不同血压水平下AASI与冠状动脉病变的相关性研究
发布时间：2018-09-06 13:26
【摘要】：研究目的:众所周知,高血压是冠心病的独立危险因素。血压升高引起的血流动力学变化以及应切力的改变导致血管内皮的损伤,血管的弹力纤维断裂从而加速血管粥样硬化。动态动脉硬化指数是利用24小时动态血压的监测数据计算出的一种评价动脉硬化程度的指标。AASI是一种有效的、无创的检测动脉功能的方法。很多研究表明AASI与冠状动脉病变密切相关,但是对不同血压水平下AASI与冠脉病变的相关性却尚未见报导。本研究通过AASI与CAG结果进行比较,以CAG为依据,明确每种血压水平下冠脉病变与非病变组AASI值的差异。明确三种血压水平下AASI与冠脉病变的相关性是怎样的,评估无创性检查方式动态血压在诊断CHD中的价值及应用前景,为临床上CHD的无创性诊断提供指导。研究方法:本研究选取石河子大学第四附属医院心血管内科2011年6月至2016年9月可疑CHD住院患者425例为研究对象。所有对象先后均行ABPM检测及CAG术,计算425例患者AASI值。根据冠脉病变的结果将425例研究分成五组分别为:血压正常组、正常血压高值组、高血压一级组、高血压二级组、高血压三级组。再分别将各组再分为冠脉正常组以及冠脉病变组,探讨五组血压水平下AASI与冠脉病变的相关性。行动态血压监测,白昼(08:00-20:00)每15分钟测量一次,夜间(20:00-08:00)每30分钟测量一次,测量有效次数85%为有效测量,且每小时区间有效读数无缺漏。测量记录的有效血压度数标准和舍弃标准:收缩压70-260mm Hg(1mm Hg=0.133k Pa),舒张压40-150mm Hg,脉压20-150mm Hg,排除不符合上述标准的患者即:收缩压260mm Hg或70mm Hg,舒张压150mm Hg或40mm Hg,脉压差150mm Hg或20mm Hg.观察指标:24h平均收缩压(24h SBP)/平均舒张压(24h DBP)。动态动脉硬化指数(AASI)=1-收缩压与舒张压直线回归的斜率。统计分析采用采用SPSS 17.0软件进行数据处理,计量资料用均数±标准差(x±s)表示,均进行正态分布方差齐性检验,两组间比较采用t检验;多组间比较采用单因素方差分析,指标相关性分析采用Spearman相关分析,P0.05为差异有统计学意义。结果:各血压水平组冠脉病变组的AASI均大于各血压水平组冠脉组正常组AASI,差异具有统计学意义(p0.05)。随着血压水平的升高AASI在各血压水平组冠脉病变组、冠脉正常组均逐渐升高,差异具有统计学意义(p0.05)。年龄、正常血压高值、高血压、AASI与冠心病呈正相关(P0.05).结论:1.在同一血压水平,冠脉病变组AASI大于冠脉正常组。2.随着血压水平的升高,动态动脉硬化指数(AASI)无论在冠脉病变组以及冠脉正常组均升高,冠脉病变风险增加。
[Abstract]:Objective: it is well known that hypertension is an independent risk factor for coronary heart disease. The changes of hemodynamics caused by high blood pressure and the change of shearing force lead to the injury of vascular endothelium and the rupture of elastic fiber of blood vessel, which accelerates atherosclerosis. Dynamic arteriosclerosis index (AASI) is an effective and noninvasive method for detecting arterial function, which is calculated by 24 hours ambulatory blood pressure monitoring data. AASI is an effective and noninvasive method to evaluate the degree of arteriosclerosis. Many studies have shown that AASI is closely related to coronary artery disease, but the correlation between AASI and coronary artery disease at different blood pressure levels has not been reported. In this study, the results of AASI and CAG were compared, and based on CAG, the difference of AASI value between coronary artery lesion and non-lesion group was determined at each blood pressure level. To determine the correlation between AASI and coronary artery disease at three blood pressure levels, to evaluate the value and application prospect of noninvasive ambulatory blood pressure (ABBP) in the diagnosis of CHD, and to provide guidance for clinical noninvasive diagnosis of CHD. Methods: a total of 425 patients with suspected CHD from June 2011 to September 2016 in Cardiovascular Department of the fourth affiliated Hospital of Shihezi University were selected as the study subjects. All subjects were examined by ABPM and CAG successively, and the AASI values of 425 patients were calculated. According to the results of coronary artery disease, 425 cases were divided into five groups: normal blood pressure group, normal blood pressure high value group, hypertension first class group, hypertension second class group, hypertension third class group. Then each group was subdivided into normal coronary artery group and coronary artery disease group, to explore the correlation between AASI and coronary artery disease at blood pressure level. Ambulatory blood pressure monitoring was carried out every 15 minutes during the day (08: 00-20: 00) and every 30 minutes at night (20: 00-08: 00). The effective number of measurements was 85%. Effective blood pressure measure and abandonment criteria: systolic blood pressure 70-260mm Hg (1mm Hg=0.133k Pa), diastolic pressure 40-150mm Hg, pulse pressure 20-150mm Hg, exclusion of patients