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高血压和冠心病的发病率仍呈上升趋势, 是目前最常见的心血管疾病, 高血压病人发生冠心病的风险较血压正常者高1~4倍,长期未治疗的高血压病人50%死于冠心病[1]。高血压在冠状动脉(冠脉)粥样硬化和冠心病的病程进展中起主要作用,对病人的身体健康和生命安全造成严重影响,因此需长期监测高血压病人的血压变化。动态血压监测(ambulatory blood pressure monitoring, ABPM)能够真实反映病人24 h整体血压水平,并能根据24 h血压波动特点揭示病人血压昼夜变化规律[2]。血压昼夜节律的减弱或消失,夜间血压水平下降幅度变小,均可导致心血管系统长期处于高水平负荷状态,引起冠脉病变[3], 但是动态血压参数与冠脉病变严重程度之间的相关性研究较少。因此,为了揭示动态血压参数与冠脉病变严重程度之间的关系, 本研究通过对322例可疑冠心病病人24 h ABMP和冠脉造影结果进行分析比较,探讨动态血压参数与冠脉病变程度的相关性。现作报道。
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冠脉正常组病人与单支、双支、三支病变组病人间年龄、TG水平及吸烟比例差异均有统计学意义(P < 0.05~P < 0.01)。冠脉正常组病人与单支、双支、三支病变组病人在性别、饮酒史、高血压史、糖尿病史比例及TC、HDL-C、HDL、体质量指数(BMI)、UA水平差异均无统计学意义(P > 0.05)(见表 1)。
变量 冠脉正常组
(n=85)单支病变组
(n=91)双支病变组
(n=77)三支病变组
(n=69)χ2 P MS组内 性别(男/女) 56/29 57/34 46/31 43/26 0.66 >0.05 — 年龄/岁 59.15±11.78 64.31±10.82 65.02±11.14 64.97±11.23 5.21* < 0.01 126.416 吸烟 25(29.41) 42(46.15) 37(48.05) 36(52.17) 9.88 < 0.05 — 饮酒 35(41.18) 39(42.86) 34(44.16) 30(43.48) 0.16 > 0.05 — 高血压 38(44.71) 41(45.05) 35(45.45) 32(46.38) 0.05 > 0.05 — 糖尿病 21(24.71) 23(25.27) 19(24.68) 17(24,64) 0.005 > 0.05 — TC/(mmol/L) 4.16±1.05 4.27±0.99 4.25±0.98 4.26±1.01 0.21* > 0.05 1.016 TG/(mmol/L) 1.95±1.39 2.41±1.23 2.54±1.47 2.47±1.44 3.09* < 0.05 1.898 LDL-C/(mmol/L) 2.08±1.22 2.36±0.99 2.39±1.01 2.34±1.03 1.50* > 0.05 1.141 HDL/(mmol/L) 0.98±0.31 0.97±0.30 0.94±0.29 0.95±0.32 0.29* > 0.05 0.093 UA/(μmol/L) 327.82±94.26 332.14±93.57 334.02±95.24 336.36±94.89 0.11* align=""0.05 8 918.133 BMI /(kg/m2) 25.35±3.32 25.21±3.29 25.40±3.40 25.44±3.38 0.07* > 0.05 11.181 *示F值 表 1 一般资料比较[n;百分率(%)]
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单支、双支、三支病变病人病人的24 hASBP、24 hAPP、dAPP、nASBP、nAPP均高于冠脉正常组(P < 0.05~P < 0.01);双支、三支病变病人诊室SBP、诊室PP、dASBP较冠脉正常组病人明显增高(P < 0.01),且随着病变支数的增多有增高的趋势(P < 0.05~P < 0.01);双支、三支病变组病人24 hADBP、dADBP、nADBP均明显低于冠脉正常组(P < 0.01),随着病变支数的增加有下降的趋势(P < 0.01);冠脉正常组病人hDBP、IDBP、ISBP与单支、双支、三支病变组病人差异均无统计学意义(P > 0.05)(见表 2)。
变量 冠脉正常组
(n=85)单支病变组
(n=91)双支病变组
(n=77)三支病变组
