绝经对女性高血压患者中心动脉压及动脉硬化的影响

发布时间：2018-08-03 21:12

【摘要】：目的:随着绝经时间的延长、女性高血压的患病率进一步增高、动脉硬化的程度也应进一步加重。本研究探讨不同绝经年限高血压女性患者相比同龄男性其中心动脉压及相关动脉硬化参数变化的特点,为女性绝经后高血压的管理提供理论依据。方法:选取2014年11月—2015年11月就诊于兰州大学第二医院高血压病科的高血压患者118人(女性N=51人;男性N=67人)年龄58.62±8.31,依据女性绝经年限分为近期绝经组(绝经年限小于5年,N=25人;年龄52.20±3.70)及远期绝经组(绝经年限大于5年,N=26人;年龄65.15±5.92)。同时分别纳入与上述两组女性换着年龄一致的男性高血压患者作为对照,其中近期对照组(N=34人;年龄51.62±4.62),远期对照组(n=33人;年龄65.55±5.23)。检测所有患者的身高、体重、腹围、血糖,血脂,并检测女性患者的性激素水平(雌二醇Estrogen、睾酮Testosterone、孕激素Progesterone),用欧姆龙电子血压计测量外周肱动脉血压,用使用Sphygmocor脉搏波分析系统间接测量中心动脉收缩压(cSBP)、中心动脉舒张压(cDBP)、中心动脉压脉压(CPP)、增强压(AP)、反射波增益指数(AIx)、75次心率增益指数校正指数(AIx75HR)及颈股动脉脉搏波传导速率(cf-PWV)。结果:(1)对于绝经年限小于5年的女性高血压患者(绝经年限=2.40±1.89)与其同龄男性高血压相比较,SBP、DBP、HR、cSBP、cDBP、cf-PWV均低于同龄男性患者,且对于SBP、DBP、cDBP,两组间差异有统计学意义(P=0.024、P=0.007、P=0.007)。绝经年限小于5年的女性高血压患者其PP、AP、CPP、AIx和AIx75HR均高于同龄男性高血压组,仅AIx75HR两组间差异具有统计学意义P0.05(P=0.035)。(2)对于绝经年限大于5年的女性高血压患者(绝经年限=16.35±6.07),与同龄男性高血压患者相比,女性组SBP、PP、HR、cSBP、CPP、AP、AIx、AIx75HR、cf-PWV均大于男性组,且两组间SBP、PP、cSBP、CPP、AP、AIx75HR差异具有统计学意义(P=0.010、P=0.001、P=0.017、P=0.002、P=0.045、P=0.007)。(3)以绝经后女性高血压患者的cSBP、cDBP、CPP、AIx75HR、cf-PWV为因变量变量,以年龄、绝经年限、高血压病史、BMI、腰围,血糖、血脂、性激素及外周血压为自变量,行多因素逐步回归发现,对于绝经后高血压女性,其中心动脉压的变化主要与SBP、DBP及HR有关,而与性激素并无统计学关联,同时女性高血压患者的脉搏波传导速率与绝经年限有关。(4)对于绝经年限小于5年的女性患者,其雌二醇(eE2)。睾酮(TSTO)及孕激素(PRGE)水平均大于绝经年限大于5年的女性患者,且两组间雌二醇水平的差异具有统计学意义(P=0.043)。而且绝经年限大于5年的高血压患者具有更高的外周血压水平和中心动脉压水平,且两组间SBP、PP、cSBP、CPP的差别均具有统计学意义,说明绝经年限较长的女性具有更高的外周及中心动脉压水平,但是其激素水平却较低。结论:对于高血压女性患者,绝经年限较短的女性患者与男性相比外周血压及中心动脉压水平均较低,而绝经年限较长的女性其外周血压及中心动脉压明显高于同龄男性患者,尽管绝经后女性患者雌激素水平下降明显,但近期绝经的的女性其体内的雌激素水平要高于远期绝经的女性患者,说明对于绝经年限较短的女性,雌激素水平仍可维持在一定的水平,使得雌激素对心血管系统的有益作用得以维持,同时研究也发现,雌激素不仅对外周血压,对中心动脉压也有保护作用。而女性组相比个男性对照组动脉硬化更为明显,可能与围绝经期及绝经期后雌激素水平异常引起的血管舒张功能异常及血管内皮炎症反应增强引起动脉硬化有关。
[Abstract]:Objective: with the prolongation of menopause time, the prevalence of hypertension in women is further increased and the degree of arteriosclerosis should be further aggravated. This study explores the characteristics of the changes of central arterial pressure and related arteriosclerosis parameters in women with different age of menopause compared to the same age male, and provides a rational management of postmenopausal hypertension for women. Methods: 118 people (female N=51 people, male N=67 people) aged 58.62 + 8.31 from November 2014 to November 2015 in the Department of hypertension, Second Hospital Affiliated to Lanzhou University, were divided into short term menopause group (menopause less than 5 years, 25 N=; age 52.20 + 3.70) and long term menopause group (menopause age big). In 5 years, N=26 people; age 65.15 + 5.92). At the same time, the male hypertension patients with the same age in the two groups were taken as the control, including the recent control group (N=34 person; age 51.62 + 4.62), the forward control group (n=33 person; age 65.55 + 5.23). The height, weight, abdominal circumference, blood sugar, blood lipid of all the patients were detected and the female patients were detected. The level of sex hormone (estradiol Estrogen, testosterone Testosterone, progesterone Progesterone), the peripheral brachial artery blood pressure measured with a OMRON sphygmomanometer, and indirect measurement of central arterial systolic pressure (cSBP), central artery diastolic pressure (cDBP), central artery pressure pulse pressure (CPP), enhanced pressure (AP), and reflected wave gain by using the Sphygmocor pulse wave analysis