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目的:通过观察高血压昼夜节律消失、血管内皮功能及血液流变学改变以了解三者之间关系。方法:选择行24h动态血压监测的Ⅰ-Ⅱ级原发性高血压患者175例,男96例,女79例。根据夜间平均动脉压下降10%以上或以下的标准,将原发性高血压患者分为杓型组(107例)和非杓型组(68例)。分别采用高分辨率彩色血管超声,以肱动脉反应性充血前、后血管内径变化检测血管内皮依赖性扩张功能并行血液流变学各指标的测定。结果:①非杓型组的肱动脉反应性充血血管内径变化显著小于杓型组[(8·7±2·1)%∶(5·1±1·7)%,P<0·01);②非杓型组的凝血因子Ⅰ(Fg)、红细胞压积、全血黏度值、血浆黏度值、全血低切还原黏度、红细胞聚集指数显著高于杓型组(P<0·01,P<0·05);③通过建立Logistic回归方程,显示自变量(Fg、反应性充血血管内径变化)对因变量(血压昼夜节律)的回归系数为-4·094,+0·949,对因变量的OR值为0·017,2·583。结论:高血压昼夜节律消失、血管内皮功能受损、血液流变学异常呈正相关,三者之间相互作用,形成恶性循环。
OBJECTIVE: To understand the relationship between the three by observing the disappearance of circadian rhythm of hypertension, changes in vascular endothelial function and hemorheology. Methods: A total of 175 patients with grade Ⅰ-Ⅱ essential hypertension who underwent ambulatory 24-hour ambulatory blood pressure monitoring were enrolled in this study. They included 96 males and 79 females. The patients with essential hypertension were divided into dipper group (n = 107) and non-dipper group (n = 68) according to the standard of mean arterial pressure drop of 10% or less at night. Respectively using high-resolution color vascular ultrasound, brachial artery reactivity before and after changes in vascular diameter changes in vascular endothelium-dependent dilation function of the parallel determination of various indicators of hemorheology. Results: (1) The changes of brachial artery reactive blood volume in non-dipper group were significantly lower than those in dipper group (8.7 ± 2.1%): (5.1 ± 1.7)%, P <0.01) ; ② The non-dipper group had higher values of Fg, hematocrit, whole blood viscosity, plasma viscosity, whole blood low-cut reduction viscosity and erythrocyte aggregation index (P <0.01, P <0.05). ③The Logistic regression equation was established to show that the regression coefficients of independent variables (Fg, reactive hyperemia) to dependent variables (blood pressure circadian rhythm) were -4.094 and +0.949, respectively The OR of dependent variables is 0 · 017 and 2 · 583. Conclusion: The disappearance of circadian rhythm of hypertension, impaired vascular endothelial function and abnormality of hemorheology are positively correlated with each other, and the interaction among the three forms a vicious cycle.