(n=69)F P MS组内 24 hASBP 114.69±10.01 120.83±11.65** 124.32±13.27** 126.34±13.85**△ 13.94 < 0.01 147.984 24 hADBP 78.12±9.78 76.03±8.39 73.28±9.77** 72.94±9.06** 5.54 < 0.01 85.553 dASBP 115.18±12.34 117.58±12.99 124.28±13.75**△△ 126.53±13.97**△△ 12.94 < 0.01 174.898 dADBP 76.02±9.79 74.69±9.14 69.34±9.97**△△ 67.85±6.98**△△ 14.98 < 0.01 83.135 nASBP 106.33±11.26 117.83±13.36** 121.54±14.85** 125.96±13.09**△△# 32.32 < 0.01 173.351 nADBP 65.94±9.33 65.53±7.68 58.97±7.88**△△ 56.85±9.81**△△ 22.09 < 0.01 75.106 24 hAPP 36.07±6.96 43.11±7.90 51.82±11.85**△△ 53.92±9.88**△△ 62.98 < 0.01 84.893 dAPP 37.34±7.75 42.91±9.77** 52.69±11.22**△△ 55.87±11.84**△△ 56.06 < 0.01 102.944 nAPP 42.11±7.83 53.24±9.37** 61.08±8.92**△△ 66.08±11.71**△△# # 95.92 < 0.01 89.381 hSBP 123.17±210.04 144.24±18.33 155.72±19.38 174.81±24.21* 3.01 < 0.05 11 963.683 hDBP 79.71±9.89 80.03±12.98 81.84±10.77 78.92±12.56 0.84 > 0.05 134.975 ISBP 101.87±15.63 103.02±12.77 104.13±17.21 104.98±13.57 0.64 > 0.05 220.847 IDBP 52.54±4.35 54.27±7.24 53.82±8.44 52.94±6.75 1.14 > 0.05 46.601 诊室SBP 118.82±16.25 121.02±16.36 131.24±18.91**△△ 135.12±18.92**△△ 15.71 < 0.01 307.510 诊室DBP 74.21±8.93 73.82±12.13 74.92±13.51 68.57±13.11*△△# # 4.25 < 0.01 143.081 诊室PP 44.57±8.02 46.34±9.82 56.13±9.16**△△ 65.23±10.59**△△# # 79.17 < 0.01 88.317 q检验:与冠脉正常组比较*P < 0.05,** P < 0.01;与单支病变组比较△P < 0.05;与双支病变组比较#P < 0.05,## P < 0.01 表 2 动态血压参数比较(x±s; mmHg)
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与杓型血压模式比较,非杓型、反杓型、超杓型血压模式的病变支数(双支、三支)均明显高于杓型血压模式(χ2=7.67、P < 0.01,χ2=64.68、P < 0.01,χ2=60.62、P < 0.01);同一血压模式下病变支数比例分布,杓型血压模式:正常 > 单支 > 双支 > 三支(P < 0.01),反杓型血压模式的病变支数:三支 > 双支 > 单支 > 正常(P < 0.01),非杓型血压模式和超杓型血压模式各组间差异无统计学意义(P > 0.05)(见表 3)。
模式 冠脉正常
(n=85)单支病变
(n=91)双支病变
(n=77)三支病变
(n=69)χ2 P 杓型血压(n=68) 42(61.76) 17(25.00) 6(8.82) 3(4.41) 60.84 < 0.01 非杓型血压(n=90) 16(17.78) 30(33.33) 25(27.78) 19(21.11) 5.42 > 0.05 反杓型血压(n=106) 11(10.38) 26(24.53) 32(30.19) 37(34.90) 32.03 < 0.01 超杓型血压(n=58) 16(27.59) 18(31.03) 14(24.14) 10(17.24) 0.81 > 0.05 表 3 动态血压模式与冠脉病变严重程度[n;构成比(%)]
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以冠心病为因变量,各危险因素(性别、年龄、吸烟、饮酒、糖尿病、BMI、UA、24 hASBP、24 hADBP、dASBP、dADBP、nASBP、nADBP、24 hAPP、dAPP、nAPP、hSBP、hDBP、ISBP、IDBP)为自变量,进行logistic多元回归分析,结果显示,女性和年龄小是冠心病的保护因素(P < 0.01);吸烟、糖尿病、24 hASBP、dASBP、24 hAPP、dAPP、nAPP是冠心病的危险因素(P < 0.05~P < 0.01)(见表 4)。
