老年男性高血压患者降压治疗后血压变异性与心室重构的相关性研究

摘要

Objective To explore the relationship between insulin resistance ( IR ), inflammation factors and carotid atherosclerosis in elderly hypertensive patients with different glucose tolerance. Methods 94 elderly hypertensive patients were examined for fasting and 2 — hour postprandial plasma glucose by the 75g OGTT test. According to the test,94 patients were divided into three groups,30 patients in normal glucose tolerance ( NOT) group,32 ones in impaired glucose tolerance ( IGT ) group, and 32 ones in diabetes meflitns ( DM ) group. In addition, there was 30 healthy people in normal control group. All patients underwent carotid ultrasound intima — media thickness ( IMT ). The level of fasting plasma glucose,fasting insulin,blood lipids,hs-CRP and TNF-α were analyzed,respectively. Ho-meostasis model assessment ( HOMA ) index was used for quantitative analysis of insulin resistance index ( HOMA-IR ). Results The level of HOMA-IR ,hs-CRP,TNF-α and IMT in DM group were significantly higher than those in other three groups,which in IGT group were significantly higher than those in NOT group or control group, and those in NOT group were significantly higher than those in control group. The differences among them were statistically significant ( P ＜0. 01 ). Correlation analysis result showed that IMT was positively correlated with the level of IRI, hs-CRP or TNF-α ( r = 0.406,0. 420 and 0. 396 ,P ＜0. 05 ). Conclusion Insulin resistance and inflammatory activity is found in elderly hypertensive patients. The levels of HOMA-IR, hs-CRP and TNF-α arc; closely correlated with carotid IMT in elderly hypertensive patients.%目的 探讨老年男性高血压患者降压治疗后动态血压变异性与心室重构的关系.方法入选老年男性原发性高血压患者212例(高血压组),均单用长效钙通道阻滞剂降压治疗超过1年,行动态血压监测(ABPM),根据24h收缩压平均实际变异性(24 hSBP AVR)的第50百分位数(P50)将高血压组分为两组:高AVR组(AVR≥10.17 mmHg)和低AVR组(AVR<10.17 mmHg),各106例.另入选48例同期年龄相匹配的非高血压老年男性患者为对照组.测定入选患者所有血压水平、24 hSBP AVR等血压变异性指标及舒张期室间隔厚度(IVST)、舒张期左心室后壁厚度(LVPWT)、左心室舒张末内径(LVEDd),计算左心室质量指数(LVMI),比较各组差异.结果 与对照组比较,高血压组24 h、日间及夜间平均收缩压,24 hSBP AVR值均高于对照组(P<0.05),高AVR组IVST及IVEDd高于低AVR组(P<0.05).相关分析显示,LVMI与24 hSBP(r=0.361,P<0.05)及24 hSBP AVR(r=0.210,P<0.05)呈正相关.结论 老年男性原发性高血压患者降压治疗后收缩压水平及收缩压变异性与左心室重构有关.