老年原发性高血压并腹型肥胖患者胫前动脉血管内皮功能及相关因素  

Endothelial function of tibial artery and related factors in essential hypertensive patients with abdominal obesity in the elderly

作　　者：黄鹤龄[1,2] 沈逸华 蔡晓琪 张玲玉[1,3] 谢良地[1,2,3] HUANG He-ling;SHEN Yi-hua;CAI Xiao-qi;ZHANG Ling-yu;XIE Liang-di(Department of Geriatrics,The First Affiliated Hospital of Fujian Medical University;Fujian Hypertension Research Institute,Fuzhou Fujian 350005,China;不详)

机构地区：[1]福建医科大学附属第一医院老年医学科,福建福州350005 [2]福建省高血压研究所 [3]福建医科大学附属第一医院全科医学科

出　　处：《中华高血压杂志》2020年第5期445-449,共5页Chinese Journal of Hypertension

摘　　要：目的探索老年原发性高血压并腹型肥胖患者血管内皮功能及相关因素。方法收集2000年8月至2016年5月在福建医科大学附属第一医院老年医学科和全科医学科门诊及病房的老年(年龄≥60岁)原发性高血压患者658例及正常血压的老年人64名的临床资料,高分辨率血管彩色多普勒超声测定反应性充血前后胫前动脉内径的变化率,作为内皮依赖性舒张功能(EDD)的指标。根据是否高血压(血压≥140/90 mm Hg)及腹型肥胖[腰围≥90(男)、≥85 cm(女)]按2×2设计将参与者分为4组:正常血压非腹型肥胖(n=34)、正常血压并腹型肥胖组(n=30)、高血压非腹型肥胖组(n=287)、高血压并腹型肥胖组(n=371),比较各组EDD,采用Pearson相关分析、析因分析和多元线性回归分析胫前动脉EDD的相关因素。结果析因分析显示,高血压和腹型肥胖均为影响EDD的因素,但两者无交互作用。从正常血压非腹型肥胖、正常血压并腹型肥胖、高血压非腹型肥胖到高血压并腹型肥胖组,EDD有逐渐下降的趋势[(9.37±1.11)%比(8.59±0.99)%比(7.70±0.30)%比(6.75±0.26)%,P<0.05]。在老年高血压并腹型肥胖的患者中,胫前动脉EDD与腰围(r=-0.139,P<0.05)、收缩压(r=-0.245,P<0.05)、脉压(r=-0.287,P<0.05)、空腹血糖(r=-0.131,P<0.05)呈负相关;多元线性逐步回归分析显示,脉压(β=-0.280,P<0.001)、腰围(β=-0.141,P=0.009)是胫前动脉EDD的相关因素。结论老年高血压合并腹型肥胖患者的胫前动脉EDD受损明显,EDD与脉压、腰围相关。Objective To investigate the endothelial function of artery and the related factors in the elderly patients with both essential hypertension and abdominal obesity.Methods A total of 658 elderly patients(≥60 years old)with essential hypertension and 64 elderly subjects without clinical evidence of hypertension were recruited from the department of geriatrics and the department of general medicine from August 2000 to May 2016.The dilatation of anterior tibial artery induced by reactive hyperemia was examined by high-resolution vascular ultrasound,and was then defined as endothelium-dependent dilatation(EDD).All the participants were divided into four groups based on blood pressure(≥140/90 mm Hg was defined as hypertension)and waist circumference(male≥90,female≥85 cm was defined as abdominal obesity):normotensive without abdominal obestiy,normotensive with abdominal obesity,hypertensive without abdominal obesity,hypertensive with abdominal obesity.Pearson correlation analysis,factorial analysis and multiple linear regression analysis were undertaken to examine the related factors of EDD.Results Factorial analysis showed that hypertension and abodominal obesity were influence factors of EDD,but there are no interaction between them.From normotensive without abdominal obestiy,normotensive with abdominal obesity,hypertensive without abdominal obesity,to hypertensive with abdominal obesity,a gradual decline in EDD was observed[(9.37±1.11)%vs(8.59±0.99)%vs(7.70±0.30)%vs(6.75±0.26)%,P<0.05].In elderly hypertensive patients with abdominal obesity,EDD correlated with waist circumference(r=-0.139,P<0.05),systolic blood pressure(r=-0.245,P<0.05),pulse pressure(r=-0.287,P<0.05),fasting glucose level(r=-0.131,P<0.05).Multivariate linear regression analysis revealed that EDD was associated with pulse pressure(β=-0.280,P<0.001)and waist circumference(β=-0.141,P=0.009).Conclusion In elderly patients with essential hypertension and central obesity,EDD is impaired,and it is negatively correlated with pulse pressure and

关 键 词：原发性高血压 内皮依赖性舒张 胫前动脉 腹型肥胖 脉压 老年 

分 类 号：R544.11[医药卫生—心血管疾病] R589.2[医药卫生—内科学]