不同危险分层原发性高血压病患者甲襞微循环改变∗

摘要

目的：：观察原发性高血压病不同危险分层患者甲襞微循环变化。方法：115例原发性高血压病患者，根据心血管危险分层分为低危组(n=7)、中危组(n=28)、高危组(n=34)和极高危组(n=46)，以同期20例年龄、性别匹配的健康志愿者为健康对照组。采用 ZL-104型微循环检测仪和微循环图像分析系统检测各组甲襞微血管视野清晰度、管袢长度、管袢数、畸形管袢数、交叉管袢数、输入支管径、输出支管径、袢顶直径、血流速度、红细胞聚集程度、白细胞数、白微栓、袢周渗出、出血、甲襞微血管乳头及乳头下静脉丛的统计学差异。结果：低危组甲襞微循环各项指标与健康对照组比较均无统计学差异(P >0.05)，中危组到极高危组甲襞微循环渐次出现明显的形态、流态和袢周状态的变化，且与低危组差异均有统计学意义(P <0.05)。形态上主要表现为：视野清晰度变差、微循环管袢数减少、畸形管袢数占比增加、输入支管径变细；流态上主要表现为：微血管内血流速度减慢、红细胞聚集增多；在袢周状态上主要表现为：微血管袢周渗出增多。且有高血压危险分层越高，上述改变越严重的趋势。结论：高血压病患者出现与危险分层相关的甲襞微循环改变。甲襞微循环变化对高血压病患者病情评估、治疗与预后判断有重要临床意义。%Objective:To investigate the alteration of nailfold microcirculation in essential hypertensive pa-tients with different risk stratification.Method:According to the criteria of cardiovascular risk stratification,1 1 5 essential hypertensive patients were divided into low-risk,moderate-risk,high-risk and very high-risk groups. Twenty age- and gender-matched healthy volunteers were also included as healthy control group.Capillaroscope (ZL-104)and image analysis software were used to monitor and analyze the paramiters as follows:vision clarity of microcirculation,number of capillary loops,the ratio of abnormal capillary loops/total loops,the ratio of crossed capillary loops/total loops,the diameter of input and output branch,the ratio of the of output branch to input branch diameter,the length of capillary loop,blood flow velocity,erythrocyte aggregation degree,the number of leukocytes,microthrombus,vasomotor,perivascular infiltration,bleeding,papillae of nailfold microcirculation and subpapillary venous plexus.The statistically differences of the paramiters above were analyzed.Results:There were no significant differences in paramiters above between low-risk and healthy control group in nailfold microcircula-tion.Patients in moderate-risk,high-risk and very high-risk groups were found significant changes in morphology, flow pattern,perivascular status in nailfold microcirculation.The morphological alteration mainly showed as poor vision clarity,decreased capillary loops,increased abnormal capillary loops/total loops ratio and narrowed input branch.The main changes in blood flow showd a lowed blood flow velocity and erythrocytes aggregation.The alter-ation in perivascular status mainly showed increased permeability.Conclusion:The essential hypertensive patients shew risk stratification-related alterations in nailfold microcirculation,which had clinical significance in evaluating the progress,clinical medication,and judging prognosis in patients with essential hypertension.