彭晓宇

[摘要]目的 觀察分析高血压对急性脑梗死患者血管内皮功能、同型半胱氨酸水平的影响。方法 选取2014年6月～2016年6月在我院住院的首发急性脑梗死患者200例进行研究。将所选患者按照是否合并高血压病，分为脑梗死正常血压组（正常组）和脑梗死合并高血压组（合并组），每组各100例，并选取同期健康体检者100例为对照组。回顾性分析所选受试者FMD、IMT、血清同型半胱氨酸（Hcy）、NO、eNOS水平，并综合分析它们之间的相互关系。结果 正常组与合并组的颈动脉IMT及血清Hcy水平明显高于对照组（P<0.05），而FMD及血清NO、eNOS水平明显低于对照组，差异有统计学意义（P<0.05）；合并组的颈动脉IMT及血清Hcy水平明显高于正常组（P<0.05），而FMD及血清NO、eNOS水平明显低于正常组，差异有统计学意义（P<0.05）。Spersman直线相关分析结果显示，正常组和合并组患者IMT与血清NO、eNOS水平均成明显负相关性（P<0.05），与血清Hcy水平成明显正相关性（P<0.05）；正常组和合并组患者FMD与血清NO、eNOS水平均成明显正相关性（P<0.05），与血清Hcy水平成明显负相关性（P<0.05）。结论 急性脑梗死患者存在血管内皮功能障碍、同型半胱氨酸血症，两者和高血压在急性脑梗死的发生、发展有着重要协同关系，通过早期超声测量IMT与FMD可以预测脑梗死的发生。

[关键词]血流介导的舒张功能；内膜-中层厚度；急性脑梗死；高血压

[中图分类号] R743.3 [文献标识码] A [文章编号] 1674-4721（2017）11（a）-0033-04

Influence of hypertension on vascular endothelial function and homocysteine level in patients with acute cerebral infarction

PENG Xiao-yu

Department of Functional Ispection，the Fourth Affiliated Hospital of Nanchang University，Jiangxi Province，Nanchang 330003，China

[Abstract]Objective To observe and analyze the influence of hypertension on vascular endothelial function and homocysteine level in patients with acute cerebral infarction.Methods From June 2014 to June 2016，200 patients with acute cerebral infarction in Department of Neurology in our hospital were selected for study.According to whether hypertension was combined or not，they were divided into cerebral infarction with normal blood pressure group（normal group） and cerebral infarction group with hypertension group （combined group），and 100 cases were in each group.At the same time，another group of 100 healthy people for physical examinations were selected as control group.FMD of brachial artery，IMT，and levels of Hcy，NO，and eNOS were retrospectively analyzed and their relationships were comprehensively analyzed.Results The levels of carotid IMT and serum Hcy in the normal group and the combined group were significantly higher than those in the control group （P<0.05）.The levels of FMD，serumNO，andeNOS were greatly lower than those in the control group，the difference was statistically significant （P<0.05）.The levels of carotid IMT and serum Hcy in the combined group were much higher than those in the normal group（P<0.05）.The levels of FMD，serumNO，andeNOS were significantly lower than those in the normal group， the difference was statistically significant （P<0.05）.The Spearman linear correlation analysis showed that there were negative correlations between IMT and serum NO，and between IMT and eNOS level in the normal group and combined group （P<0.05），but a positive correlation with serum Hcy level （P<0.05）.The FMD was positively correlated with the levels of serum NO and eNOS in the normal group and combined group （P<0.05），but negatively correlated with serum Hcy level （P<0.05）.Conclusion There are vascular endothelial dysfunction and homocysteinemia in patients with acute cerebral infarction，and both of them have important synergistic relationship with the occurrence and development of acute cerebral infarction together with hypertension.Early ultrasound measurement of IMT and FMD can predict the occurrence of cerebral infarction.endprint

[Key words]Flow mediated dilation （FMD）；Intima media thickness （IMT）；Acute cerebral infarction；Hypertension

脑梗死是临床常见脑血管疾病，目前已成为我国第三位致死原因，严重威胁人们的健康生活[1-2]。有研究显示，任何导致血栓形成的因素均与血管内皮细胞损伤有关[3]。血压升高是内皮损伤的始动因素，由于血流动力增加，引起缩血管物质增加，扩血管物质减少，使血压进一步增加。同时，升高的血压引起血管内皮损伤，由其合成及分泌的肱动脉血流介导的舒张功能（flow mediated dilation，FMD）、内膜-中层厚度（intima media thickness，IMT）（IMT）、血清同型半胱氨酸（Hcy）、一氧化氮（NO）、内皮型一氧化氮合成酶（eNOS）水平水平发生变化，导致血管张力调节失衡，又加剧血压升高，形成恶性循环[4-5]。本研究选取首发急性脑梗死患者作为观察对象，探讨其血管内皮功能障碍、高同型半胱氨酸血症在急性脑梗死进程中的作用和致病机制，评价FMD、IMT、Hcy、NO、eNOS水平对急性脑梗死患者临床预后的影响，为临床早期干预和药物治疗提供理论指导和客观依据，现报道如下。……