摘要目的 探讨高血压前期合并糖耐量异常患者颈动脉内膜中膜厚度及心脏左心室结构、功能改变情况,并分别对两者危险因素进行分析.方法 300例患者分为正常对照组(NC组)61例、单纯高血压前期组(PH组)83例、单纯糖耐量异常组(IGT组)91例、高血压前期合并糖耐量异常组(PH+ IGT组)65例,超声测定颈动脉内膜中层厚度(IMT),心脏彩超计算左心室质量指数(LVMI)、室壁中层缩短率(mFS)、舒张早晚期充盈速度比值(E/A).结果 (1)IMT在PH组、IGT组、PH+IGT组均高于NC组[(0.7±0.1)mm、(0.7±0.1)mm和(1.0 ±0.1)mm比(0.6 ±0.1)mm,P均＜0.01],且PH+ IGT组较PH组、IGT组也表现出明显升高(P＜0.01),但在PH组与IGT组间比较差异无统计学意义(P＞0.05);血压血糖对其存在交互作用;回归分析示高敏C反应蛋白(hs-CRP)、餐后2h血糖(2 hPBG)、收缩压、舒张压与IMT正相关.(2)LVMI在PH组、PH+ IGT组高于NC组及IGT组[(97.0 ±3.3)g/m2、(97.1 ±2.8)g/m2比(87.0 ±2.0) g/m2、(87.9±1.5) g/m2,P均＜0.01],mFS在PH组、PH+ IGT组低于NC组及IGT组[(14.0±0.8)％、(14.0±0.8)％比(18.3±1.0)％、(18.2±0.5)％,P＜0.01],而LVMI、mFS在PH组与PH+ IGT组及NC组与IGT组间比较差异无统计学意义.回归分析LVMI与收缩压、舒张压呈正比,mFS则随收缩压、舒张压增加而减少.E/A值虽与收缩压呈反比,但4组间比较差异无统计表学意义(均P ＞0.05).结论 高血压前期即存在血管损害及心脏重构和收缩功能减退.合并糖耐量异常会加重动脉粥样硬化,但对心脏结构及功能影响不明显.

abstractsObjective To investigate the intima-media thickness and cardiac remodeling in patients with prehypertension and impaired glucose tolerance.Method Three-hundred patients were divided into four groups:normal control ( NC,n = 61 ),prehypertension ( PH,n = 83 ),impaired glucose tolerance ( IGT,n = 91 ),prehypertension and impaired glucose tolerance ( PH + IGT,n = 65 ).Intima-media thickness (IMT) was measured by doppler ultrasonography.Left ventricle mess (LVMI),midwall fractional shortening (mFS),peakE/peakA ( E/A ) were measured by echocardiography.Results ( 1 ) IMT was significantly increased in PH,IGT and PH + IGT groups than in NC group [ (0.7 ± 0.1 ) mm,(0.7 ± 0.1 )mm and( 1.0 ±0.1 ) mm vs.(0.6 ±0.1 ) mm,all P ＜0.01 ],which was significantly high in PH + IGT group than in PH or IGT group.Regression analysis demonstrated that high-sensitivity C-reactive protein (hsCRP),2-hour postprandial blood glucose (2hPBG),systolic pressure (SBP),diastolic blood pressure (DBP) were independent predictors to increased IMT.(2) LVMI was higher in PH and PH + IGT groups than in NC group [ (97.0 ± 3.3 ) g/m2,(97.1 ± 2.8 ) g/m2 vs.( 87.0 ± 2.0) g/m2,( 87.9 ± 1.5 ) g/m2,all P ＜ 0.01 ],and positively related with SBP,DBP.( 3 ) mFS was lower in PH and PH + IGT groups [(14.0±0.8)％,(14.0±0.8)％ vs.(18.3±1.0)％,(18.2±0.5)％,P＜0.01],negatively related with SBP and DBP.E/A was similar among groups and lower E/A was associated with higher SBP.Conclusion Vascular and left ventricular structure remodeling and systolic dysfunction could be detected in prehypertension patients.Impaired glucose tolerance could enhance vascular remodeling in prehypertension patients.