老年原发性高血压合并2型糖尿病患者的肱动脉内皮依赖性舒张功能与血清胆红素有关  

Endothelial-dependent vasodilatation of brachial artery is related to bilirubin in elderly hypertensive patients with diabetes mellitus

作　　者：方娟娟[1,2] 张玲玉[1] 沈逸华[1] 谢良地[1] 

机构地区：[1]福建医科大学附属第一医院福建省高血压研究所,福建福州350005 [2]福建医科大学附属福州市第一医院

出　　处：《中华高血压杂志》2015年第6期537-542,共6页Chinese Journal of Hypertension

基　　金：福建医科大学临床重点学科(高血压学)经费资助(XK201107)

摘　　要：目的探讨老年原发性高血压(EH)合并2型糖尿病(T2DM)患者的肱动脉内皮依赖性舒张功能(BA-EDD)与血清胆红素的关系。方法选择EH和(或)T2DM患者共251例,分为EH(n=123)、T2DM(DM,n=43)、EH+T2DM组(EHDM,n=85),选择同期血压血糖正常者作为对照组(n=66)。所有受试者测量身高、体质量、血压,测定间接胆红素(IBIL)等生化指标。采用高分辨率血管超声多普勒测定静息状态下肱动脉(BA)内径,作为内径基础值(D0);反应性充血前后肱动脉内径的变化率作为BA-EDD。结果EHDM和EH组的BAD0较对照组大[(0.44±0.09),(0.43±0.08)比(0.40±0.07)cm],BA-EDD较对照组小[(9.14±4.85)%,(11.14±5.90)%比(13.15±6.35)%,均P<0.05],且BA-EDD在对照组、EH组、EHDM组有逐渐降低趋势(P<0.05)。多元逐步回归分析显示,BAD0是BA-EDD的影响因素,仅在≥60岁的EH合并T2DM患者中,IBIL是BA-EDD的影响因素,IBIL每升高10μmol/L,BA-EDD增加6.04%。结论 EH患者合并T2DM后加重肱动脉BA-EDD的损害。BAD0是BA-EDD的影响因素。在≥60岁的EH合并T2DM患者中,IBIL是BA-EDD的保护因素。Objective To investigate the relationship between endothelial-dependent vasodilatation of brachial artery （BA-EDD） and serum bilirubin in elderly essential hypertensive （EH） patients with type 2 diabetes mellitus （T2DM）. Methods A total of 251 patients with EH and/or T2DM were divided into EH group （EH, n= 123）, T2DM group （DM, n=43） and EH with T2DM group （EHDM, n=85）. Sixty-six subjects with normal blood pressure and fasting blood glucose were served as controls （normal group, N group）. All participants＂ height, body weight, blood pressure and plasma biochemical indexes, including serum indirect bilirubin （IBIL） were recorded. The vessel resting diameter （D0 ） was examined by high-resolution ultrasound. The change rate of brachial artery （BA） diameter, induced by reactive hyperemia,was used to determine the endothelium-dependent dilation （EDD）. Results Compared to N group, EHDM and EH group had larger BADo[（0.44±0.09）, （0.43±0.08） vs （0.40± 0.07）cm], and lower BA-EDD[（9.14±4.85）%, （11.14±5.90）% vs （13.15±6.35）%] （all P〈0.05）, which showed a trend of gradual decrease in N, EH and EHDM group （P〈0.05）. Stepwise multiple regression analysis showed that BADo was a critical influence on BA-EDD, and IBIL only affected BA-EDD in EHDM patients ≥60 years old. The concentration of IBIL increased by 10 μmol/L, BA-EDD increased by 6.04%. Conclusion Endo- thelial function was more severely impaired in EH patients with T2DM. BAD0 is a critical influence on BA-EDD, while IBIL is a protective factor for BA-EDD in ≥60 years old EH patients with T2DM.

关 键 词：原发性高血压 2型糖尿病 内皮依赖性舒张 胆红素 

分 类 号：R544.1[医药卫生—心血管疾病]