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高血压是老年人常见的慢性病,随着高血压研究的深入,在老年原发性高血压病人评估中除了血压绝对值外,血压变异性(BPV)的作用越来越被人们重视。BPV是指一定时间内血压波动的程度,2013年欧洲高血压指南指出动态血压不仅可反映病人的血压绝对值,而且能监测BPV[1]。BPV与高血压靶器官损伤有关,是预测老年病人心脑血管事件的重要指标,决定高血压病人预后[2-3]。尿酸是人体嘌呤代谢的最终产物,老年人代谢功能及尿酸排泄功能较差,易出现血尿酸水平升高;血尿酸升高可导致高血压发病率升高,是高血压发病的独立危险因素[4-6],但目前关于血尿酸和高血压病人血压水平、BPV的相关性研究较少,尤其在老年病人中。本研究旨在了解老年高血压病人体内血尿酸水平和血压、BPV的关系,为老年人群高血压的防治提供参考。现作报道。
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2组年龄及性别比、血糖差异无统计学意义(P>0.05), 具有可比性(见表 1)。
分组 n 年龄/岁 男性[n; 百分率(%)] 血尿酸/(μmol/L) 血糖/(mmol/L) NUA组 30 80.17±9.30 23(76.67) 263.17±47.52 6.19±2.21 HUA组 31 80.52±8.40 27(87.10) 419.64±83.40 5.70±1.12 t — 0.15 1.12* 9.04# 1.09# P — >0.05 >0.05 < 0.01 >0.05 *示χ2值;#示t′值 表 1 2组一般资料比较(x±s)
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2组病人24hDBP、dDBP、nSBP和nDBP差异无统计学意义(P>0.05),NUA组nDBP和dSBP均低于HUA组(P < 0.05);NUA组24hSBPSD水平低于HUA组(P < 0.05),2组24hDBPSD差异无统计学意义(P>0.05)(见表 2)。
分组 n 24hSBP 24hDBP dSBP dDBP nSBP nDBP 24hSBPSD 24hDBPSD NUA组 30 125.80±11.32 69.20±5.01 126.53±11.88 70.40±5.03 125.13±11.83 68.10±6.58 13.31±3.25 10.98±2.68 HUA组 31 132.16±11.67 67.39±6.30 133.16±11.72 68.65±6.45 130.32±13.45 65.13±7.56 15.19±3.25 10.86±2.30 t — 2.16 1.24 2.19 1.18 1.60 1.63 2.26 0.19 P — < 0.05 >0.05 < 0.05 >0.05 >0.05 >0.05 < 0.05 >0.05 表 2 2组血压水平及BPV参数比较(x±s; mmHg)
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病人血尿酸与24hSBP、dSBP、24hSBPSD呈正相关关系(r=0.372、0.364、0.324, P < 0.05~P < 0.01)。
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A组血尿酸水平低于B组(P < 0.01);A组24hSBP、dSBP和nSBP水平低于B组(P < 0.01),2组24hDBP、dDBP、nDBP、24hSBPSD和24hDBPSD差异均无统计学意义(P>0.05)(见表 3)。
分组 n 24hSBP 24hDBP dSBP dDBP nSBP nDBP 24hSBPSD 24hDBPSD 血尿酸/(μmol/L) A组 35 120.80±6.85 67.26±5.48 121.77±6.59 69.40±5.56 119.66±7.48 65.63±6.95 13.34±3.21 11.24±2.67 310.43±93.30 B组 26 140.12±7.93 69.65±5.88 140.85±8.90 71.00±5.93 138.69±10.18 67.88±7.58 15.52±3.20 10.48±2.15 386.12±103.16 t — 10.18 1.63 9.63 1.08 8.42 1.20 2.63 1.19 2.30 P — < 0.01 >0.05 < 0.01 >0.05 < 0.01 >0.05 >0.05 >0.05 < 0.01 表 3 不同血压水平的血尿酸及动态血压参数的比较(x±s;mmHg)
老年原发性高血压病人血尿酸水平与动态血压的关系
Relationship of serum uric acid and ambulatory blood pressure in elderly patients with primary hypertension
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摘要:
目的 探讨老年原发性高血压病人体内血尿酸水平与动态血压的关系。 方法 随机选取61例老年原发性高血压病人进行24 h动态血压检查,并采血检测血尿酸水平,根据血尿酸水平中位数将病人分为尿酸正常组(NUA组)和尿酸偏高组(HUA组),比较2组24 h收缩压和舒张压平均值(24hSBP和24hDBP)、白昼收缩压和舒张压平均值(dSBP和dDBP)、夜间收缩压和舒张压平均值(nSBP和nDBP),及血压变异性(BPV)参数包括24 h收缩压标准差(24hSBPSD)、24 h舒张压标准差(24hDBPSD)。并行相关分析血尿酸水平与各动态血压参数的相关性。按24hSBP再将病人分为血压控制良好组和血压控制不良组,比较2组血尿酸水平和动态血压各参数的区别。 结果 HUA组24hSBP、dSBP和24hSBPSD均较NUA组增高(P < 0.05),并与血尿酸水平呈显著正相关关系(P < 0.05~P < 0.01);血压控制良好组血尿酸水平低于血压控制不良组(P < 0.01);血压控制良好组24hSBP、dSBP和nSBP水平均低于血压控制不良组(P < 0.01)。 结论 老年原发性高血压病人血尿酸水平越高,收缩压也随之增高,收缩压BPV也越大,监测血尿酸水平对高血压的防治有重要临床意义。 -
关键词:
- 高血压 /
- 血尿酸 /
- 血压变异 /
- 24 h动态血压检查
