CAJ | 학술논문

目的观察左心室射血分数（LVEF）正常的原发性高血压患者晨峰血压对颈动脉硬化、同型半胱氨酸（Hcy）和尿微量白蛋白（UmAlb）的影响，探讨Hcy和UmAlb在晨峰血压所致颈动脉硬化中的作用。方法 ①应用24 h动态血压监测仪器对197例原发性高血压且LVEF正常的患者行24 h血压监测，按晨峰血压的高低分为两组：A组：晨峰血压正常组，共90例；B组：晨峰血压增高组，共107例。②应用多普勒超声仪对每例患者均行左、右两侧颈总动脉内径（LCCAd、RCCAd）、颈内动脉内径（LICAd、RICAd）、颈总动脉内膜‐中层厚度（LCA‐IM T、RCA‐IM T ）及确定左侧、右侧颈动脉有无斑块，计算双侧颈总动脉内径均值（CCAdM）、双侧颈内动脉内径均值（ICAdM）、双侧颈总动脉内膜‐中层厚度均值（CCA‐IMTM）以及两组患者存在颈动脉硬化斑块的患者例数。③入院24 h内对以上患者均留取空腹静脉血，利用OLYMPUS AU640全自动生化仪检测Hcy、UmAlb及血脂等观察指标。结果 ①A组与B组患者在24 h、日间、夜间收缩压（SBP）和舒张压（DBP）的血压平均值，24 h平均动脉压（MAP）等方面均无显著性意义（ P＞0．01）。②B组在颈动脉硬化各参数、颈动脉硬化斑块患者例数方面均明显高于A组，差异有显著性意义（ P＜0．05）。③B组在Hcy和UmAlb水平方面均明显高于A组，差异有显著性意义（ P＜0．01）。④晨峰血压与颈动脉硬化各参数、Hcy和UmAlb均显著相关（ P＜0．01），其中晨峰血压与CCA‐IMTM相关性最强（ r ＝0．623，P ＝0．000）。结论晨峰血压在LVEF正常的原发性高血压患者所致早期颈动脉硬化方面有重要的意义，且与Hcy、UmAlb密切相关，提示晨峰血压的控制是高血压诊治过程中的重要环节。
목적 관찰좌심실사혈분수（LVEF）정상적원발성고혈압환자신봉혈압대경동맥경화、동형반광안산（Hcy）화뇨미량백단백（UmAlb）적영향，탐토Hcy화UmAlb재신봉혈압소치경동맥경화중적작용。방법 ①응용24 h동태혈압감측의기대197례원발성고혈압차LVEF정상적환자행24 h혈압감측，안신봉혈압적고저분위량조：A조：신봉혈압정상조，공90례；B조：신봉혈압증고조，공107례。②응용다보륵초성의대매례환자균행좌、우량측경총동맥내경（LCCAd、RCCAd）、경내동맥내경（LICAd、RICAd）、경총동맥내막‐중층후도（LCA‐IM T、RCA‐IM T ）급학정좌측、우측경동맥유무반괴，계산쌍측경총동맥내경균치（CCAdM）、쌍측경내동맥내경균치（ICAdM）、쌍측경총동맥내막‐중층후도균치（CCA‐IMTM）이급량조환자존재경동맥경화반괴적환자례수。③입원24 h내대이상환자균류취공복정맥혈，이용OLYMPUS AU640전자동생화의검측Hcy、UmAlb급혈지등관찰지표。결과 ①A조여B조환자재24 h、일간、야간수축압（SBP）화서장압（DBP）적혈압평균치，24 h평균동맥압（MAP）등방면균무현저성의의（ P＞0．01）。②B조재경동맥경화각삼수、경동맥경화반괴환자례수방면균명현고우A조，차이유현저성의의（ P＜0．05）。③B조재Hcy화UmAlb수평방면균명현고우A조，차이유현저성의의（ P＜0．01）。④신봉혈압여경동맥경화각삼수、Hcy화UmAlb균현저상관（ P＜0．01），기중신봉혈압여CCA‐IMTM상관성최강（ r ＝0．623，P ＝0．000）。결론 신봉혈압재LVEF정상적원발성고혈압환자소치조기경동맥경화방면유중요적의의，차여Hcy、UmAlb밀절상관，제시신봉혈압적공제시고혈압진치과정중적중요배절。
Objective]To observe the effect of morning peak blood pressure on carotid atherosclerosis ,homocysteine(Hcy) and u‐rinary microalbumin(UmAlb) in essential hypertension patients with normal left ventricular ejection fraction(EF% ) ,and to explore the role of Hcy and UmAlb in carotid atherosclerosis caused by morning blood pressure .[Methods]The 24h ambulary blood pressure moni‐toring(ABPM) was used to monitor blood pressure in 190 cases of essential hypertension with normal EF% .According to morning peak blood pressure ,all patients were divided into group A(normal morning peak blood pressure ,n=90) and group B(increased morn‐ing peak blood pressure ,n=107) .Doppler ultrasound was performed in each patient to measure left and right sides of common carotid artery diameter(LCCAd and RCCAd) ,internal carotid artery diameter(LICAd and RICAd) ,common carotid artery intima‐media thick‐ness(LCA‐IMT and RCA‐IMT) and determine whether left and right carotid artery plaque was formed .The mean carotid artery diame‐ter(CCAdM) ,mean internal carotid artery diameter(ICAdM) ,mean common carotid artery intima‐media thickness(CCA‐IMTM) of two sides and the number of patients with carotid atherosclerosis plaque were calculated .The fasting venous blood of patients within 24h on admission was collected .OLYMPUS AU640 automatic biochemical analyzer was used to detect Hcy ,UmAlb ,blood lipids and other indicators .[Results]There was no significant difference in 24h‐,daytime and nighttime mean systolic blood pressure(SBP) and diastolic blood pressure(DBP) and 24h mean arterial pressure(MAP) between group A and group B( P>0 .05) .The carotid athero‐sclerosis parameters and number of patients with carotid atherosclerosis plaque in group B were obviously higher than those in group B , and there was significant differenc( P<0 .05) .The levels of Hcy and UmAlb in group B were obviously higher than those in group A , and there was significant difference( P<0 .05) .Morning peak blood pressure was significantly correlated with carotid atherosclerosis parameters ,Hcy and UmAlb( P<0 .05) .There was strongest correlation between morning peal blood pressure and CCA‐IMTM( r=0 .623 ,P=0 .000) .[Conclusion]Morning peak blood pressure is of great significance in carotid atherosclerosis in essential hyperten‐sion patients with normal EF% ,and closely correlated with Hcy and UmAlb .It suggests that the control of morning peak blood pres‐sure is an important process of the diagnosis and treatment of essential hypertension .