CAJ | 학술논문

目的：研究高血压病不同危险分层对原发性高血压患者球结膜微循环形态及功能的影响。方法根据血压水平（1、2、3级）、其他心血管危险因素（年龄、吸烟、血胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、早发心血管家族史、体质量指数、高敏C反应蛋白等）、靶器官损害及并发症的情况，对118例高血压病患者进行分层，研究不同危险分层的高血压病患者和同期20例健康志愿者球结膜微循环的变化。结果与健康对照组比较，低危组高血压病患者球结膜微循环改变主要表现为稀疏网格结构、微血管数目减少及细静脉管径变细，两者差异有统计学意义（P＜0.05）。中危以上（含中危）组高血压病患者球结膜微循环出现形态、流态和袢周状态的明显改变。其形态改变主要为视野清晰度下降、微血管数减少、细动脉及细静脉管径变细、微血管粗细不均增多，并出现网格结构、微血管瘤、囊状扩张及缺血区。其流态改变主要为微血管内血流速度减慢、红细胞聚集。其管周渗出增加、含铁血黄素沉着增多。随着高血压危险分层的增加，球结膜微血管密网格结构比例逐渐增多、微血管数逐渐减少、微血管内血流速度逐渐减慢、红细胞聚集程度逐渐加重，差异有统计学意义（P＜0.05）。结论高血压病患者出现与危险分层相关的球结膜微循环改变。
목적：연구고혈압병불동위험분층대원발성고혈압환자구결막미순배형태급공능적영향。방법근거혈압수평（1、2、3급）、기타심혈관위험인소（년령、흡연、혈담고순、저밀도지단백담고순、고밀도지단백담고순、조발심혈관가족사、체질량지수、고민C반응단백등）、파기관손해급병발증적정황，대118례고혈압병환자진행분층，연구불동위험분층적고혈압병환자화동기20례건강지원자구결막미순배적변화。결과여건강대조조비교，저위조고혈압병환자구결막미순배개변주요표현위희소망격결구、미혈관수목감소급세정맥관경변세，량자차이유통계학의의（P＜0.05）。중위이상（함중위）조고혈압병환자구결막미순배출현형태、류태화번주상태적명현개변。기형태개변주요위시야청석도하강、미혈관수감소、세동맥급세정맥관경변세、미혈관조세불균증다，병출현망격결구、미혈관류、낭상확장급결혈구。기류태개변주요위미혈관내혈류속도감만、홍세포취집。기관주삼출증가、함철혈황소침착증다。수착고혈압위험분층적증가，구결막미혈관밀망격결구비례축점증다、미혈관수축점감소、미혈관내혈류속도축점감만、홍세포취집정도축점가중，차이유통계학의의（P＜0.05）。결론고혈압병환자출현여위험분층상관적구결막미순배개변。
ObjectiveTodetermine the effect ofessential hypertension(EH)with different risk stratificationon the morphology and function of bulbar conjunctival microcirculation in EH patients.MethodsBlood pressure (grades 1, 2, and3), other cardiovascular risk factors (age, smoking, blood cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, family history of premature cardiovascular diseases, body mass index,andhigh sensitivity C reactive protein),andtarget organ damage and complications were used tostratify 118EHpatientsadmitted in the hypertension clinic of our hospital from April 2014 to February 2015. Bulbar conjunctival microcirculation was monitored and analyzed in the patients and20 healthy volunteers in the same period.Results Compared with the healthy volunteers,thelow-riskpatientshad statistically sparser grid structure,lessmicrovessels, and thinner venules (P<0.05).While themoderate-, high-, and very high-riskpatientsdisplayed obviouschanges in morphology, blood flow in microvessles, and surrounding loop state. The morphological changes were mainly characterized byblurred vision, reduced microvessels, thinner arterioles and venules,moremicrovessels ofunevendiameters,grid structureand microaneurysm, cystic dilation and ischemic area.Theyalso showed slowed blood flow velocity, increased erythrocyte aggregation and exudation, and hemosiderin deposition in surrounding loop. With the increase in risk stratification,there weregraduallymoregrid structure density, decreased number ofmicrovessels, reduced blood flow velocity,and enhancederythrocyte aggregation (P<0.05).Conclusion EH patients with different risk stratification show different alterationsin bulbar conjunctival microcirculation.