高血压伴或不伴2型糖尿病患者血压晨峰与冠脉病变的相关性研究

发布时间：2018-03-15 21:53

本文选题：高血压　切入点：血压晨峰　出处：《第三军医大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景及目的:近年来,冠心病在全球范围内的发病率越日益增高,致病因素多样性导致不易有效预防其发生,而疾病初期无明显症状导致其发展并预后不佳,目前我们临床上诊断冠心病的最重要的方法为冠脉CTA检查和冠脉造影检查(Coronary angiography,CAG),但大多数基层或远离城市的医疗单位不能有效开展,寻找更方便易开展的检查方法是有必要的。动态血压监测(Ambulatory blood pressure monitoring,ABPM)是对患者全天(包括睡眠时)不间断进行血压监测,获取相关血压参数并分析,可以有效的避免白大衣高血压(White Coat Hypertension,WCH)及漏诊隐匿性高血压(Masked Hypertension,MH)。高血压是冠心病的独立危险因素,有研究表明,高血压患者血压晨峰和心脑血管疾病及高血压靶器官损害存在相关性,且血压晨峰也被多个研究证明可以独立预测心血管事件的发生,而大量的研究证实合并糖尿病的高血压患者较单纯高血压患者其相关病死率、微血管病发生率均显著升高,同时患有糖尿病和高血压会使心血管疾病患者心脑血管事件风险增加,目前高血压合并糖尿病的血压晨峰患者对冠状动脉影响的研究尚少。本研究旨在探讨高血压合并2型糖尿病患者血压晨峰的特点及其与冠脉病变之间的关系,分析其影响因素及发生机制,从而为降低心血管事件的发生提供理论及临床依据。方法:1.选择2014年1月至2015年8月我科住院的原发性高血压患者244例,其中男性118例,女性126例,年龄(64.7±11.5)岁;2.采集所有研究对象的临床相关资料及实验室检查结果;3.患者入院后使用进行动态血压监测(ABPM),记录白天、夜间的收缩压、舒张压,并计算血压晨峰值(MBPS),根据是否合并糖尿病及其动态血压监测结果将其分为4组:糖尿病晨峰组(D-S,36例)、糖尿病非晨峰组(D-nS,56例)、非糖尿病晨峰组(nD-S,72例)、非糖尿病非晨峰组(nD-nS,80例),比较四组患者动态血压参数情况;4.入选的244例患者全部进行冠状动脉造影检查(CAG,Coronary arteriography),根据造影结果记录冠状动脉病变支数,根据病变支狭窄程度计算每例患者的冠状动脉总积分,作为冠状动脉狭窄程度判断指标的标准,分别比较4组患者冠状动脉病变严重程度。结果:1.糖尿病晨峰组、糖尿病非晨峰组和非糖尿病晨峰组24 h平均收缩压、白天平均收缩压均高于非糖尿病非晨峰组(P0.05);糖尿病晨峰组24 h平均舒张压、白天平均舒张压高于糖尿病非晨峰组、非糖尿病晨峰组和非糖尿病非晨峰组(P0.05);2.晨峰组三支病变率、C型病变率及晨峰组Gensini总积分显著高于非晨峰组(P0.01);3.Pearson相关分析显示,冠状动脉病变严重程度与年龄(r=0.786,P0.05)、BMI(0.284,P0.05)、空腹血糖(r=0.712,P0.05)、LDL-C(r=0.765,P0.05)、晨峰程度(r=0.852,P0.05)及24 h MSBP(r=0.804,P0.05)呈正相关;4.多元线性回归分析显示,Age、FBG、24 hMSBP及MBPS为冠脉病变程度独立危险因素。结论:1.原发性高血压患者单独合并糖尿病或MBPS时,主要表现为收缩压的升高,当两者同时存在时,表现为收缩压升高的基础上舒张压也升高,这类患者在临床上可能更加应该注重降压治疗,此为高血压的治疗提供了一些新思路。2.对于伴或不伴糖尿病的高血压患者来说,有效控制该类患者的晨峰血压及24 h长效平稳的降压可减少对靶器官的损害,降低心血管事件发生。3.在临床工作中关注患者血糖和血压治疗达标的同时,也要关注血压晨峰现象,关注其对冠脉病变的影响。
[Abstract]:Background and purpose: in recent years, the morbidity of coronary heart disease in the worldwide rate is increasing, the diversity of pathogenic factors leading to difficult to effectively prevent its occurrence, and the onset of the disease had no obvious symptoms in its development and poor prognosis, the most important method we present clinical diagnosis of coronary heart disease were coronary CTA examination and coronary angiography (Coronary angiography, CAG), but the most basic or away from the city's medical units can not be effectively carried out, looking for more convenient and easy to carry out the inspection method is necessary. Ambulatory blood pressure monitoring (Ambulatory blood pressure monitoring, ABPM) is the patient all day long (including sleep) continuous blood pressure monitoring and analysis, access to relevant parameters of blood pressure and can effectively avoid the white coat hypertension (White Coat, Hypertension, WCH) and missed diagnosis of occult hypertension (Masked, Hypertension, MH). Hypertension is coronary heart disease alone Independent risk factors, studies have shown that the correlation between hypertension morning peak and cardiovascular disease and hypertension target organ damage, and the morning peak blood pressure was also shown in multiple studies can independently predict cardiovascular events, and a large number of studies have confirmed that patients with hypertension and diabetes than patients with simple hypertension related mortality, microvascular the disease incidence rate increased significantly, with diabetes and hypertension can cause cardiovascular disease in patients with increased risk of cardiovascular events, the morning surge in blood pressure in patients with hypertension and diabetes mellitus on coronary artery effect is less. The purpose of this study was to investigate the relationship between characteristics of hypertension with