高血压患者脉压及脉压指数与冠心病的关系
本文选题:冠心病 + 高血压 ; 参考:《北京协和医学院》2017年硕士论文
【摘要】:第一部分北京市成人高血压患者脉压及脉压指数与冠心病的关系研究目的探讨北京市成人高血压患者的脉压(Pulse Pressure,PP)和脉压指数(Pulse Pressure Index,PPI)与冠心病的关系。研究方法本研究选取2011年“北京市心脑肾及糖尿病慢性病流行病学综合调查研究”中的高血压患者为研究对象。收集研究对象的性别、年龄、地区、受教育水平等基本资料。血压测量选用统一的欧姆龙HEM/770A电子血压计,收缩压(Systolic Blood Pressure,SBP)≥140 mmHg(mmHg=0.133 kPa)和(或)舒张压(Diastolic Blood Pressure,DBP)≥90 mmHg和(或)近两周内服用过降压药者定义为高血压患者。PP为SBP与DBP之差,PPI为PP与SBP的比值。了解北京市成人高血压患者PP和PPI的水平和特点,采用Logistic回归模型探讨PP和PPI与冠心病的关系。研究结果共有7 563例北京市成人高血压患者纳入本次研究。研究对象的平均年龄为(51.7±12.4)岁,其中有4 102例(54.2%)男性,年龄在18~59岁之间的研究对象有5 806例(76.8%),冠心病患者有799例(10.6%)。老年(60~79岁)高血压患者的PP和PPI均高于青、中年(18~59岁)高血压患者(PP:68.1 mmHg vs.52.4 mmHg,P0.001;PPI:0.44vs.0.36,P0.001)。高血压合并冠心病患者的 PP 和PPI均高于高血压未合并冠心病者(PP:61.0 mmHg vs.55.5 mmHg,P0.001;PPI:0.41 vs.0.37,P0.001),且不同性别、地区等研究对象中均存在此现象。Logistic回归分析结果显示,单因素分析中高血压患者的PP和PPI均与冠心病相关[PP:比值比(Odds Ratio,OR)=1.25,95%置信区间(Confidence Interval,CI):1.20~1.31,P0.001;PPI:OR=1.93,95%CI:1.75~2.13,P0.001];调整年龄、性别、体质指数、地区、受教育水平、当前吸烟和饮酒后的多因素分析结果显示,高血压患者的PP与冠心病的相关性无统计学意义,而PPI仍与冠心病相关(OR=1.18,95%CI:1.04~1.33,P=0.008);进一步调整是否服用降压药后,高血压患者的PP和PPI与冠心病的相关性均无统计学意义。研究结论北京市成人高血压患者中,合并冠心病者的PP和PPI均高于未合并冠心病者。调整年龄、性别、体质指数、地区、受教育水平、当前吸烟和饮酒后,高血压患者的PPI仍与冠心病相关;进一步调整是否服用降压药后,上述相关性无统计学意义。第二部分高血压患者动态脉压及脉压指数与冠心病的关系研究目的探讨高血压患者的24小时动态脉压(24-hour Ambulatory Pulse Pressure,24hPP)、24 小时动态脉压指数(24-hour Ambulatory Pulse Pressure Index,24hPPI)和夜间动态脉压指数(Night-time Ambulatory Pulse Pressure Index,NPPI)与冠心病的关系,为高血压患者的动态脉压及脉压指数的临床应用提供参考。研究方法研究对象均选自2016年5月至2016年7月在中国医学科学院阜外医院进行动态血压监测(Ambulatory Blood Pressure Monitoring,ABPM)者,ABPM 有效读数需≥75%。详细询问研究对象的一般资料,记录年龄、性别、身高、体重、近两周内是否服用降压药等基本信息。24小时平均收缩压(24-hour Mean Systolic Blood Pressure,24hSBP)≥ 130mmHg(1 mmHg=0.133 kPa)和(或)24 小时平均舒张压(24-hour Mean Diastolic Blood Pressure,24hDBP)≥80mmHg 和(或)近两周内服用降压药的研究对象定义为高血压患者。根据ABPM数据计算研究对象的24hPP、24hPPI和NPPI,并分析它们与冠心病的相关性,比较各指标对冠心病的风险评估和预测价值的优劣。24hPP为24hSBP与24hDBP之差,24hPPI为24hPP与24hSBP的比值,NPPI为夜间(22:00~次日06:00)平均PP与平均SBP的比值。研究结果共有305例在中国医学科学院阜外医院进行ABPM者纳入本次研究。研究对象平均年龄为(58.2± 14.4)岁,其中男性172例(56.4%),高血压患者222例(72.8%)。高血压患者的24hPP、24hPPI和NPPI均高于血压正常者(24hPP:49.0 mmHg vs.42.2 mmHg,P0.001;24hPPI:0.39 vs.0.37,P=0.004;NPPI:0.40 vs.0.38,P=0.009)。高血压患者中,共有116例(52.3%)冠心病患者,冠心病患者的24hPP、24hPPI和 NPPI 均高于无冠心病者(24hPP:50.9 mmHg vs.47.0 mmHg,P=0.013;24hPPI:0.41vs.0.38,P0.001;NPPI:0.42vs.0.38,P0.001);而在血压正常者中,冠心病患者和无冠心病者上述指标之间的差异均无统计学意义。Logistic回归模型结果显示,单因素分析中高血压患者的24hPP、24hPPI和NPPI均与冠心病相关[24hPP:比值比(Odds Ratio,OR)=1.35,95%置信区间(Confidence Interval,CI):1.06~1.72,P=0.014;24hPPI:OR=2.46,95%CI:1.57~3.86,P0.001;NPPI:OR=2.56,95%CI:1.66~3.95,P0.001];调整年龄、性别、体质指数、是否服用降压药后只有 24hPPI 和 NPPI 与冠心病相关(24hPPI:OR=1.98,95%CI:1.11~3.52,P=0.021;NPPI:OR=2.26,95%CI:1.29~3.97,P=0.004)。受试者工作特征曲线(Receiver Operator Characteristic Curve,ROC曲线)分析结果显示高血压患者的24hPPI和NPPI对冠心病预测价值的ROC曲线下面积均大于24hPP。研究结论高血压患者的24hPPI和NPPI与冠心病密切相关,有助于临床上高血压患者合并冠心病的预测和诊断,且效果优于24hPP。
