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目的探讨高血压合并左心室肥厚(LVH)患者的血流介导的内皮依赖性血管舒张功能(FMD)与尿酸的关系。方法选择2006-08-2011-02福建医科大学附属第一医院门诊轻中、度高血压患者277例(包括未降压治疗和已接受降压治疗的患者),男159例,女118例,年龄(58.5±11.0)岁。根据左心室质量指数(LVMI)≥125(男)或≥110g/m2(女)分为高血压合并LVH组(LVH组,n=83)与高血压无LVH组(non-LVH组,n=194);选择同期未服用任何药物在我院门诊初诊的体检正常的非高血压患者41例作为对照组。采用超声心动图法测定LVMI;采用高分辨超声技术测定反应性充血前后肱动脉内径的变化率,作为肱动脉FMD。采用氧化酶法测定空腹尿酸。结果与对照组比较,non-LVH组和LVH组FMD均减退[(7.3±3.5)%,(5.7±2.2)%比(9.9±3.1)%,P<0.05],高尿酸血症(HUA)发生率明显升高(39.2%,40.1%比17.1%,P<0.05)。高血压患者中,HUA与尿酸正常患者比较,FMD减弱[(6.3±2.5)%比(7.1±3.6)%,P<0.05];进一步的亚组分析发现,non-LVH组HUA与尿酸正常者比较,FMD减弱[(6.5±1.9)%比(7.7±2.6)%,P<0.05],但LVH组HUA与尿酸正常患者的FMD差异无统计学意义。相关分析显示FMD与尿酸呈负相关(r=-0.18,P<0.05)。结论尿酸与血管内皮功能相关,已有LVH的高血压患者,尿酸对血管内皮功能进一步影响不明显。
Objective To investigate the relationship between blood flow-mediated endothelium-dependent vasodilation (FMD) and uric acid in hypertensive patients with left ventricular hypertrophy (LVH). Method Selection 2006-08-2011-02 First Affiliated Hospital of Fujian Medical University outpatient 277 cases of patients with mild to moderate hypertension (including not antihypertensive treatment and has been receiving antihypertensive treatment of patients), 159 males and 118 females, Age (58.5 ± 11.0) years old. Patients were divided into hypertension group (LVH group, n = 83) and hypertension group without LVH group (n = 0) according to the left ventricular mass index (LVMI) ≥125 (male) or ≥110g / 194). 41 patients with normal non-hypertensive patients who did not take any medications in our hospital during the same period were selected as the control group. The LVMI was measured by echocardiography. The rate of change of the brachial artery diameter before and after reactive hyperemia was measured by high resolution ultrasound as the brachial artery FMD. Fasting uric acid was determined by oxidase method. Results Compared with the control group, the FMD in both non-LVH group and LVH group decreased (7.3 ± 3.5)%, (5.7 ± 2.2)% vs (9.9 ± 3.1)%, P <0.05, and hyperuricemia (HUA) The incidence was significantly higher (39.2%, 40.1% vs 17.1%, P <0.05). Compared with patients with normal uric acid, HUA decreased (6.3 ± 2.5)% (7.1 ± 3.6)%, P <0.05) in hypertensive patients with HUA. Further subgroup analysis found that patients with non-LVH had HUA and uric acid (6.5 ± 1.9)% vs (7.7 ± 2.6)%, P <0.05]. However, there was no significant difference in FMD between HUA and normal uric acid group in LVH group. Correlation analysis showed that FMD was negatively correlated with uric acid (r = -0.18, P <0.05). Conclusions Uric acid is related to the function of vascular endothelium. Hypertension patients with existing LVH have no obvious effect on vascular endothelial function.