原发性高血压患者血管内皮功能障碍的危险因素分析

发布时间：2018-01-27 11:25

本文关键词： 高血压血管内皮功能动脉粥样硬化影响因素相关分析　出处：《山西医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:近年来对血管内皮功能障碍与AS的关系,以及致血管内皮功能障碍的危险因素的研究成为热点,研究发现血管内皮功能障碍是AS最早期的病理生理变化,在血管硬化与斑块产生,及出现多器官并发症的过程中占有重要地位,许多已知或未明确的致AS改变的危险因素与内皮功能异常有一定的关联。本实验旨在对几种心血管危险因素和代谢因素与原发性高血压患者血管内皮功能异常之间的关系进行相关分析,探讨影响原发性高血压患(EH)者内皮功能的因素,为这些原发性高血压患者动脉粥样硬化性心血管疾病的预防提供依据。方法:择取2014年8月—2015年10月在山大一院高血压病房住院的诊断为原发性高血压的病人496例,利用高频线阵探头对肱动脉进行扫描,测量身体静息状况下、驱血充血后的血管直径,计算肱动脉血流介导的血管舒张功能(FMD),按FMD值大小将EH病人分成三组,对所有的血管危险因素和代谢因素先进行单因素分析,分别比较各组间不同血管危险因素情况,对筛选出来的数种有价值的成份再行多重线性回归分析进一步比较与FMD的相关性。结果:1.单因素分析结果:高血压病史、降压药物服用史、吸烟史、年龄、SBP、DBP、血糖、总胆固醇、HDL-C、LDL-C、Hcy、超敏C反应蛋白、FIB在各组间比较差别有统计学意义(P0.05)。2.直线线性回归分析结果:FMD与年龄(r=-0.407,P0.001)、收缩压(r=-0.423,P0.001)、舒张压(r=-0.117,P=0.009)、血糖(r=-0.240,P0.001)、总胆固醇(r=-0.186,P0.001)、甘油三酯(r=-0.121,P=0.007)、低密度脂蛋白胆固醇酯(r=-0.113,P=0.012)、载脂蛋白B(r=-0.133,P=0.03)、脂蛋白α(r=-0.134,P=0.003)、磷脂(r=-0.099,P=0.028)、尿酸(r=-0.112,P=0.013)、血同型半胱氨酸(r=-0.118,P=0.009)、超敏C反应蛋白(r=-0.241,P0.001)、血浆纤维蛋白原(r=-0.268,P0.001)负相关,与高密度脂蛋白胆固醇酯(r=-0.137,P=0.002)、载脂蛋白A(r=-0.134,P=0.003)正相关。3.多重线性回归分析结果:吸烟(Β=-0.397,P0.001)、收缩压(Β=-0.361,P0.001)、年龄(Β=-0.361,P0.001)、总胆固醇(Β=-0.302,P0.001)、LDL-C(Β=-0.206,P=0.003)、hsCRP(Β=-0.137,P0.001)、空腹血糖(Β=-0.128,P0.001)、Hcy(Β=-0.104,P=0.004)与FMD存在独立相关性,且相关程度逐渐降低。结论:吸烟、年龄、SBP、总胆固醇、LDL-C、hs CRP、空腹血糖、Hcy是原发性高血压患者血管内皮功能异常的独立危险因素。既往高血压病史的存在可加重血管内皮功能异常,既往降压药物的使用可改善血管内皮功能。上述危险指标可诱发或促进血管内皮损伤,使血管硬化及斑块生成。血管内皮功能障碍可能与其致AS的机制有关。临床上应对这些危险指标进行早期干预,以达到预防和减缓原发性高血压病人AS及ASCVD发生发展的目的。
[Abstract]:Objective: in recent years, the research on the relationship between vascular endothelial dysfunction and as, and the risk factors of vascular endothelial dysfunction has become a hot topic. It is found that vascular endothelial dysfunction is the earliest pathophysiological change of as and plays an important role in the process of vascular sclerosis plaque formation and multiple organ complications. Many known or undefined risk factors for atherosclerosis are associated with endothelial dysfunction. This study was designed to investigate several cardiovascular risk factors and metabolic factors associated with vascular endothelial dysfunction in patients with essential hypertension. The relationship between the two groups was analyzed. Objective: to investigate the factors affecting endothelial function in patients with essential hypertension (EH). To provide evidence for the prevention of atherosclerotic cardiovascular disease in patients with essential hypertension. Methods:. A total of 496 patients diagnosed as essential hypertension were selected from August 2014 to October 2015 in the hypertension ward of the first Hospital of Shanshan University. The brachial artery was scanned with a high frequency linear array probe. The diameter of the blood vessel after ejection was measured and the vasodilation function mediated by the brachial artery blood flow was calculated. EH patients were divided into three groups according to the value of FMD. All vascular risk factors and metabolic factors were analyzed by univariate analysis. Multiple linear regression analysis was performed to compare the correlation with FMD. Results: 1. Single factor analysis: history of hypertension, history of taking antihypertensive drugs, history of smoking. Age: SBP, DBP, blood glucose, total cholesterol, HDL-C, LDL-C, hypersensitive C-reactive protein. The difference of FIB among the groups was statistically significant (P 0.05). The results of linear regression analysis were as follows: 1: FMD and age: r = -0.407 (P 0.001). The results showed that the systolic blood pressure was 0. 423 (P 0.001), the diastolic blood pressure was 0. 117 ~ 0. 117 / P ~ (0.009), and the blood glucose was 0. 240 ~ 0. 240 / P ~ (0.001)). Total cholesterol r-0.186U P0.001C, triglyceride r-0.121g, low density lipoprotein cholesterol triglyceride r-0.113. P0. 012, apolipoprotein Bnr-0. 133, P0. 03, lipoprotein 伪-r-0.134, P0. 003, phospholipid r-0. 099. The results were as follows: (P < 0.05), the serum homocysteine (rhomocysteine) was 0.118 (P _ (0.009)), the serum homocysteine was (0.028), the uric acid was (0.112) (P ~ ((0.013))). There was a negative correlation between the hypersensitive C-reactive protein and the plasma fibrinogen (r-0.268, P0.001). With high density lipoprotein cholesterol ester r-0.137, apolipoprotein apolipoprotein A r-0.134. The results of multiple linear regression analysis showed that smoking (尾 -0.397) and systolic blood pressure (尾 -0.361g / P 0.001) were positive correlation. Age (尾 -0.361), total cholesterol (尾 -0.302), LDL-C (尾 -0.206). HsCRP (尾 -0.137) P 0.001g, fasting blood glucose (尾 -0.128N) P 0.001 (尾 -0.104). Conclusion: smoking, age, total cholesterol, LDL-Chs, fasting blood glucose were independent correlation between P0. 004) and FMD. Hcy is an independent risk factor for vascular endothelial dysfunction in patients with essential hypertension. The use of antihypertensive drugs can improve vascular endothelial function. The above risk indicators can induce or promote vascular endothelial injury. Vascular sclerosis and plaque formation. Vascular endothelial dysfunction may be related to the mechanism of atherosclerosis. Early intervention of these risk indicators should be carried out clinically. In order to prevent and slow down the occurrence and development of as and ASCVD in patients with essential hypertension.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R544.11

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