老年高血压病患者血清胱抑素C、左室质量指数、心踝血管指数与动态脉压指数的关系及其影响因素分析

发布时间：2018-04-13 15:47

本文选题：老年高血压病 + 血清胱抑素C　；参考：《华北理工大学》2017年硕士论文

【摘要】：目的血清胱抑素C(Cys C)是近年来发现早期肾脏损害的灵敏指标,它不但能够反映老年高血压病早期肾脏损害,并且也能早期预测到老年高血压病患者心血管事件。左室肥厚是老年高血压病最常见的心脏损害之一,左室质量指数(LVMI)是诊断左室肥厚的标准。心踝血管指数(CAVI)是反映老年高血压病患者的主动脉僵硬程度和血管顺应性的指标。本研究探讨老年高血压病患者血清胱抑素C、左室质量指数、心踝血管指数与动态脉压指数的关系及其影响因素的分析。方法选取2015年4月至2016年4月就诊于华北理工大学附属医院老年病科住院的老年高血压病患者符合入选标准的122例,年龄在60-86岁,入选标准均符合中国高血压防治指南的高血压诊断标准(2010)年版,对入选患者行24小时动态血压监测,并记录动态血压各数据。依据APPI值中位数将入选患者分为2组:取APPI≥0.41为A组,APPI0.41为B组。根据24小时动态血压参数计算出动态脉压指数:APPI=24小时动态脉压/24小时平均收缩压。收集患者基本资料及病史并记录,行生化检查,化验Cys C,与此同时,对入选患者行动脉硬化检测仪测算出心踝血管指数,行心脏超声,左室质量指数可根据Devereux公式算出。建立临床数据库,应用SPSS17.0统计软件完成分析。正态分布的计量资料采用均数±标准差表示。计量资料组间差异分析采用t检验,用率或者构成比来表示计数资料的分布情况,不同组间差异则采用卡方检验分析。应用Logistic回归模型分析相关因素与老年人血压变异性的相关性。变量间采用Spearman秩相关分析进行相关性研究。在单因素相关分析中,将具有相关性的指标(P0.05)全部作为自变量进入多元线性回归进行分析,分析各因素的影响程度。P0.05为差异有统计学意义。结果1 A组与B组在性别、年龄、体重指数(BMI)、心率(HR)以及生化指标空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、诊室收缩压(OSBP)、诊室舒张压(ODBP)方面差异均无统计学意义(P0.05)。2 A组Cys C、LVMI及CAVI均明显高于B组,差异有统计学意义(P0.01)。3 Cys C水平的高低与动态脉压指数(APPI)存在关系。说明Cys C水平越低,APPI水平越低;Cys C水平增高,APPI水平也随之增大,两个关系相当密切。LVMI水平的高低与APPI存在关系。说明LVMI水平越低,APPI水平越低;LVMI水平增高,APPI水平也随之增大,两个关系十分密切。CAVI水平的高低与APPI存在关系。说明CAVI水平越低,APPI水平越低;CAVI水平增高,APPI水平也随之增大,两个关系相当密切。多因素Logistic回归分析显示结果提示Cys C、LVMI、CAVI是动态脉压指数的独立危险因素(β0,OR1)。4 24h SBP、24h DBP、d SBP、n SBP均与Cys C相关,其中24h SBP、24h DBP与Cys C的相关性最大,而OSBP、ODBP与Cys C无相关性。年龄、24h SBP、24h DBP、d SBP、n SBP均与LVMI相关,其中24h SBP、24h DBP与LVMI的相关性最大,而OSBP、ODBP与LVMI无相关性。24h SBP、24h DBP、d SBP、n SBP、n DBP均与CAVI相关,其中24h SBP、24h DBP与CAVI的相关性最大,而OSBP、ODBP与CAVI无相关性。结论1在老年高血压病患者中,随着血清胱抑素C、左室质量指数、心踝血管指数水平的增大,动态脉压指数水平的也逐步增大。2在老年高血压病患者中,血清胱抑素C、左室质量指数、心踝血管指数是动态脉压指数增高的独立危险因素。3在老年高血压病患者中,24小时平均收缩压、24小时平均舒张压对Cys C、LVMI、CAVI影响最大。
[Abstract]:The purpose of serum cystatin C (Cys C) is a recently discovered sensitive indexes of early renal damage, it can not only reflect the early renal damage in elderly patients with hypertension, and also to the early prediction of elderly patients with hypertension cardiovascular events. Left ventricular hypertrophy is one of the most common cardiac damage in elderly hypertension see, left ventricular mass index (LVMI) is a diagnosis of left ventricular hypertrophy. Cardio ankle vascular index (CAVI) is a reflection of the aged patients with hypertension aortic stiffness and vascular compliance index. The study of C disease serum cystatin C in elderly patients with hypertension, left ventricular mass index, analysis the relationship and influence factors of cardio ankle vascular index and ambulatory pulse pressure index methods from April 2015 to April 2016. In North China Polytechnic University Affiliated Hospital of geriatrics Hospital of elderly patients with hypertension 122 cases, aged 60-86 Old, inclusion criteria were accorded with the diagnostic criteria of hypertension guidelines for prevention and treatment of hypertension (2010 years) of the China version, for selected patients with 24 hours ambulatory blood pressure monitoring, ambulatory blood pressure and record each data. According to the APPI value median selected patients were divided into 2 groups: APPI = 0.41, A group, APPI0.41 B group is calculated. According to the dynamic pulse pressure index of 24 hour ambulatory blood pressure parameters: APPI=24 hours ambulatory /24 hours average systolic blood pressure were collected. The basic information and the history and records for biochemical examination, laboratory Cys C, at the same time, the