动态血压监测在单纯夜间高血压靶器官损害与预后研究中的应用

发布时间：2018-04-01 04:39

本文选题：动态血压　切入点：单纯夜间高血压　出处：《山西医科大学》2017年硕士论文

【摘要】：目的:探讨单纯夜间高血压患者的靶器官损害情况及其与动态血压监测指标的相关性,以及动态血压监测相关指标与单纯夜间高血压患者发生心脑肾不良事件的关系。方法:入选单纯夜间高血压患者(动态血压监测白天平均血压135/85mmHg和夜间平均血压≥120/70 mmHg)77例、全天高血压患者(动态血压监测白天平均血压≥135/85mmHg和夜间平均血压≥120/70 mmHg)75例和动态血压正常者(动态血压监测白天平均血压135/85mmHg和夜间平均血压120/70 mmHg和血压昼夜节律为10%~20%,晨峰血压35mmHg)79例。动态血压监测指标包括全天平均收缩压、全天平均舒张压、白天平均收缩压、白天平均舒张压、夜间平均收缩压、夜间平均舒张压、白天收缩压标准差、白天舒张压标准差、夜间收缩压标准差、夜间舒张压标准差、收缩压昼夜节律、舒张压昼夜节律、晨峰血压、动态动脉僵硬指数。颈动脉斑块、左心室肥厚和扩大、血清肌酐和尿微量白蛋白分别用于评估血管、心脏和肾脏损害。随访不良事件包括心脑肾事件(包括急性心肌梗死、心力衰竭、脑卒中、慢性肾衰及由此原因引起的患者死亡)。结果:1.单纯夜间高血压患者的左心室肥厚和扩大检出率(22.1%)和颈动脉斑块检出率(55.8%)与全天高血压患者的左心室肥厚和扩大检出率(32.0%)和颈动脉斑块检出率(68.0%)之间差异无统计学意义,但两者均高于正常组的左心室肥厚和扩大检出率(7.6%)和颈动脉斑块检出率(32.9%)(P0.0167);单纯夜间高血压患者的血清肌酐(68.0±23.5μmol/L)和尿微量白蛋白(15.9±19.6mg/L)与正常组之间差异无统计学意义,两者均小于全天高血压组患者的血清肌酐(80.9±43.1μmol/L)和尿微量白蛋白(53.5±80.0mg/L)(P0.05)。2.单纯夜间高血压患者有无颈动脉斑块的动态血压相关指标差异无统计学意义;单纯夜间高血压左心室肥厚和扩大的患者夜间平均舒张压(77.6±5.5mmHg)高于没有左心室肥厚和扩大的患者(74.9±4.6 mmHg)(P0.05);单纯夜间高血压患者有无血清肌酐异常的动态血压相关指标无统计学意义;单纯夜间高血压尿微量白蛋白异常的患者夜间收缩压标准差(14.1±3.9mmHg)和舒张压标准差(10.6±3.0mmHg)均大于尿微量白蛋白正常的患者(11.3±3.2mmHg和8.6±2.6mmHg)(P0.05)。3.单纯夜间高血压组患者的心脑肾不良事件发生率(10.4%)和全天高血压组患者的心脑肾不良事件发生率(10.7%)均高于正常组(1.3%)(P0.0167)。单因素二分类非条件logistic回归分析结果表明,单纯夜间高血压组患者的夜间平均收缩压130mmHg[OR=10.889,95%CI=(1.268,93.512)]和舒张压昼夜节律呈反杓型(0%)[OR=6.548,95%CI=(1.394,30.755)]是心脑肾不良事件发生的危险因素。多因素logistic回归分析显示夜间平均收缩压130mmHg[OR=4.095,95%CI=(0.352,47.698)]和舒张压昼夜节律呈反杓型(0%)[OR=2.112,95%CI=(0.290,15.390)]与心脑肾不良事件发生的独立相关性无统计学意义。结论:动态血压监测可用于评估单纯夜间高血压患者的靶器官损害。夜间平均收缩压和舒张压昼夜节律与心脑肾风险相关,尚未达到独立预测水平。
[Abstract]:Objective: To explore the simple night target organ damage in hypertensive patients and its correlation with ambulatory blood pressure monitoring index, and the relationship between ambulatory blood pressure monitoring in patients with isolated nocturnal hypertension cardiovascular and renal adverse events. Methods: the patients with isolated nocturnal hypertension patients (mean daytime ambulatory blood pressure monitoring and blood pressure 135/85mmHg average blood pressure at night more than 120/70 mmHg) 77 cases of patients with hypertension, all day long (ambulatory blood pressure monitoring during the daytime average blood pressure more than 135/85mmHg and average blood pressure at night more than 120/70 mmHg) and 75 cases of normal ambulatory blood pressure (ambulatory blood pressure monitoring and blood pressure 135/85mmHg mean daytime nighttime mean blood pressure and circadian rhythm of blood pressure was 120/70 mmHg 10%~20%, Mbps 35mmHg) in 79 cases. Ambulatory blood pressure monitoring indicators include all day long the average systolic blood pressure, all day long average diastolic blood pressure, daytime average systolic blood pressure, daytime average diastolic blood pressure, nighttime average closing Systolic pressure, night diastolic blood pressure, daytime systolic blood pressure standard deviation, standard deviation of daytime diastolic blood pressure, nighttime systolic blood pressure standard deviation, standard deviation of nocturnal diastolic blood pressure, systolic blood pressure, diastolic blood pressure circadian rhythm, circadian rhythm, morning peak blood pressure, ambulatory arterial stiffness index. Carotid plaque, left ventricular hypertrophy and expansion, albumin serum creatinine and urine were used to