血压负荷与颈动脉粥样硬化的关系

发布时间：2018-04-22 20:30

本文选题：血压 + 血压负荷　；参考：《重庆医科大学》2014年硕士论文

【摘要】：研究背景与目的：血压与颈动脉硬化的存在相关性已有较多文献证实，但多为研究偶测血压与颈动脉硬化的关系[1]。偶测血压对患者真实血压的反应受到较多因素影响，例如测量者水平、白大褂高血压、服药的规律性、血压控制情况等，对真实血压的反应存在局限。动态血压在临床越来越受到医生的重视，可以通过动态血压监测观察到血压波动情况、昼夜节律、晨峰血压等，对指导临床工作很有意义[2]。本临床研究通过收集病人的动态血压指标，探讨病人血压负荷与颈部粥样硬化（CIMT增厚或颈部斑块性质）之间的关系。方法：所有入选患者均为2012年1月至2013年12月在重医附二院神经内科住院治疗患者，符合纳入排除标准，收集24小时动态血压指标（包括血压负荷及平均血压）、吸烟饮酒史、代谢指标、HBP病程、血压控制情况，彩超测定CIMT、颈动脉斑块性质等。血压负荷分为3个等级（0~10%，10~40%，40%以上），CIMT大于1mm记为增厚，斑块性质分为无斑块、硬斑、混合斑、软斑。使用Logistic回归分析研究血压负荷与CIMT增厚、血压负荷与颈动脉斑块性质的关系。结果：（1）白昼SBPL（10-40%）是白昼SBPL（0-10%)造成CIMT增厚的6.68倍（OR：6.68,95%CI：1.22~36.46），，白昼SBPL（40%）较白昼SBPL（0-10%）造成CIMT明显增厚(OR：133,95%CI：13~1335)，CIMT增厚与白昼SBPL存在相关性，将一般情况、代谢因素、既往病史、服药史等相关变量带入模型一起分析仍能得出同样结论。即白昼SBPL越重CIMT增厚越明显。（2）CIMT增厚除与白昼SBPL明显相关，还与脑卒中病史、总胆固醇水平、降压药服用史、降脂药服用史存在相关性(P0.05)。CIMT增厚与性别、吸烟史、饮酒史、心脏病史、糖尿病史、服用降糖药、空腹血糖、血CRP、TG、LDL、HDL等无明显相关性（P0.05）。（3）同时考虑代谢、吸烟等相关影响因素后，斑块性质与血压负荷之间的相关性无统计学差异。结论：（1）中老年人的CIMT增厚与白昼SBPL存在正相关，白昼SBPL越重颈动脉硬化越重，白昼SBPL是CIMT增厚的独立影响因素。（2）CIMT增厚与脑卒中病史、总胆固醇水平、降压药、降脂药服用史也存在关联性，脑卒中病史、高胆固醇血症是颈动脉硬化的危险因素，规律服用降压药、降脂药是预防颈动脉硬化的保护因素。（3）中老年高血压病人颈动脉斑块性质与血压负荷未见明显相关性。
[Abstract]:Background and objective: the correlation between blood pressure and carotid atherosclerosis has been confirmed in many literatures, but the relationship between occasional blood pressure and carotid arteriosclerosis has been studied [1]. The response of occasional blood pressure to patients' real blood pressure is affected by many factors, such as the level of the measured person, white coat hypertension, the regularity of taking medicine, the blood pressure control and so on, and the reaction to the real blood pressure is limited. Ambulatory blood pressure (ABBP) has been paid more and more attention by doctors in clinic. The fluctuation of blood pressure, circadian rhythm, morning peak blood pressure and so on can be observed through ambulatory blood pressure monitoring, which is of great significance in guiding clinical work. This clinical study was conducted to investigate the relationship between blood pressure load and CIMT thickening or cervical plaques in patients with cervical atherosclerosis by collecting ambulatory blood pressure indexes. Methods: all the patients were admitted to the Department of Neurology, second affiliated Hospital from January 2012 to December 2013. They met the exclusion criteria and collected 24 hour ambulatory blood pressure indexes (including blood pressure load and mean blood pressure), smoking and drinking history. The course of HBP, blood pressure control, CIMT and carotid plaque were measured by color Doppler ultrasound. The blood pressure load was divided into 3 grades. More than 40% CIMT was more than 1mm recorded as thickening. The plaque nature was divided into no plaque, hard spot, mixed spot and soft spot. Logistic regression analysis was used to study the relationship between blood pressure load and CIMT thickening, blood pressure load and carotid plaque. Results: (1) it was the daytime SBPLT 10-40) that caused the thickening of CIMT by 6.68 times (OR 6.68 / 95 CI: 1.22N 36.46) and the daytime SBPLL (40) than the daytime SBPLL (0-10).) the thickening of CIMT was significantly increased by ORW 13395CIW 131335CIMT, which was related to the daytime SBPL, and the general situation, metabolic factors, past medical history, and the following factors were also found to be related to the thickening of the CIMT in the day, and the results showed that there was a significant correlation between the thickening of the CIMT and the SBPL during the day, so that there was a significant correlation between the thickening of the CIMT and the diurnal SBPL. The same conclusion can still be drawn from the analysis of related variables such as the history of medication into the model. That is to say, the thicker the day SBPL, the more obvious the thickening of CIMT. The thickening of CIMT is related not only to the daytime SBPL, but also to the history of stroke, the level of total cholesterol, the history of taking antihypertensive drugs, the history of taking lipid-lowering drugs, the thickening of CIMT with sex, the history of smoking, and the history of drinking. History of heart disease, diabetes mellitus, taking hypoglycemic drugs, fasting blood glucose, serum CRP TGG LDLU HDL, etc.) there was no statistical difference between plaque nature and blood pressure load after taking into account the related factors of metabolism, smoking and so on. Conclusion there is a positive correlation between CIMT thickening and daytime SBPL in middle and old people. The more severe carotid arteriosclerosis in daytime SBPL, the more severe carotid arteriosclerosis. Day SBPL is an independent influencing factor of CIMT thickening. The thickening of SBPL is associated with stroke history, total cholesterol level and antihypertensive drugs. The history of taking lipid-lowering drugs is also related to the history of stroke, hypercholesterolemia is a risk factor of carotid atherosclerosis, regular use of antihypertensive drugs, Lipid lowering drug is the protective factor of preventing carotid arteriosclerosis. There is no significant correlation between carotid plaque character and blood pressure load in middle-aged and elderly patients with hypertension.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R544.1

【参考文献】