变量 B SE Waldχ2 OR 95%CI P 性别 -1.239 0.408 9.230 0.290 0.130~0.644 < 0.01 年龄 -0.065 0.016 16.787 0.937 0.908~2.916 < 0.01 吸烟 1.404 0.382 13.475 4.070 1.924~8.611 < 0.01 饮酒 0.016 0.008 3.641 1.016 1.000~1.033 > 0.05 糖尿病 2.000 0.501 15.957 7.392 2.770~19.724 < 0.01 BMI -0.059 0.035 2.777 0.943 0.880~1.010 > 0.05 UA 0.001 0.002 0.683 1.001 0.998~1.005 > 0.05 24 hASBP 0.406 0.200 4.105 1.500 1.013~2.221 < 0.05 24 hADBP -0.150 0.265 0.323 0.860 0.512~1.445 > 0.05 dASBP -0.379 0.176 4.639 1.684 0.485~1.966 < 0.05 dADBP 0.327 0.220 2.218 1.387 0.902~2.134 > 0.05 nASBP -0.133 0.072 3.403 0.876 0.760~1.008 > 0.05 nADBP 0.061 0.090 0.456 1.062 0.981~1.266 > 0.05 24 hAPP -0.613 0.180 11.640 1.542 0.381~2.770 < 0.01 dAPP 0.622 0.180 11.932 1.863 1.309~2.653 < 0.01 nAPP -0.586 0.178 10.865 1.557 0.393~2.789 < 0.01 hSBP -0.040 0.040 1.027 0.961 0.887~1.038 > 0.05 hDBP -0.150 0.265 0.323 0.860 0.512~1.445 > 0.05 ISBP 0.000 0.002 0.050 1.000 0.997~1.003 > 0.05 IDBP -0.019 0.040 0.221 0.981 0.907~1.012 > 0.05 表 4 多因素分析冠心病的相关危险因素
动态血压参数与冠状动脉病变严重程度的相关性研究
Study on the correlation between ambulatory blood pressure parameters and severity of coronary lesion
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摘要:
目的探讨不同动态血压参数与冠状动脉(冠脉)病变严重程度的相关性。 方法可疑冠心病病人322例,均行24 h动态血压监测和冠脉造影,按照冠脉造影结果分为冠脉正常组(n=85)、单支病变组(n=91)、双支病变组(n=77)和三支病变组(n=69),比较各组动态血压参数。 结果单支、双支和三支病变病人的24 h平均收缩压(24 hASBP)、24 h平均脉压(24 hAPP)、白天平均脉压(dAPP)、夜间平均收缩压、夜间平均脉压(nAPP)、均高于冠脉正常组(P < 0.05~P < 0.01)。与杓型血压模式比较,非杓型、反杓型、超杓型血压模式的病变支数(双支、三支)均明显高于杓型血压模式(P < 0.01);同一血压模式下病变支数比例分布,杓型血压模式:正常>单支>双支>三支(P < 0.01),反杓型血压模式的病变支数:三支>双支>单支>正常(P < 0.01)。logistic多元回归分析显示,吸烟、糖尿病、24 hASBP、dASBP、24 hAPP、dAPP、夜间平均脉压均为冠心病的危险因素(P < 0.05~P < 0.01)。 结论动态血压模式与高血压靶器官损害的严重程度具有相关性。 Abstract:ObjectiveTo study the correlation between ambulatory blood pressure parameters and severity of coronary lesion. MethodsThe 24 h ambulatory blood pressure and coronary angiography in 322 patients suspected by coronary heart disease were detected.According to the results of coronary angiography, the patients were divided into the normal coronary artery group(85 cases) and single vessel lesion group(91 cases), two branches lesion group(77 cases) and three branches lesion group(69 cases).The ambulatory blood pressure parameters were compared among 4 groups. ResultsThe 24-h ASBP, 24-h APP, dAPP, nASBP and nAPP in patients with single, double and three-vessel lesions were significantly higher than those in patients with normal coronary artery(P < 0.05 to P < 0.01).The number of lesion branches(double and three branches) in