assess the vascular, heart and kidney damage. The follow-up adverse events included cardiovascular and renal events (including acute myocardial infarction, heart failure, stroke, caused by chronic renal failure and the cause of death in patients with). Results: 1. isolated nocturnal hypertension with left ventricular hypertrophy and the rate of detection rate (22.1%) and the carotid plaque (55.8%) and left ventricular hypertrophy in patients with hypertension all day long and expand the detection rate (32%) and the detection rate of carotid artery plaque (68%) there was no significant difference between the two, but were higher than the normal group left Ventricular hypertrophy detection rate (7.6%) and the detection rate of carotid plaques (32.9%) (P0.0167); isolated nocturnal hypertension patients serum creatinine (68 + 23.5 mol/L) and microalbuminuria (15.9 + 19.6mg/L) with no significant difference between the two was less than normal group, serum creatinine in patients with hypertension were all day long. (80.9 + 43.1 mol/L) and microalbuminuria (53.5 + 80.0mg/L) (P0.05) had no significant difference between.2. indexes of ambulatory blood pressure in patients with isolated nocturnal hypertension without carotid plaque; isolated nocturnal hypertension and left ventricular hypertrophy and patients with enlarged night diastolic blood pressure (77.6 + 5.5mmHg) was higher than that of no left ventricular hypertrophy and patients with enlarged (74.9 + 4.6 mmHg) (P0.05); isolated nocturnal hypertension with ambulatory blood pressure related indicators of abnormal serum creatinine was not statistically significant; isolated nocturnal hypertension with abnormal urinary albumin Nocturnal systolic blood pressure standard deviation (14.1 + 3.9mmHg) and diastolic blood pressure standard deviation (10.6 + 3.0mmHg) were higher than patients with normal urinary albumin (11.3 + 3.2mmHg and 8.6 + 2.6mmHg) (P0.05).3. incidence of isolated nocturnal hypertension in patients with cardiovascular and renal adverse events (10.4%) and the incidence of hypertension group were all day long the cardiovascular and renal adverse events (10.7%) were higher than the normal group (1.3%) (P0.0167) two. The single factor classification of non conditional logistic regression analysis indicated that the isolated nocturnal hypertension patients with nocturnal mean systolic blood pressure 130mmHg[OR=10.889,95%CI= (1.268,93.512) and diastolic blood pressure circadian rhythm in anti dipper (0%) [OR=6.548,95%CI= (1.394,30.755)] is the risk factors of cardiovascular and renal adverse events. Logistic regression analysis showed that the nighttime average systolic blood pressure 130mmHg[OR=4.095,95%CI= (0.352,47.698) and diastolic blood pressure circadian rhythm in anti dipper (0% [OR=2.112,95%C) I= (0.290,15.390)] is independently associated with cardiovascular and renal adverse events was not statistically significant. Conclusion: ambulatory blood pressure monitoring can be used to evaluate the isolated nocturnal hypertension target organ damage. The nocturnal mean systolic and diastolic blood pressure circadian rhythm and cardiovascular and renal risk has not yet reached the independent prediction level.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

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