patients action arteriosclerosis detector calculates the cardio ankle vascular index, echocardiography, left ventricular mass index according to the Devereux formula. The establishment of clinical database, using SPSS17.0 statistical software to complete the analysis. The measurement data of normal distribution expressed by the mean and standard deviation analysis of the difference of measurement data between groups using t test, with the rate or The distribution of ratios of count data, differences between different groups using chi square test. The correlation analysis using Logistic regression analysis of related factors and the elderly blood pressure variability. Among the variables by Spearman rank correlation analysis correlation. In univariate analysis, with correlation index (P0.05) of all as the independent variable into the multivariate linear regression analysis, analysis of the factors affecting the degree of.P0.05 difference was statistically significant. Results of the 1 A group and B group in gender, age, body mass index (BMI), heart rate (HR) and the biochemical indexes of fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG). High density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), systolic blood pressure (OSBP), consulting room, consulting room, diastolic blood pressure (ODBP) has showed no significant difference (P0.05) of.2 group A Cys C, LVMI and CAVI were significantly higher than that of In B group, the difference was statistically significant (P0.01) level of.3 Cys and pulse pressure index in the level of C (APPI) Cys C. The relationship between the lower level, the lower the level of APPI increased; Cys C level, APPI level increases, the two level of APPI and.LVMI are closely related to the level of existence. The lower the LVMI level, APPI level is low; the levels of LVMI increased, the level of APPI increased two, a very close relationship between the level of APPI and.CAVI levels between CAVI. The lower level, the lower the level of APPI; the levels of CAVI increased, the level of APPI increases two, a very close relationship. Many factors Logistic regression analysis showed that the results suggest that Cys, C, LVMI, CAVI are independent risk factors of ambulatory pulse pressure index (beta 0, OR1).4 24h SBP, 24h DBP, D SBP, n SBP were associated with Cys C, the 24h SBP, 24h DBP and Cys C of the maximum correlation, and OSBP, there is no relationship between ODBP and Cys C years. At the age of 24h SBP, 24h, DBP, D, SBP, N and SBP were associated with LVMI, which 24h SBP, 24h DBP and LVMI OSBP, the maximum correlation, ODBP and LVMI had no correlation with.24h SBP, 24h DBP, D SBP, n SBP, n DBP was associated with CAVI, which 24h SBP, 24h and DBP the correlation between CAVI and OSBP, the largest, there is no correlation between ODBP and CAVI. Conclusion: 1 in elderly patients with hypertension, with serum cystatin C, left ventricular mass index, increase the cardio ankle vascular index level, index level of dynamic pulse pressure is gradually increased.2 in elderly patients with hypertension, serum cystatin C, left ventricular mass index, cardio ankle vascular index is dynamic pulse pressure index increased the independent risk factors of.3 in elderly patients with hypertension, 24 hour mean systolic pressure, mean diastolic blood pressure of LVMI for 24 hours, Cys C, CAVI has the greatest effect.

【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

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