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目的了解80岁以上老老年高血压患者的动脉缓冲功能和内皮调节功能变化。方法采用高分辨率超声检测单纯收缩期高血压(ISH)和非单纯收缩期高血压(NISH,指收缩压与舒张压都升高)各10例患者在静息状态下的肱动脉横断面顺应性(CSC)、容积扩张性(VD),以及反应性充血时和舌下含服硝酸甘油后的内皮依赖性血管功能(FMD)和非内皮依赖性血管功能(NID),用于评估动脉的缓冲功能和内皮调节功能,并检测心脏功能。结果NISH组肱动脉横断面顺应性(CSC)、肱动脉容积扩张性(VD)均明显高于ISH组,差异有显著性(P=0·046,P<0·01),而动脉硬化指数(β)则明显小于ISH组,差异有显著性(P<0·01);在反应性充血状态下NISH组内皮依赖性血管舒张功能(FMD)亦明显高于ISH组(P=0·014)。左室后壁收缩期厚度(LPWS)NISH组则明显小于ISH组(P=0·031)。多因素分析结果FMD、β是与肱动脉容积扩张性(VD)关系最为密切的参数。结论两组患者动脉的缓冲功能和内皮调节功能均降低,同时ISH组患者动脉的缓冲功能和内皮调节功能明显低于NISH组患者。
Objective To understand the changes of arterial buffering function and endothelial function in elderly hypertensive patients over 80 years old. Methods High-resolution ultrasonography was used to measure the brachial artery cross-section compliance at rest in 10 patients with isolated systolic hypertension (ISH) and non-isolated systolic hypertension (NISH, both elevated systolic and diastolic pressures) (CSC), volume expansibility (VD), and endothelium-dependent vascular function (FMD) and non-endothelium-dependent vascular function (NID) after reactive hyperemia and sublingual nitroglycerin were used to assess arterial Buffering function and endothelial function, and testing heart function. Results The cross-sectional compliance of brachial artery (CSC) and brachial artery volume expansion (VD) in NISH group were significantly higher than those in ISH group (P = 0.046, P <0.01) (β) was significantly lower than that of ISH group (P <0.01). Endothelium-dependent vasodilation (FMD) in NISH group was also significantly higher than that of ISH group in reactive hyperemia (P = 0.014) ). Left ventricular posterior wall systolic thickness (LPWS) NISH group was significantly less than the ISH group (P = 0 · 031). Multivariate analysis of the results FMD, β and brachial artery volume expansion (VD) the most closely related parameters. Conclusion The arterial cushion function and endothelial function in both groups were decreased. In the meantime, the arterial cushion function and endothelial function in ISH group were significantly lower than those in NISH group.