中青年高血压患者血压与颈动脉IMT、ABI、PWV的关联研究
发布时间：2018-03-31 18:47
本文选题：颈动脉内中膜厚度 切入点：踝臂指数 出处：《天津医科大学》2017年硕士论文
【摘要】：目的:通过检测颈动脉内中膜厚度(IMT)、踝臂指数(ABI)、脉搏波传导速度(PWV)评估中青年高血压患者的动脉硬化状况,并分析其与血压的关系,从而为早期预测及防治中青年高血压患者心血管病变提供可能的依据。方法:自9858例体检人群中选取中青年高血压患者(高血压组)及同年龄段非高血压者(对照组)各600例,高血压组男性308例,女性292例,平均年龄(47.81±7.83)岁,对照组男性317例,女性283例,平均年龄(47.48±7.98)岁。高血压患者又分为单纯舒张压增高(A组,n=125)、单纯收缩压增高(B组,n=223)及收缩压和舒张压均增高(C组,n=252)三组。排除继发性高血压、糖尿病、恶性肿瘤、主要脏器功能严重衰竭等患者。采用现场问卷调查方式收集研究对象的年龄、性别、高血压史、吸烟史、饮酒史等信息,测量所有入选者的体重指数(BMI)、收缩压(SBP)、舒张压(DBP),空腹取血检测总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、总胆红素(TB)、直接胆红素(DB)、尿酸(UA)、肌酐(Cr)、尿素氮(BUN)、血糖(FBS)等血清学指标。应用颈动脉彩超观察颈动脉斑块,测量颈动脉IMT,计算斑块积分。应用动脉硬化检查仪测定ABI及PWV,数据采用SPSS22.0软件包和SAS9.3软件包进行统计分析,以双侧p0.05界定差异具有统计学意义。结果:⑴高血压组与对照组间性别、年龄无明显差异(p0.05)。高血压组BMI、SBP、DBP均高于对照组(p0.05)。高血压组有吸烟或饮酒习惯者及有糖尿病、高血压或冠心病家族史者占比显著大于对照组(p0.05)。⑵高血压组TG、UA、BUN、Cr、FBS均高于对照组,HDL-C低于对照组(p0.05);而TC、LDL-C、TB、DB两组间均无统计学差异(p0.05)。⑶与对照组相比高血压组颈动脉IMT水平、IMT增厚者占比及颈动脉斑块检出率明显增高(p0.05);斑块积分明显增大,其中斑块积分≥5.0者显著增多(均p0.05)。⑷高血压组ABI、ba PWV水平及ABI、ba PWV异常者检出率均高于对照组(p0.05)。⑸经多元Logistic分析,BMI、TG、Cr、BUN、FBS的升高为高血压患病的危险因素。吸烟、有糖尿病或高血压家族史者更易罹患高血压。⑹高血压、年龄与ABI呈显著正相关而LDL-C与ABI呈显著负相关(p0.05);高血压、TG、FBS与ba PWV呈显著正相关(p0.05);高血压、年龄、BMI、LDL-C、UA、FBS与颈动脉IMT呈显著正相关而HDL-C与其呈负相关(p0.05);相比于女性,男性中ba PWV升高及IMT增厚者更为多见。⑺ABI、ba PWV在A、B、C三组呈逐渐增高趋势;B组颈动脉IMT高于A、C二组。⑻分别以SBP、DBP、脉压(DP)评估ABI、ba PWV及IMT,曲线下面积在ba PWV为SBPDBPDP;在ABI和IMT均为SBPDBP≈DP。评估ABI、ba PWV、IMT异常的对应AUC(OCP)分别为0.76(137.5mm Hg)、0.80(132.5mm Hg)和0.72(127.5mm Hg)。结论:⑴BMI,TG、Cr、BUN、FBS、吸烟、饮酒、糖尿病及/或高血压家族史可能为中青年高血压患者动脉硬化的危险因素。⑵中青年高血压患者存在动脉壁的结构改变,表现为颈动脉IMT增厚及斑块积分增大。⑶中青年高血压患者ABI、ba PWV水平及其ABI、ba PWV异常者检出率均高于同龄血压正常对照组,提示其动脉硬化和钙化的存在更为明显。⑷C组ABI、ba PWV改变较A、B组更显著,提示SBP和DBP均高对动脉硬化具有更大的危害性。⑸单纯SBP增高患者IMT增厚最为明显,且以SBP评价ABI、ba PWV的曲线下面积最大,提示SBP的升高可能与动脉硬化的关系更为密切。⑹颈动脉超声、ABI、ba PWV无创评估动脉硬化方便可行,但鉴于本研究例数尚少,部分结果尚需加大样本进一步证实。
[Abstract]:Objective: to detect the carotid artery intima-media thickness (IMT), ankle brachial index (ABI), pulse wave velocity (PWV) assessment of atherosclerosis in middle-aged hypertensive patients, and analyze its relationship with blood pressure, so as to provide the basis for early cardiovascular disease may young patients with hypertension. Methods in prediction and prevention: the selection of young patients with hypertension from 9858 cases in patients with hypertension (hypertension group) and the same age (control group) 600 cases, hypertension group male 308 cases, female 292 cases, average age (47.81 + 7.83), the control group 317 cases were male, 283 were female, the average age (47.48 + 7.98) years old. Patients with hypertension was divided into simple diastolic Ya Zenggao (group A, n=125), isolated systolic hypertension (B group, n=223) and systolic blood pressure and diastolic blood pressure were increased (group C, n=252) three groups. To exclude secondary high blood pressure, diabetes, cancer, organ function in severe failure Patients. Questionnaire survey collected the age, gender, history of hypertension, smoking history, drinking history and other information, all subjects measured body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting serum total cholesterol (TC), triglyceride (TG). Low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total bilirubin (TB), direct bilirubin (DB), uric acid (UA), creatinine (Cr), urea nitrogen (BUN), blood glucose (FBS) serum. Application of carotid artery ultrasound observation of carotid artery plaque the measurement of carotid artery IMT, plaque integral calculation. The determination of ABI and PWV application of arteriosclerosis detection instrument, data were analyzed by SPSS22.0 software and SAS9.3 software, to define the bilateral P0.05 difference was statistically significant. Results: the hypertension group and control group had no significant difference between gender, age (P0.05). The hypertension group BMI. SBP, DBP Higher than that of the control group (P0.05). The hypertension group have the habit of smoking or drinking, diabetes, family history of hypertension or coronary heart disease accounted for significantly greater than the control group (P0.05). The hypertension group TG, UA, BUN, Cr, FBS were higher than the control group, HDL-C was lower than the control group (P0.05); TC, LDL-C, TB, DB between the two groups were not statistically significant (P0.05). Results compared with the control group IMT group carotid artery hypertension, IMT and thickening of carotid artery plaque detection rate increased significantly (P0.05); plaque score increased significantly, of which more than 5 were significantly increased plaque score (P0.05). The hypertension group ABI, BA PWV and ABI Ba level, PWV abnormal detection rate was higher than that of control group (P0.05). The multivariate analysis of Logistic, BMI, TG, Cr, BUN, FBS increased as the risk factors of hypertension. Smoking, diabetes or a family history of hypertension are more likely to suffer from hypertension. Such as hypertension, age and ABI was significantly positive 鐩稿叧鑰孡DL-C涓嶢BI鍛堟樉钁楄礋鐩稿叧(p0.05);楂樿鍘，
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