non-dipper, reverse dipper and super-dipper blood pressure patterns patients were higher than those in dipper blood pressure patterns patients(P < 0.01).Under the arytenoid blood pressure pattern, the proportional distribution of normal, single, double and three branches lesion gradually decreased(P < 0.01).Under the inverting arytenoid blood pressure pattern, the proportional distribution of three, double, single and normal branches lesion gradually decreased(P < 0.01).The results of multiple logistic regression analysis showed that the smoking, diabetes, 24 hASBP, dASBP, 24 hAPP, dAPP, and nAPP were the risk factors for coronary heart disease(P < 0.05 to P < 0.01). ConclusionsThe ambulatory blood pressure pattern is significantly correlated with the severity of hypertensive target organ damage. -
表 1 一般资料比较[n;百分率(%)]
变量 冠脉正常组
(n=85)单支病变组
(n=91)双支病变组
(n=77)三支病变组
(n=69)χ2 P MS组内 性别(男/女) 56/29 57/34 46/31 43/26 0.66 >0.05 — 年龄/岁 59.15±11.78 64.31±10.82 65.02±11.14 64.97±11.23 5.21* < 0.01 126.416 吸烟 25(29.41) 42(46.15) 37(48.05) 36(52.17) 9.88 < 0.05 — 饮酒 35(41.18) 39(42.86) 34(44.16) 30(43.48) 0.16 > 0.05 — 高血压 38(44.71) 41(45.05) 35(45.45) 32(46.38) 0.05 > 0.05 — 糖尿病 21(24.71) 23(25.27) 19(24.68) 17(24,64) 0.005 > 0.05 — TC/(mmol/L) 4.16±1.05 4.27±0.99 4.25±0.98 4.26±1.01 0.21* > 0.05 1.016 TG/(mmol/L) 1.95±1.39 2.41±1.23 2.54±1.47 2.47±1.44 3.09* < 0.05 1.898 LDL-C/(mmol/L) 2.08±1.22 2.36±0.99 2.39±1.01 2.34±1.03 1.50* > 0.05 1.141 HDL/(mmol/L) 0.98±0.31 0.97±0.30 0.94±0.29 0.95±0.32 0.29* > 0.05 0.093 UA/(μmol/L) 327.82±94.26 332.14±93.57 334.02±95.24 336.36±94.89 0.11* align=""0.05 8 918.133 BMI /(kg/m2) 25.35±3.32 25.21±3.29 25.40±3.40 25.44±3.38 0.07* > 0.05 11.181 *示F值 表 2 动态血压参数比较(x±s; mmHg)
变量 冠脉正常组
(n=85)单支病变组
(n=91)双支病变组
(n=77)三支病变组
(n=69)F P MS组内 24 hASBP 114.69±10.01 120.83±11.65** 124.32±13.27** 126.34±13.85**△ 13.94 < 0.01 147.984 24 hADBP 78.12±9.78 76.03±8.39 73.28±9.77** 72.94±9.06** 5.54 < 0.01 85.553 dASBP 115.18±12.34 117.58±12.99 124.28±13.75**△△ 126.53±13.97**△△ 12.94 < 0.01 174.898 dADBP 76.02±9.79 74.69±9.14 69.34±9.97**△△ 67.85±6.98**△△ 14.98 < 0.01 83.135 nASBP 106.33±11.26 117.83±13.36** 121.54±14.85** 125.96±13.09**△△# 32.32 < 0.01 173.351 nADBP 65.94±9.33 65.53±7.68 58.97±7.88**△△ 56.85±9.81**△△ 22.09 < 0.01 75.106 