组比较,血压水平[收缩压(136.0±10.1)mmHg vs(131.9±7.0)mmHg,舒张压(80.9±8.9)mmHg vs(73.2±7.9)mmHg],差异无统计学意义(均P>0.05)。颈动脉IMT[H型高血压组(1.52±0.08)mm vs非H型高血压组(1.09±0.06)mm]、扩张性[H型高血压组(0.23±0.14)mmHg-1×100 vs非H型高血压组(0.46±0.14)mmHg-1×100]、血清Hcy[H型高血压组(15.37±5.89)vs非H型高血压组(8.19±4.53)μmol/L],差异有统计学意义(均P<0.05),H型高血压组血浆超敏C反应蛋白、纤维蛋白原、肿瘤坏死因子-α水平,均高于非H型高血压组,且与颈动脉结构与功能参数变化呈正相关。结论 H型高血压患者更易发生颈动脉结构与功能损害。亚临床炎症和H型高血压患者颈动脉结构与功能损害密切相关。H型高血压患者更易发生颈动脉结构与功能损害的机制,可能与亚临床炎症、高同型半胱氨酸血症对高血压的协同作用有关,应采取积极干预措施。Objective To investigate the changes in the structure and function of the carotid artery and their relationship with subclinical inflammation in patients with H-type hypertension. Methods Sixty patients with H-type hypertension and 49 with non-H-type hypertension were enrolled in this study, with 20 healthy volunteers as the control group. All the subjects underwent color Doppler ultrasound examination of the carotid artery, and their blood levels of hyper-sensitive C-reactive protein （hs-CRP）, fibrinogen （FIB）, and tumor necrosis factor-α （TNF-α） were measured to investigate the correlation between the structural and functional changes of the carotid artery and the inflammatory factors. Results No significant difference was found in the blood pressure level between the H-type and non-H-type hypertension groups （136.0±10.1 vs 131.9±7.0 mmHg for systolic blood pressure, P〉0.05; 80.9 ± 8.9 vs 73.2 ± 7.9 mmHg for diastolic pressure, P〉0.05）. The intima-media thickness, distensibility of the common carotid artery, carotid artery stiffness, and blood homocysteine level all showed significant differences between patients with H-type and non-H-type hypertension （1.52±0.08 vs 1.09±0.06 mm, 0.23±0.14 mmHg-1×100 vs 0.46±0.14 mmHg-1×100, and 15.37±5.89 vs 8.19±4.53 μmol/L, respectively, P〈0.05）. The H-type hypertensive patients showed significantly higher hs-CRP, FIB, and TNF-α levels than the non-H-type hypertensive patients, and these inflammatory factors were positively correlated with the structural and functional changes of the carotid artery. Conclusions The patients with H-type hypertension are more likely to have carotid artery structure and function impairments, which closely correlate with the subclinical inflammatory factors. These changes might be attributed to the synergism of subclinical inflammation and hyperhomocysteinemia, for which active intervention may prove beneficial.

关 键 词：H型高血压 颈动脉硬化 亚临床炎症 

分 类 号：R544.1[医药卫生—心血管疾病]