原发性高血压患者不同盐敏感风险分层血流介导血管舒张功能的比较

Comparison of flow-mediated vasodilation in different salt-sensitivity risk stratification in essential hypertensive patients

关键词:  盐敏感性风险分层  动态血压监测  血流介导血管舒张功能  原发性高血压

Key words:  salt-sensitivity risk stratification  ambulatory blood pressure monitoring  flow-mediated vasodilation  essential hypertension

摘要:

目的　探讨原发性高血压患者不同盐敏感风险分层组血流介导的血管舒张功能（FMD）的变化。方法　选择2017年2月至8月，大连医科大学附属第一医院高血压科住院的原发性高血压患者171例，根据动态血压中的24小时平均心率（24hHR）与夜间平均动脉压下降率（MAPNF），将患者分为盐敏感低风险组（24hHR ≤70次/min且MAP_NF> 10%）、中风险组（24hHR > 70次/min，MAP_NF> 10%；或24hHR ≤ 70次/min，MAP_NF≤ 10%）及高风险组（24hHR > 70次/min且MAP_NF≤ 10%），比较各组间临床基本特征及FMD，探讨FMD与各因素的相关性。结果　高风险组体质量指数（BMI）、24hHR显著高于低风险组与中风险组（均P＜0.05），低密度脂蛋白胆固醇（LDL-C）显著高于中风险组，而MAPNF显著低于中风险组与低风险组（均P＜0.05）；中风险组24hHR显著高于低风险组（P＜0.05），而MAP_NF显著低于低风险组（P＜0.05）。高风险组FMD显著低于中风险组与低风险组（均P＜0.05）；而中风险组FMD与低风险组无统计学差异（P＞0.05）。FMD与24hHR呈负相关（β=-0.170，P=0.044），与MAP_NF呈正相关（β=0.223，P=0.007）；而与BMI、LDL-C无相关性（P＞0.05）。 结论　高血压患者盐敏感性可能与血管内皮功能相关。

Abstract:

Objective To investigate the changes of flow-mediated vasodilation (FMD) in different salt-sensitivity risk stratification in essential hypertensive (EH) patients. Methods Totally 171 hospitalized EH patients were recruited. All participants received ambulatory blood pressure monitoring (ABPM). According to the 24-h mean heart rate (24hHR) and nocturnal fall of mean arterial pressure (MAP_NF) gained from ABPM, participants were divided into salt-sensitivity low risk group (24hHR≤70 bpm, MAP_NF>10%， LRG, n=33), intermediate risk group (24hHR>70 bpm, MAP_NF>10%， or 24hHR ≤ 70 bpm, MAP_NF≤ 10%, IRG, n=96) and high risk group (24hHR > 70 bpm, MAP_NF≤ 10%，HRG, n=42). Background clinical data and FMD were compared among groups. And the correlation between FMD and clinical features were analyzed. Results The body mass index (BMI), 24hHR of HRG were significantly higher than LRG and IRG (P＜0.05)，but the MAP_NFand FMD were significantly lower than LRG and IRG (P＜0.05). The BMI and 24hHR of IRG were significantly higher than IRG (P＜0.05), meanwhile, the MAP_NFand FMD were significantly lower than LRG (P＜0.05). Multiple linear regression analysis showed that FMD was negatively correlated with 24hHR (β=-0.170, P<0.05), but positively correlated with MAP_NF(β=0.223, P＜0.05). Conclusion Salt-sensitivity might be correlated with vascular endothelial function in hypertensive patients.