24 hAPP 36.07±6.96 43.11±7.90 51.82±11.85**△△ 53.92±9.88**△△ 62.98 < 0.01 84.893 dAPP 37.34±7.75 42.91±9.77** 52.69±11.22**△△ 55.87±11.84**△△ 56.06 < 0.01 102.944 nAPP 42.11±7.83 53.24±9.37** 61.08±8.92**△△ 66.08±11.71**△△# # 95.92 < 0.01 89.381 hSBP 123.17±210.04 144.24±18.33 155.72±19.38 174.81±24.21* 3.01 < 0.05 11 963.683 hDBP 79.71±9.89 80.03±12.98 81.84±10.77 78.92±12.56 0.84 > 0.05 134.975 ISBP 101.87±15.63 103.02±12.77 104.13±17.21 104.98±13.57 0.64 > 0.05 220.847 IDBP 52.54±4.35 54.27±7.24 53.82±8.44 52.94±6.75 1.14 > 0.05 46.601 诊室SBP 118.82±16.25 121.02±16.36 131.24±18.91**△△ 135.12±18.92**△△ 15.71 < 0.01 307.510 诊室DBP 74.21±8.93 73.82±12.13 74.92±13.51 68.57±13.11*△△# # 4.25 < 0.01 143.081 诊室PP 44.57±8.02 46.34±9.82 56.13±9.16**△△ 65.23±10.59**△△# # 79.17 < 0.01 88.317 q检验:与冠脉正常组比较*P < 0.05,** P < 0.01;与单支病变组比较△P < 0.05;与双支病变组比较#P < 0.05,## P < 0.01 表 3 动态血压模式与冠脉病变严重程度[n;构成比(%)]
模式 冠脉正常
(n=85)单支病变
(n=91)双支病变
(n=77)三支病变
(n=69)χ2 P 杓型血压(n=68) 42(61.76) 17(25.00) 6(8.82) 3(4.41) 60.84 < 0.01 非杓型血压(n=90) 16(17.78) 30(33.33) 25(27.78) 19(21.11) 5.42 > 0.05 反杓型血压(n=106) 11(10.38) 26(24.53) 32(30.19) 37(34.90) 32.03 < 0.01 超杓型血压(n=58) 16(27.59) 18(31.03) 14(24.14) 10(17.24) 0.81 > 0.05 表 4 多因素分析冠心病的相关危险因素
变量 B SE Waldχ2 OR 95%CI P 性别 -1.239 0.408 9.230 0.290 0.130~0.644 < 0.01 年龄 -0.065 0.016 16.787 0.937 0.908~2.916 < 0.01 吸烟 1.404 0.382 13.475 4.070 1.924~8.611 < 0.01 饮酒 0.016 0.008 3.641 1.016 1.000~1.033 > 0.05 糖尿病 2.000 0.501 15.957 7.392 2.770~19.724 < 0.01 BMI -0.059 0.035 2.777 0.943 0.880~1.010 > 0.05 UA 0.001 0.002 0.683 1.001 0.998~1.005 > 0.05 24 hASBP 0.406 0.200 4.105 1.500 1.013~2.221 < 0.05 24 hADBP -0.150 0.265 0.323 0.860 0.512~1.445 > 0.05 dASBP -0.379 0.176 4.639 1.684 0.485~1.966 < 0.05 dADBP 0.327 0.220 2.218 1.387 0.902~2.134 > 0.05 nASBP -0.133 0.072 3.403 0.876 0.760~1.008 > 0.05 nADBP 0.061 0.090 0.456 1.062 0.981~1.266 > 0.05 24 hAPP -0.613 0.180 11.640 1.542 0.381~2.770 < 0.01 dAPP 0.622 0.180 11.932 1.863 1.309~2.653 < 0.01 nAPP -0.586 0.178 10.865 1.557 0.393~2.789 < 0.01 hSBP -0.040 0.040 1.027 0.961 0.887~1.038 > 0.05 hDBP -0.150 0.265 0.323 0.860 0.512~1.445 > 0.05 ISBP 0.000 0.002 0.050 1.000 0.997~1.003 > 0.05 IDBP -0.019 0.040 0.221 0.981 0.907~1.012 > 0.05 -
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