高血压晨峰现象与老年退行性心脏瓣膜病相关性研究

发布时间：2018-04-09 18:23

本文选题：血压晨峰　切入点：老年退行性心脏瓣膜病　出处：《河南中医药大学》2016年硕士论文

【摘要】：目的:对高血压患者心脏彩色超声和24小时动态血压监测参数及临床资料的回顾性分析及研究,探讨血压晨峰(MBPS)现象相关影响因素与老年退行性心脏瓣膜病相关性,进而为临床预防与诊疗提供指导。方法:1.对最终纳入完全符合入选标准已行心脏彩色超声检查的216例患者分析,其中男性122例,女性94例,平均年龄(75.75±8.26)岁;2.所有患者按照监测的24小时动态血压结果分组,血压晨峰增加程度是否超过35mm Hg分为晨峰组与非晨峰组,分别为99例、117例;3.采集患者血常规及生化检验、超声心动图及相关炎症因子数值;4.比较两组患者基本临床资料,24小时动态血压监测值及心脏瓣膜钙化情况,分析老年人群高血压晨峰现象发生的重要相关因素,单因素分析与心脏瓣膜钙化相关因素,进而一并行退行性心脏瓣膜的多因素Logistic回归分析。结果:1.一般资料分析本研究中共选择216例患者病例,其中男性122例,女性94例,平均年龄(75.75±8.26)岁。晨峰现象发生率为45.83%;表1可见男性晨峰现象发生率为54.54%,女性为45.46%,男性发生率与女性发生率无显著差别(P=0.680.05),晨峰组平均年龄为71.48±7.76岁,非晨峰组平均年龄68.66±6.35岁,两组年龄比较有显著统计学差异(P=0.004)。既往糖尿病史方面,晨峰组较非晨峰组有统计学差异(P=0.0450.05),在冠心病史比较来说,晨峰组较非晨峰组有显著统计学差异(P0.001);而两组在吸烟率方面差异无统计学意义(P=0.580.05)。2.(1).晨峰组心脏瓣膜钙化者比例明显高于非晨峰组患者;晨峰组主动脉瓣及主动脉瓣合并二尖瓣钙化者显著高于非晨峰组(25.26%vs 12.82%,P0.001;17.18%vs 7.69%,P0.001)。晨峰组患者退行性瓣膜钙化者51例(51.52%),非晨峰组患者退行性瓣膜钙化者31例(26.50%);(2).两组患者瓣膜退行性钙化者主要为主动脉瓣膜钙化(18.52%),其次为主动脉瓣合并二尖瓣钙化者(12.04%),单纯二尖瓣钙化者发生率为较低,未发现明显肺动脉瓣与三尖瓣钙化者。(3).动态血压参数:晨峰组平均SBP数值及晨峰数值均高于非晨峰组,差异有统计学意义(P=0.003);平均DBP比较两组差异无统计学意义(P=0.0730.05)。(4).CRP水平:晨峰组CRP数值高于非晨峰组,差异有统计学意义(P=0.0370.05)。3.(1).按年龄分为69-70岁组共52例,70-80岁组31例,80岁组16例,与小年龄段相比,晨峰程度有逐渐增长趋势,且组间差异具有统计学意义(P0.001或P0.015)。(2).上述研究显示血压晨峰现象在男女之间无统计学差异(P=0.680.05);但晨峰程度在男女之间差异却具有统计学意义(P=0.002)。4.分别以年龄、性别、吸烟史、糖尿病史、冠心病史、是否有晨峰为自变量,以是否发生瓣膜退行性病变为因变量分别进行单因素分析,依据资料类型分别采用相关分析,结果表明年龄、性别、出现血压晨峰、血压病程10年、吸烟史、糖尿病史及冠心病史皆与瓣膜退行性病变发生具有相关性(P0.05)。(见表5)LDL-C、CRP、动态血压平均SBP呈正相关(P0.05)。与性别、TC、TG、BMI及动态血压平均DBP相关性无统计学意义(P0.05)。5.采用Logistic回归分析进行影响因素的筛选;研究显示年龄、高血压病程及出现晨峰现象是心脏瓣膜退行性钙化病变重要影响因素。结论:1.高血压长病程以及出现晨峰现象与发生退行性心脏瓣膜钙化病变之间密切相关,二者是心脏瓣膜钙化病变发生发展的重要影响因素。2.年龄是出现血压晨峰现象的重要影响因素,另外与晨峰程度高低也存在密切的相关性;同时年龄也是发生老年退行性瓣膜病的危险因素;3.男女性别之间在是否出现晨峰现象方面无统计学差异,但在晨峰程度方面却存在一定的差异;
[Abstract]:Objective : To study the correlation between blood pressure ( MBPS ) and heart valve calcification in elderly hypertensive patients ( P = 0 . 0 . 0 . 0 . 0 . 0 . 0 . 05 ) . The percentage of cardiac valve calcification in the morning peak group was significantly higher than that in the non - morning peak group ( 25.26 % vs 12.82 % , P0.001 ; 17.18 % vs 7.69 % , P0.001 ) . In the morning peak group , 51 patients ( 51.52 % ) had degenerative valve calcification , 31 ( 26.50 % ) of patients with non - morning peak valve calcification , and ( 2 ) two groups of patients with valve degenerative calcification were mainly aortic valve calcification ( 18.52 % ) , followed by aortic valve calcification ( 12.04 % ) , with low incidence of simple mitral valve calcification and no significant pulmonary valve and tricuspid calcification . Dynamic blood pressure parameters : mean SBP value and morning peak value in the morning peak group were higher than those in the non - morning peak group ( P = 0.003 ) . There was no significant difference between the two groups ( P = 0.0730.05 ) . The CRP level was higher in the morning peak group than in the non - morning peak group ( P = 0.0370 . 05 ) . 3 . ( 1 ) . There were 52 cases aged 69 - 70 years of age , 31 in 70 - 80 years of age , 16 in 80 years of age , and there were gradually increasing trend of the morning peak compared with the small age group ( P 0.001 or P 0 . 015 ) . Results : 1 . The age , sex , smoking history , history of diabetes , history of coronary heart disease , history of diabetes , history of diabetes mellitus and history of coronary heart disease were correlated with the occurrence of valvular degenerative calcification ( P0.05 ) .

【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R544.1;R542.5

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