[Abstract]:Part 1 the relationship between pulse pressure and pulse pressure index (PPI) and coronary heart disease (CHD) in adults with high blood pressure in Beijing, the relationship between pulse pressure (Pulse Pressure, PP) and pulse pressure index (Pulse Pressure Index, PPI) and coronary heart disease in adults with high blood pressure in Beijing city was studied. The research methods selected "Beijing cardio brain kidney and diabetes chronic disease" in 2011 Basic data on the sex, age, area and education level of the subjects were collected. The blood pressure measurement was selected by a unified OMRON HEM/770A electronic sphygmomanometer, Systolic Blood Pressure (SBP) or more than 140 mmHg (mmHg=0.133 kPa) and (or) diastolic pressure (Diastolic Blo). Od Pressure, DBP) more than 90 mmHg and (or) those who had taken antihypertensive drugs within nearly two weeks were defined as the difference between SBP and DBP in hypertensive patients and the ratio of PPI to PP and SBP. To understand the level and characteristics of PP and PPI in adult hypertensive patients in Beijing, the relationship between them and coronary heart disease was investigated with the regression model. The results of the study included 7563 cases in Beijing. The average age of the subjects was (51.7 + 12.4) years, including 4102 (54.2%) men, 5806 (76.8%) and 799 (10.6%) for coronary heart disease (10.6%). The PP and PPI of the elderly (60~79 years old) high blood pressure patients were higher than those of young people (18~59 years old). PP:68.1 mmHg vs.52.4 mmHg, P0.001; PPI:0.44vs.0.36, P0.001). The PP and PPI in patients with hypertension and coronary heart disease are higher than those of hypertension without coronary heart disease (PP:61.0 mmHg vs.55.5). In the analysis of hypertension, PP and PPI were all associated with the [PP: ratio of coronary heart disease (Odds Ratio, OR) =1.25,95% confidence interval (Confidence Interval, CI): 1.20 ~ 1.31, P0.001; PPI:OR=1.93,95%CI:1.75 ~ 2.13, adjusted age, sex, body mass index, area, education, current smoking and alcohol consumption analysis results showed that There is no statistically significant correlation between PP and coronary heart disease in hypertensive patients, but PPI is still associated with coronary heart disease (OR=1.18,95%CI:1.04 ~ 1.33, P=0.008). There is no significant correlation between the correlation of PP and PPI with coronary heart disease in patients with hypertension. The conclusion is that in Beijing adult patients with hypertension, coronary heart disease is associated with coronary heart disease. Both PP and PPI were higher than those without coronary heart disease. Adjustment of age, sex, body mass index, area, education level, current smoking and drinking, the PPI of hypertensive patients is still associated with coronary heart disease; further adjustment is not statistically significant after taking antihypertensive drugs. Second the dynamic pulse pressure and pulse pressure index of partial hypertension patients The relationship between the 24 hours dynamic pulse pressure (24-hour Ambulatory Pulse Pressure, 24hPP), the 24 hour dynamic pulse pressure index (24-hour Ambulatory Pulse Pressure Index, 24hPPI) and the night dynamic pulse pressure index (24hPP) were used to study the relationship