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背景:近年来研究认为内皮功能是动脉粥样硬化性疾病的新的独立危险因子,但藏汉两族人群内皮功能的差异尚未得到充分研究。目的:比较藏汉两族人群内皮功能的差异,同时比较血脂及肥胖相关指标。设计:对比分析。单位:解放军总医院心内科和解放军西藏军区总医院心内科。对象:选择272名藏族男性代表藏族人群,年龄(43±9)岁,均为拉萨本地居民。选择580名青藏铁路建设工人代表汉族人群,均为男性,年龄(42±11)岁;均来自四川省;且在拉萨市居住1年以上,同样生活在同一高原地区(拉萨市海拔3658m)。所有参试者均为2006-02/05在解放军西藏军区总医院进行常规健康体检者,且对检测项目知情同意。方法:①测量身高、体质量、腰围、臀围、收缩压、舒张压,计算体质量指数(体质量/身高2)。②肱动脉舒张功能检查:采用GE公司Vivid7超声仪、10MHz高频探头扫描右臂肱动脉。先记录肱动脉基础直径,之后将袖带充气至高于受试者收缩压50mm Hg(1mm Hg=0.133kPa)以阻断动脉血流,并保持4min。在充气状态下及放气后2min时分别测量肱动脉直径。袖带放气后,血管反应性充血,此时血流量增加以适应前臂阻力血管的扩张。使用计算机辅助软件计算肱动脉直径。肱动脉内皮功能绝对变化和相对变化由Vivid 7超声仪本身附带软件自动计算得出。③生化检查:禁食12h后,采用日立7600型全自动生化分析仪测定血总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平。④计量资料比较采用方差分析,计数资料采用卡方检验。主要观察指标:比较两组之间的体质量指数、腰臀比、血压、血脂、基础肱动脉直径和肱动脉直径变化。结果:藏族人272名和汉族人580名均进入结果分析。①肱动脉舒张功能:藏族人群基础肱动脉直径明显大于汉族人群[(4.28±0.06),(4.03±0.04)mm,t=71.9156,P<0.01],肱动脉绝对及相对变化分别为(0.124±0.005)mm,(2.934±0.204)%,明显小于汉族[(0.141±0.006)mm,(3.587±0.152)%,t=40.5820,52.1732,P<0.01]。②体格检查结果:藏族人群体质量指数、腰臀比分别为(30.1±2.5)kg/m2,0.92±0.07,明显大于汉族人群[(26.5±3.4)kg/m2]。③血清三酰甘油和低密度脂蛋白胆固醇水平:藏族人群分别为(2.31±1.31),(3.49±0.91)mmol/L,明显高于汉族人群[(1.97±1.44),(3.07±0.86)mmol/L,t=3.4200,6.5223,P<0.01]。结论:①藏族人群肱动脉舒张功能较汉族人群差,即血管反应性差。②藏族人群腹型肥胖较汉族严重,血脂也较高。
BACKGROUND: In recent years, studies suggest that endothelial function is a new independent risk factor for atherosclerotic disease. However, the differences in endothelial function between Tibetan and Han populations have not yet been fully studied. Objective: To compare the difference of endothelial function between Tibetan and Han populations, and to compare the indexes of blood lipid and obesity. Design: comparative analysis. SETTING: Department of Cardiology, PLA General Hospital and Department of Cardiology, Tibet Military Region General Hospital, People’s Liberation Army. PARTICIPANTS: 272 Tibetan males were selected to represent Tibetan people, aged (43 ± 9) years old, both of Lhasa residents. 580 Qinghai-Tibet Railway construction workers were selected to represent Han Chinese, both of whom are male and aged (42 ± 11) years old. They all came from Sichuan Province. They lived in Lhasa for more than one year and lived in the same plateau (Lhasa 3658m above sea level). All participants were from 2006-02 / 05 in the People’s Liberation Army General Hospital of Tibet Military General examination, and the informed consent of the test items. Methods: ①The height, body mass, waist circumference, hip circumference, systolic pressure and diastolic pressure were measured, body mass index (body weight / height 2) was calculated. Brachial artery diastolic function test: Vivid7 GE company, 10MHz high-frequency probe scanning the right arm brachial artery. The brachial artery base diameter was recorded before the cuff was inflated to 50 mm Hg above the subject’s systolic pressure (1 mm Hg = 0.133 kPa) to block the arterial blood flow for 4 minutes. Brachial artery diameter was measured at inflated state and at 2 min after deflation. After cuff deflation, vascular reactivity congestion, blood flow increased at this time to adapt to the expansion of forearm resistance vessels. Brachial artery diameter was calculated using computer aided software. The absolute changes in brachial artery endothelium function and relative changes were automatically calculated by the Vivid 7 ultrasound system itself. ③ biochemical tests: After fasting 12h, using Hitachi 7600 automatic biochemical analyzer determination of blood total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol levels. ④ measurement data were compared using analysis of variance, counting data using chi-square test. MAIN OUTCOME MEASURES: Body mass index, waist-hip ratio, blood pressure, blood lipids, basal brachial artery diameter and brachial artery diameter were compared between the two groups. Results: 272 Tibetan and 580 Han people all entered the result analysis. Brachial artery diastolic function: The basal brachial artery diameter of Tibetan population was significantly larger than that of Han nationality (4.28 ± 0.06), (4.03 ± 0.04) mm, t = 71.9156, P <0.01. The absolute and relative changes of brachial artery were (0.124 ± 0.005) mm, and (2.934 ± 0.204)%, respectively, which was significantly lower than that in Han [(0.141 ± 0.006) mm, (3.587 ± 0.152)%, t = 40.5820,52.1732, P <0.01]. ② Physical examination results: Body mass index and waist-hip ratio were (30.1 ± 2.5) kg / m 2 and 0.92 ± 0.07 respectively in Tibetan population, which were significantly higher than those in Han population [(26.5 ± 3.4) kg / m 2]. Serum triglycerides and LDL-C levels were significantly higher in Han nationality than in Han nationality [(2.31 ± 1.31) and (3.49 ± 0.91) mmol / L, respectively] [(1.97 ± 1.44) and (3.07 ± 0.86) mmol / /L,t=3.4200,6.5223,P<0.01]. Conclusion: (1) The diastolic function of brachial artery in Tibetan people is worse than that in Han people, that is, the vascular reactivity is poor. ② Tibetan people belly obesity is more serious than Han, blood lipids are also higher.