腹型肥胖对不同性别老年原发性高血压患者胫前动脉血管内皮功能的影响  

The influence of abdominal obesity on endothelial function of tibial artery in the elderly essential hypertensives of different gender

作　　者：蔡晓琪[1,2,3] 黄鹤龄 沈逸华[2,3] 张玲玉 徐国焱 林沁[2,4] 谢良地[1,2,3] CAI Xiao-qi;HUANG He-ling;SHEN Yi-hua;ZHANG Ling-yu;XU Guo-yan;LIN Qin;XIE Liang-di(Department of Geriatrics,Department of General Medicine,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 [4]厦门大学附属翔安医院肾内科

出　　处：《中华高血压杂志》2020年第10期947-952,共6页Chinese Journal of Hypertension

摘　　要：目的探究腹型肥胖对不同性别老年原发性高血压(EH)患者胫前动脉血管内皮功能的影响。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及全科医学科门诊及病房就诊的老年(年龄≥60岁)EH患者658例及正常血压老年人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(男性腰围≥90 cm、女性腰围≥85 cm)将研究对象分为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)。结果从正常血压非腹型肥胖者、正常血压并腹型肥胖者、高血压非腹型肥胖者到高血压并腹型肥胖者,胫前动脉EDD呈递减趋势[(9.37±1.11)%比(8.59±0.99)%比(7.70±0.30)%比(6.75±0.26)%,P<0.05]。总体上老年男性与女性EH患者的EDD差异无统计学意义。分层分析发现,无论是否合并腹型肥胖,男性与女性老年EH患者之间EDD差异无统计学意义。进一步分层分析显示,在老年男性EH患者中,与非腹型肥胖相比,腹型肥胖患者的EDD受损更明显[(6.31±0.38)%比(7.46±0.38)%,P<0.05]。而非腹型肥胖与腹型肥胖的老年女性EH患者的EDD差异无统计学意义。相关分析提示老年男性EH患者胫前动脉EDD与腰围呈负相关(r=-0.194,P<0.05),但在女性中二者无明显相关。多元逐步回归分析显示,腰围是老年男性EH患者的相关因素(β=-0.161,P<0.05),不是老年女性EH患者的相关因素。结论腰围是老年男性EH患者胫前动脉EDD的相关因素,腹型肥胖对老年女性EH患者的胫前动脉EDD影响不明显。Objective To investigate the relationship between abdominal obesity and endothelial function of tibial artery in the elderly essential hypertensives of different gender.Methods A total of 658 elderly patients(≥60 years old)with essential hypertension(EH)and 64 elderly subjects without clinical evidence of hypertension were recruited from the department of geriatrics from August 2000 to May 2016.The dilatation of anterior tibial artery(TA)induced by reactive hyperemia was examined by high-resolution vascular ultrasound,and was defined as endothelium-dependent dilatation(EDD).All the participants were divided into four groups based on blood pressure(≥140/90 mm Hg)and waist circumference(male≥90 cm,female≥85 cm):normotensive without abdominal obesity(n=34),normotensive with abdominal obesity(n=30),hypertensive without abdominal obesity(n=287)and hypertensive with abdominal obesity(n=371).Results 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]from normotensive without abdominal obesity,normotensive with abdominal obesity,hypertensive without abdominal obesity to hypertensive with abdominal obesity.There was no significant difference in EDD between the male and female elderly hypertensives with or without abdominal obesity.In male elderly hypertensives,EDD in those with central obesity was more blunted compared with those without central obesity[(6.31±0.38)%vs(7.46±0.38)%,P<0.05].Whereas,in female elderly hypertensives,EDD in those with abdominal obesity was similar to those without abdominal obesity.In male elderly hypertensives,EDD was correlated with waist circumference(r=-0.194,P<0.05),such association was not shown in female.Multivariate linear regression analysis revealed that waist circumference was associated with EDD(β=-0.161,P<0.05)in the male elderly hypertensives,but not in female.Conclusions Waist circumference may be an influencing factor of EDD in the male elderly EH patients,abdominal obesity do not aggravate impairment of EDD of tibia

关 键 词：原发性高血压 内皮依赖性舒张 胫前动脉 腹型肥胖 性别 老年 

分 类 号：R544.1[医药卫生—心血管疾病]