between the coronary heart disease and the coronary heart disease. The clinical application of dynamic pulse pressure and pulse pressure index of blood pressure patients was provided. The research methods were selected from the Ambulatory Blood Pressure Monitoring (ABPM) in Fuwai Hospital of the Chinese Academy of Medical Sciences from May 2016 to July 2016, and the general information on the effective reading of ABPM was required for the detailed inquiries of 75%.. Material, record age, sex, height, weight, basic information on.24 hourly mean systolic blood pressure (24-hour Mean Systolic Blood Pressure, 24hSBP) > 130mmHg (1 mmHg=0.133 kPa) and (or) 24 hour mean diastolic pressure (24-hour Mean), or (or) for nearly two weeks. The subjects were defined as hypertensive patients. According to ABPM data, 24hPP, 24hPPI and NPPI were calculated and the correlation between them and coronary heart disease was analyzed. The value of each index to the risk assessment and prediction of coronary heart disease was compared to the difference between 24hSBP and 24hDBP, 24hPPI was the ratio of 24hPP to 24hSBP, and NPPI was at night (22:00 ~ (22:00). The average age of 305 cases of ABPM in Fuwai Hospital of the Chinese Academy of Medical Sciences was (58.2 + 14.4) years old, including 172 men (56.4%) and 222 cases of hypertension (72.8%). The 24hPP, 24hPPI and NPPI of high blood pressure patients were higher than those of normal blood pressure (24hP) (24hP). The results of the study were 305 cases in Fuwai Hospital of the Chinese Academy of Medical Sciences. P:49.0 mmHg vs.42.2 mmHg, P0.001; 24hPPI:0.39 vs.0.37, P=0.004; NPPI:0.40 vs.0.38, P=0.009). In patients with hypertension, there are 116 cases (52.3%) of coronary heart disease. Among those with normal blood pressure, the difference between the coronary heart disease patients and those without coronary heart disease was not statistically significant.Logistic regression model results showed that the 24hPP, 24hPPI and NPPI in the univariate analysis were all with the [24hPP: ratio of coronary heart disease (Odds Ratio, OR) = 1.35,95% confidence interval (Confidence Interval, CI): 1.06 ~ 1.72, P=0.014; 24hPPI:OR=2.46,95%CI:1.57 ~ 3.86, P0.001; NPPI:OR=2.56,95%CI:1.66 ~ 3.95, P0.001]; adjustment of age, sex, body mass index, and whether only 24hPPI and NPPI were associated with coronary heart disease (24hPPI:OR=1.98,95%CI:1.11 ~ 3.52, P=0.021; NPPI:OR= 2.26,95%CI:1.29 to 3.97, P=0.004). The results of iver Operator Characteristic Curve, ROC curve) analysis showed that the area of 24hPPI and NPPI in hypertensive patients was greater than 24hPP. in the ROC curve predictive value for coronary heart disease. Conclusion the 24hPPI and NPPI of hypertension patients were closely related to coronary heart disease, which was helpful to the prediction and diagnosis of coronary heart disease in patients with hypertension, and the effect was effective. Better than 24hPP.
【学位授予单位】:北京协和医学院
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R544.1;R541.4
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