morning blood pressure surge in patients with type 2 diabetes and coronary artery disease and analyze the influencing factors and mechanism, so as to provide theoretical and clinical basis for reducing cardiovascular events. Methods: 1. From January 2014 to August 2015 in our hospital 244 Cases of hypertensive patients, including 118 cases of male, female 126 cases, age (64.7 + 11.5) years; the related clinical data and laboratory results of 2. acquisition of all subjects; 3. patients admitted to the hospital after the use of ambulatory blood pressure monitoring (ABPM), recorded during the day nighttime systolic blood pressure, diastolic blood pressure, and calculate the morning blood pressure peak (MBPS), according to whether complicated with diabetes mellitus and dynamic blood pressure monitoring results will be divided into 4 groups: diabetes mellitus group morning peak (D-S, 36 cases) and non diabetes group (56 cases of morning peak D-nS), non-diabetic group (nD-S, morning peak 72 cases of non diabetes), morning peak group (nD-nS, n = 80), patients with ambulatory blood pressure parameters between the four groups; 244 Cases of 4. patients were enrolled all coronary artery angiography (CAG Coronary arteriography), according to the results of angiography records of coronary artery lesions, according to the degree of stenosis lesions The calculation of each patient's coronary artery score, as the degree of coronary artery stenosis index for judging standard, compare the 4 groups of patients, the severity of coronary artery disease. Results: 1. diabetes morning peak group, morning peak group and non diabetes group morning peak 24 h mean systolic blood pressure of non diabetes, average systolic blood pressure was higher than that of non white day non diabetes group (P0.05); morning peak morning peak diabetes group 24 h mean diastolic blood pressure, daytime average diastolic blood pressure is higher than the non diabetes group morning peak, non peak morning diabetes group and non diabetes group (P0.05) morning peak; 2. morning peak group three branch lesions, C disease rate and the morning peak group the total score of Gensini was significantly higher than that in non Mbps group (P0.01); 3.Pearson correlation analysis showed that the severity of coronary artery disease and age (r=0.786, P0.05), BMI (0.284, P0.05), fasting blood glucose (r=0.712, P0.05), LDL-C (r=0.765, P0.05), morning peak level (r=0.852, P0.05) and 24 h MSBP (r=0.804, P0.05) 4. positive correlation; multiple linear regression analysis showed that Age, FBG, hMSBP 24 and MBPS were the independent risk factors. Conclusion: the severity of coronary artery lesions in 1. patients with essential hypertension complicated with diabetes alone or MBPS, mainly for the elevated systolic blood pressure, when both exist at the same time, performance based on the diastolic systolic blood pressure the pressure also increased, these patients may be more attention should be paid to antihypertensive therapy in clinic, provides some new ideas for.2. in hypertensive patients with or without diabetes for the treatment of hypertension, effective control of the patients in the morning peak blood pressure and 24 h long-term stable pressure can reduce the damage to the target organ. To reduce the incidence of cardiovascular events in.3. on standard blood glucose and blood pressure in patients in the clinical work, but also should pay attention to morning blood pressure surge, concerned about its impact on coronary artery disease.

【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1;R587.1

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