血管回声跟踪技术评价血压对血管内皮功能的影响

摘要

目的 应用血管回声跟踪(ET)技术评价血压对血管内皮功能的影响.方法 选择高血压组(HP)30例、正常高值血压组(HN)30例和正常血压对照组(NC)30例,常规二维超声测量颈动脉内膜中层厚度(IMT)和应用ET技术检测颈动脉弹性(Eρ、β、AC、AI、PWVβ),并进行统计学分析.结果 随着血压的升高,IMT、Eρ、β、AI、PWVβ升高而AC值降低,排除混杂因素之前,各硬化参数在HN和NC组、HP和NC组、HP和HN组间的差异均有统计学意义,排除混杂因素之后,HN和NC组间仅PWVβ有统计学意义,HP和NC组、HP和HN间各参数比较仍有显著性差异,其中收缩压对IMT、Eρ、AC、AI、PWVβ有显著影响,舒张压对AI有显著影响,脉压差对Eρ、β显著影响.结论 正常高值血压对血管并没有明显影响,高血压早期血压本身才是血管内皮功能损伤的独立危险因素；在动脉硬化早期,收缩压对血管内皮功能影响最明显,其次为脉压差和舒张压.%Objective To evaluate the effect of blood pressure on vascular endothelial function using echo-tracking (ET) technology. Methods Thirty hypertensive (HP) patients, 30 subjects with high normal blood pressure (HN), and 30 normotensive control (NC) subjects were enrolled in this study. For each subject, conventional two-dimensional ultrasound was performed to measure the intima-media thickness (IMT), and an ET system was utilized to assess the carotid elasticity (Ep, β, AC, AI, and PWVβ). Results As the blood pressure increased, IMT, Ep, β, AI, and PWVβ values all increased and AC value decreased. Before excluding the confounding factors, the difference in IMT, Ep, β, AC, AI, and PWVβ values were significant between the 3 groups. After excluding the confounding factors, only PWVβ value was significantly different between HN group and NC group; but between HP and NC group and between HP and HN group, the other parameters still showed significant differences. Systolic blood pressure had significant influences on IMT, Ep, AC, AI, and PWVp values, diastolic blood pressure significantly affected AI value, and pulse pressure significantly affected Ep and (3 values. Conclusion High normal blood pressure has no obvious effects on vascular function, and blood pressure is an independent risk factor of vascular endothelial dysfunction only in the stage of early hypertention. In early atherosclerosis, systolic blood pressure is the most significant factors affecting vascular endothelial function, followed by pulse pressure and diastolic blood pressure.