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目的探讨高血压昼夜节律与血浆一氧化氮(NO)和内皮素(ET)及其与左心室肥大的关系。方法选择原发性高血压患者90例,根据24 h动态血压(24ABPM)检测结果将其分为血压昼夜节律正常组50例及血压昼夜节律消失组40例;另选血压正常者30例作为对照组。采用G riess法测NO,用放射免疫法测ET;采用PH ILIPS HD I 5000型彩色多普勒仪测定三组受试者的室间隔厚度(IVS),左室舒张末期内径(LVDd)、左室后壁厚度(LVPW)、左心室重量(LVM),以>215 g为左心室肥大的诊断标准。结果血压昼夜节律消失组与血压昼夜节律正常组比较,ET、IVS、LVPW、LVDd、和LVM均显著增高,NO、ET、NO/ET明显降低(P<0.05)。夜间血压下降率与NO、NO/ET呈正相关(r=0.467,0.267,0.713,P<0.05),与ET、IVS、LVPW、LVDd和LVM呈负相关(r=-0.761~-0.264,P<0.05)。结论NO和ET水平可能参与昼夜血压节律的调节,ET升高与血压昼夜节律消失有关,并加重左心室肥大。
Objective To investigate the relationship between circadian rhythm of hypertension and plasma levels of nitric oxide (NO), endothelin (ET) and left ventricular hypertrophy. Methods Ninety patients with essential hypertension were divided into two groups according to 24-hour ambulatory blood pressure (24ABPM) test: 50 cases of normal circadian rhythm group and 40 cases of disappearance of circadian rhythm; and 30 cases of normal blood pressure as control group. The NO was determined by Giefer’s method and the ET was measured by radioimmunoassay. IVS, LVDd, left ventricular diastolic dimension (LVDd) were measured by PH ILIPS HD I 5000 color Doppler, The posterior wall thickness (LVPW), left ventricular mass (LVM),> 215 g for the diagnosis of left ventricular hypertrophy. Results The levels of ET, IVS, LVPW, LVDd and LVM were significantly higher in patients with disappearance of circadian rhythm than in those with normal circadian rhythm. The levels of NO, ET and NO / ET were significantly decreased (P <0.05). The rate of nocturnal decline in blood pressure was positively correlated with NO and NO / ET (r = 0.467,0.267,0.713, P <0.05), and negatively correlated with ET, IVS, LVPW, LVDd and LVM (r = -0.761-0.264, P < 0.05). Conclusions The levels of NO and ET may be involved in the regulation of diurnal blood pressure rhythm. The elevation of ET is related to the disappearance of circadian rhythm of blood pressure and aggravate left ventricular hypertrophy.