糖代谢异常对原发性高血压患者心血管功能的影响(英文)  

Influence of impaired glucose metabolism on cardiovascular function in patients with essential hypertension

作　　者：王钢[1] 夏冰[2] 

机构地区：[1]广州军区广州总医院老年病科,广东广州510010 [2]广州军区广州总医院医学实验科,广东广州510010

出　　处：《心血管康复医学杂志》2014年第4期370-375,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：Medical science research fund of Guangdong Province(A2009490)~~

摘　　要：目的:探讨糖代谢异常(IGM)对原发性高血压(EH)患者心血管功能的影响。方法:选择46例单纯EH及36例合并2型糖尿病(T2DM)的EH患者,检测其血糖、血脂、血尿酸(UA)、纤维蛋白原(Fb)、血同型半胱氨酸(Hcy)、尿微量白蛋白(UM)等指标水平,同时行24h动态血压监测及心脏彩色超声多普勒检查,对两组患者的各项临床指标、动态血压参数及心脏舒张障碍发生率进行对比分析,并以心脏舒张功能障碍为二分类因变量,进行多因素逐步二分类回归分析。结果:合并T2DM的EH患者人体质量指数(BMI)、血糖、血脂(除高密度脂蛋白胆固醇、载脂蛋白A I外)、UA、Fb、血Hcy及UM水平均显著高于单纯EH患者(P<0.05或P<0.01),且合并T2DM的EH患者24h平均收缩压(24hSBP)、日间平均收缩压(dSBP)、24h平均脉压(24hPP)及日间平均脉压(dPP)均显著高于单纯EH患者(P<0.05或P<0.01),而两组间其他动态血压参数的差异则无显著性意义(P>0.05);两组EH患者左心室射血分数(LVEF)值均大于40%,而合并T2DM的EH患者心脏舒张功能障碍发生率显著高于单纯EH患者(72.2%比45.7%,P=0.016),二元Logistic回归分析显示,年龄(OR=1.160,95%CI:1.002~1.342,P=0.012)、糖尿病(OR=3.095,95%CI:1.056~9.079,P=0.029)、HbA1c水平(OR=1.756,95%CI:1.261~2.445,P=0.008)是EH患者心脏舒张功能障碍的独立危险因素。结论:糖代谢异常通过加剧动脉硬化及心脏舒张早期功能障碍,以加重EH患者的心血管系统功能异常,改善EH患者的糖代谢状态有助于降低其心血管疾病的危险。Objective： To explore the influence o[ impalreCl glucose lll~：tdt）Ull^li patients with essential hypertension （EHS. Methods： A total of 46 pure EH patients and 36 EH ＋ type 2 diabetes mellitus （T2DM） patients were selected. Levels of blood glucose, blood lipids, serum uric acid （UA）, fibrinogen （Fb）, serum homocysteine （Hey） and urinary microalbumin were measured, and patients received 24h ambulatory blood pressure monitoring （ABPM） and color Doppler echocardiography. Clinic indexes, ambulatory blood pressure parameters and incidence rate of cardiac diastolic dysfunction were compared and analyzed between two groups. Cardiac diastolic dysfunction was regarded as a binary dependent variable, and it underwent multi-factor gradual binary regression analysis. Results： Body mass index （BMI）, blood glucose, blood lipids （except high density lipopro- tein cholesterol, apoprotein AD, UA, Fb, serum Hey and urinary microalbumin levels in EH ＋T2DM group were significantly higher than those of pure EH group （P〈0.05 or P〈0.01）, and their 24h mean systolic blood pressure （24hSBP）, daytime mean SBP （dSBP）, 24h mean pulse pressure （24hPP） and daytime mean PP （dPP） were significantly higher than those of pure EH patients （P^0.05 orP〈 o. 015. Left ventricular ejection fraction （LVEF） of both groups was 40%, and incidence rate of cardiac diastolic dysfunction in EH ＋ T2DM group （72.2%） was significantly higher than that of pure EH group （45, 7% ）, P = 0. 016, Binary Logistic regression analysis indicated thatage （OR=1.160, 95%CI.. 1. 002~1. 342,P=0.0125, DM （OR=3.095, 95%CI： 1.056-9.079, P= 0. 0295 and glycosylated hemoglobin （HbAlc, OR=1. 756, 95%CI： 1. 261-2.445, P=0. 0085 were independent risk factors for cardiac diastolic dysfunction in EH patients. Conclusion： Impaired glucose metabolism aggravates cardiovascular system dysfunction in patients with essential hypertension through aggravating atherosclerosis and cardiac early

关 键 词：葡萄糖代谢障碍 高血压 心血管系统 

分 类 号：R544.109[医药卫生—心血管疾病]