Abstract:Objective To explore the relationship of serum uric acid and ambulatory blood pressure in patients with primary hypertension. Methods The 24-hour ambulatory blood pressure in 61 elderly patients with primary hypertension was monitored, and the serum levels of uric acid were detected.According to the median level of serum uric acid, the patients were divided into the normal uric acid group(NUA group) and high uric acid group(HUA group).The 24 h average systolic and diastolic blood pressure(24hSBP and 24hDBP), daytime average systolic and diastolic blood pressure(dSBP and dDBP), nighttime average systolic and diastolic blood pressure(nSBP and nDBP) and blood pressure variability(BPV)[including 24-hour systolic blood pressure standard deviation(24hSBPSD) and 24-hour diastolic blood pressure standard deviation(24hDBPSD)] were compared between two groups.The correlation between serum uric acid level and blood pressure indexes was analyzed.According to 24hSBP, the patients were devided into the group with good blood pressure control and the group with poor blood pressure control, and the differences of serum uric acid level and ambulatory blood pressure parameters between the two groups were compared. Results The 24hSBP, dSBP and SBPSD in HUA group were higher than those in NUA group(P < 0.05), and significantly positively correlated with the serum uric acid level(P < 0.05 to P < 0.01).The uric acid level in the group with good blood pressure control was lower than that in the group with poor blood pressure control(P < 0.01).The levels of SBP, dSBP and nSBP in the group with good blood pressure control were lower than those in the group with poor blood pressure control(P < 0.01). Conclusions With the increasing of the level of serum uric acid in patients with primary hypertension, the systolic blood pressure and BPV increase.Monitoring the serum uric acid has important clinical significance in the prevention of hypertension. -
表 1 2组一般资料比较(x±s)
分组 n 年龄/岁 男性[n; 百分率(%)] 血尿酸/(μmol/L) 血糖/(mmol/L) NUA组 30 80.17±9.30 23(76.67) 263.17±47.52 6.19±2.21 HUA组 31 80.52±8.40 27(87.10) 419.64±83.40 5.70±1.12 t — 0.15 1.12* 9.04# 1.09# P — >0.05 >0.05 < 0.01 >0.05 *示χ2值;#示t′值 表 2 2组血压水平及BPV参数比较(x±s; mmHg)
分组 n 24hSBP 24hDBP dSBP dDBP nSBP nDBP 24hSBPSD 24hDBPSD NUA组 30 125.80±11.32 69.20±5.01 126.53±11.88 70.40±5.03 125.13±11.83 68.10±6.58 13.31±3.25 10.98±2.68 HUA组 31 132.16±11.67 67.39±6.30 133.16±11.72 68.65±6.45 130.32±13.45 65.13±7.56 15.19±3.25 10.86±2.30 t — 2.16 1.24 2.19 1.18 1.60 1.63 2.26 0.19 P — < 0.05 >0.05 < 0.05 >0.05 >0.05 >0.05 < 0.05 >0.05 表 3 不同血压水平的血尿酸及动态血压参数的比较(x±s;mmHg)
分组 n 24hSBP 24hDBP dSBP dDBP nSBP nDBP 24hSBPSD 24hDBPSD 血尿酸/(μmol/L) A组 35 120.80±6.85 67.26±5.48 121.77±6.59 69.40±5.56 119.66±7.48 65.63±6.95 13.34±3.21 11.24±2.67 310.43±93.30 B组 26 140.12±7.93 69.65±5.88 140.85±8.90 71.00±5.93 138.69±10.18 67.88±7.58 15.52±3.20 10.48±2.15 386.12±103.16 t — 10.18 1.63 9.63 1.08 8.42 1.20 2.63 1.19 2.30 P — < 0.01 >0.05 < 0.01 >0.05 < 0.01 >0.05 >0.05 >0.05 < 0.01 -
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