system. Index (AIx), 75 heart rate gain index correction index (AIx75HR) and cervical femoral pulse pulse wave conduction rate (cf-PWV). Results: (1) compared to the same age male hypertension in women with menopause less than 5 years (=2.40 + 1.89), SBP, DBP, HR, cSBP, cDBP, cf-PWV were lower than those of the same age male patients, and DBP, SBP, DBP. BP, the difference between the two groups was statistically significant (P=0.024, P=0.007, P=0.007). The PP, AP, CPP, AIx and AIx75HR in women with menopause less than 5 years were higher than those of the same age male hypertension group, but the difference between the AIx75HR two groups was statistically significant (P=0.035). (2) for women with menopause for more than 5 years (menopause years) SBP, PP, HR, cSBP, CPP, AP, AIx, AIx75HR, cf-PWV in the female group were more than the male group, and the two groups of SBP, PP, cSBP, 0.002, respectively. (3) the female hypertensive patients after menopause For variable variables, age, menopause, history of hypertension, BMI, waist circumference, blood sugar, blood lipids, sex hormones and peripheral blood pressure were independent variables, and multiple factors stepwise regression was found. For postmenopausal women with hypertension, the changes in central arterial pressure were mainly related to SBP, DBP and HR, but had no statistical correlation with sex hormones. The pulse wave conduction rate was related to the period of menopause. (4) for women with menopause less than 5 years, the levels of estradiol (eE2), testosterone (TSTO) and progesterone (PRGE) were greater than those of women with menopause for more than 5 years, and the difference of estradiol levels between the two groups was statistically significant (P=0.043). And the period of menopause was higher than 5 years. The blood pressure patients have higher peripheral blood pressure level and central arterial pressure level, and the differences of SBP, PP, cSBP and CPP between the two groups are statistically significant, indicating that women with longer menopausal years have higher peripheral and central arterial pressure levels, but their hormone levels are low. Conclusion: for women with hypertension, the menopause is shorter. Female patients have lower peripheral blood pressure and central arterial pressure compared with men, while women with longer menopausal women have higher peripheral blood pressure and central arterial pressure than men of the same age. Although estrogen levels in postmenopausal women have a significant decrease in estrogen levels, the levels of estrogen in the recent menopause women are higher than those of long-term menopause. The female patients showed that the estrogen level still maintained at a certain level for women with shorter menopause, which kept the beneficial effects of estrogen on the cardiovascular system, and the study also found that estrogen not only had peripheral blood pressure, but also had a protective effect on central arterial pressure, while the female group was more hard than a male control group. It is more obvious that it may be associated with abnormal vasodilatation and increased vascular endothelial inflammatory reaction caused by abnormal estrogen level in perimenopause and postmenopausal period.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

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