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目的探讨老年原发性高血压(EH)合并2型糖尿病(T2DM)患者的肱动脉内皮依赖性舒张功能(BA-EDD)与血清胆红素的关系。方法选择EH和(或)T2DM患者共251例,分为EH(n=123)、T2DM(DM,n=43)、EH+T2DM组(EHDM,n=85),选择同期血压血糖正常者作为对照组(n=66)。所有受试者测量身高、体质量、血压,测定间接胆红素(IBIL)等生化指标。采用高分辨率血管超声多普勒测定静息状态下肱动脉(BA)内径,作为内径基础值(D0);反应性充血前后肱动脉内径的变化率作为BA-EDD。结果EHDM和EH组的BAD0较对照组大[(0.44±0.09),(0.43±0.08)比(0.40±0.07)cm],BA-EDD较对照组小[(9.14±4.85)%,(11.14±5.90)%比(13.15±6.35)%,均P<0.05],且BA-EDD在对照组、EH组、EHDM组有逐渐降低趋势(P<0.05)。多元逐步回归分析显示,BAD0是BA-EDD的影响因素,仅在≥60岁的EH合并T2DM患者中,IBIL是BA-EDD的影响因素,IBIL每升高10μmol/L,BA-EDD增加6.04%。结论 EH患者合并T2DM后加重肱动脉BA-EDD的损害。BAD0是BA-EDD的影响因素。在≥60岁的EH合并T2DM患者中,IBIL是BA-EDD的保护因素。
Objective To investigate the relationship between brachial artery endothelium-dependent diastolic function (BA-EDD) and serum bilirubin in elderly patients with essential hypertension (EH) and type 2 diabetes mellitus (T2DM). Methods A total of 251 patients with EH and / or T2DM were enrolled and divided into EH (n = 123), T2DM (DM, n = 43) and EH + T2DM (n = 85) Control group (n = 66). All subjects measured height, body mass, blood pressure, determination of indirect bilirubin (IBIL) and other biochemical indicators. The diameter of the brachial artery (BA) at resting state was measured by high-resolution vascular Doppler and taken as the basic value of internal diameter (D0). The change rate of internal diameter of brachial artery before and after reactive hyperemia was regarded as BA-EDD. Results Compared with the control group, BAD0 in EHDM group and EH group was significantly (0.44 ± 0.09) and (0.40 ± 0.07) cm, respectively, and BA-EDD was significantly lower than that in control group (9.14 ± 4.85% vs 11.14 ± 5.90)% (13.15 ± 6.35)% respectively, all P <0.05]. The BA-EDD decreased gradually in the control group, EH group and EHDM group (P <0.05). Multivariate stepwise regression analysis showed that BAD0 was the influencing factor of BA-EDD. IBIL was the influencing factor of BA-EDD only in EH patients with T2DM≥60 years old. The increase of BA-EDD was 6.04% for every 10μmol / L IBIL, . Conclusion The EH patients with T2DM complicated with brachial artery BA-EDD damage. BAD0 is the influencing factor of BA-EDD. IBIL is a protective factor for BA-EDD in patients with EH and T2DM ≥60 years of age.