高醛固酮血症对血管内皮功能及动脉弹性的影响  

The effect of hyperaldosteronemia on endothelial function and arterial elasticity

作　　者：丁美琳[1] 贾敏[2] 陈龙[1] 苏晨[3] 刘星 陶军[1,3] 

机构地区：[1]中山大学附属第一医院老年病科,广东广州510080 [2]中山大学附属第一医院肾内科 [3]中山大学附属第一医院高血压血管病科 [4]中山大学附属第三医院心内科

出　　处：《中华高血压杂志》2017年第11期1050-1054,共5页Chinese Journal of Hypertension

基　　金：国家自然科学基金资助项目(81100201);广东省医学科学技术研究基金项目(C2015047)

摘　　要：目的通过对比研究原发性醛固酮增多症患者(PAs)与年龄、血压匹配的原发性高血压患者(EHs),探讨高醛固酮血症对血管内皮功能及动脉弹性的影响。方法入选20例PAs、20例年龄和血压匹配的EHs、20例年龄匹配的健康志愿者(HSs)。采用高分辨率血管超声方法检测肱动脉血流介导的内皮依赖性血管舒张功能(FMD);应用袖带震荡技术检测肱动脉与胫后动脉之间的肱踝动脉脉搏波传导速度(baPWV)。结果与HSs相比,PAs及EHs的FMD明显下降[(4.97±1.35)%,(6.80±1.19)%比(11.34±1.47)%],baPWV明显升高[(1982.6±306.7),(1678.5±268.3)比(1257.9±152.6)cm/s],差异有统计学意义(均P<0.05);与EHs比,PAs的FMD下降更明显[(4.97±1.35)%比(6.80±1.19)%],baPWV升高也更明显[(1982.6±306.7)比(1678.5±268.3)cm/s],差异有统计学意义(P<0.05)。PAs予螺内酯60~120 mg/d口服治疗4~6周后,FMD较治疗前明显升高[(9.03±1.64)%比(4.97±1.35)%],baPWV较治疗前明显下降[(1589.8±297.2)比(1982.6±306.7)cm/s],差异有统计学意义(P<0.05)。结论相同年龄和血压水平的PAs与EHs相比较,血管内皮功能损伤及动脉硬化程度更为严重,提示高醛固酮血症除了导致高血压外可能还具有额外的血管损伤作用。Objective To study the effect of hyperaldosteronemia on vascular endothelial function and arterial elas- ticity among patients with primary aldosteronism （PAs） and ageand blood pressure-matched patients with essential hypertension （EHs）. Methods Twenty PAs, 20 age- and blood pressure-matched EHs, and 20 age-matched healthy subjects （HSs） were recruited in this study. The flow-mediated dilation （FMD） of brachial artery was examined by high-resolution vascular ultrasound,and brachial-ankte pluse wave velocity （baPWV） was non-invasively detected using the automatic detector /VP 1000 ）. Results Compared with HSs, FMD was decreased[（ 4.97± 1.35））, （6. 804-1.19）% vs （11.34±1.47）G] and baPWV was increased [（1982.6±306.7）, （1678.5±268.3） vs （1257.9±152.6）cm/s] in PAs and EHs （all P^0.05）. And compared with EHs, FMD was decreased more ob- viously [（4. 97±1.35）% vs （6.80± 1.19）%] and baPWV was increased more obviously [（1982.6 ± 306.7） vs （1678.5±268.3）cm/s] in PAs （all P〈0.05）. After treatment with oral spironolactone （60--120） mg/d for 4-6 weeks, FMD was significantly increased [ （ 9.03 ±1.64 ） % vs （ 4.97 ±1.35 ） %] and baPWV was significantly decreased [（1589.8_297.2） vs （1982.6±306.7）cm/s] in PAs （all P〈0.05）. Conclusion PAs showed more serious vascular endothelial dysfunction and arteriosclerosis than age- and blood pressure-matched EHs, which suggested potential damage effect of hyperaldosteronemia on arterial wall in addition to elevating blood pressure. Keywords： aldosterone; atherosclerosis; endothelial function; arterial elasticity

关 键 词：醛固酮 动脉粥样硬化 血管内皮功能 动脉弹性 

分 类 号：R544.1[医药卫生—心血管疾病] R586.24[医药卫生—内科学]