who do not meet the above criteria: systolic blood pressure 260mm Hg or 70mm Hg, diastolic blood pressure 150mm Hg or 40mm Hg, pulse pressure difference 150mm Hg or 20mm Hg. An observational measure of 24 hours mean systolic blood pressure (24 h SBP) / mean diastolic blood pressure (24 h DBP).) Dynamic arteriosclerosis index (AASI) 1-slope of linear regression between systolic and diastolic blood pressure. The statistical analysis was conducted by SPSS 17.0 software, and the measurement data were expressed as mean 卤standard deviation (x 卤s). The homogeneity test of normal distribution variance was carried out, the t test was used for the comparison between the two groups, and the single factor analysis of variance was used for the comparison between the two groups. Index correlation analysis using Spearman correlation analysis (P0.05) was statistically significant. Results: the AASI of coronary artery lesion group in each blood pressure group was higher than that of normal coronary artery group in each blood pressure level group (p0. 05). With the increase of blood pressure, AASI increased gradually in the coronary artery lesion group and the normal coronary artery group in each blood pressure level group, the difference was statistically significant (p0. 05). Age, normal blood pressure and AASI were positively correlated with coronary heart disease (P0.05). Conclusion 1. At the same blood pressure level, AASI in the coronary lesion group was higher than that in the normal coronary artery group. 2. 2. With the increase of blood pressure, the dynamic arteriosclerosis index (AASI) increased in both the coronary artery lesion group and the normal coronary artery group, and the risk of coronary artery lesion increased.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1
本文编号：2226481
[Abstract]:Objective: it is well known that hypertension is an independent risk factor for coronary heart disease. The changes of hemodynamics caused by high blood pressure and the change of shearing force lead to the injury of vascular endothelium and the rupture of elastic fiber of blood vessel, which accelerates atherosclerosis. Dynamic arteriosclerosis index (AASI) is an effective and noninvasive method for detecting arterial function, which is calculated by 24 hours ambulatory blood pressure monitoring data. AASI is an effective and noninvasive method to evaluate the degree of arteriosclerosis. Many studies have shown that AASI is closely related to coronary artery disease, but the correlation between AASI and coronary artery disease at different blood pressure levels has not been reported. In this study, the results of AASI and CAG were compared, and based on CAG, the difference of AASI value between coronary artery lesion and non-lesion group was determined at each blood pressure level. To determine the correlation between AASI and coronary artery disease at three blood pressure levels, to evaluate the value and application prospect of noninvasive ambulatory blood pressure (ABBP) in the diagnosis of CHD, and to provide guidance for clinical noninvasive diagnosis of CHD. Methods: a total of 425 patients with suspected CHD from June 2011 to September 2016 in Cardiovascular Department of the fourth affiliated Hospital of Shihezi University were selected as the study subjects. All subjects were examined by ABPM and CAG successively, and the AASI values of 425 patients were calculated. According to the results of coronary artery disease, 425 cases were divided into five groups: normal blood pressure group, normal blood pressure high value group, hypertension first class group, hypertension second class group, hypertension third class group. Then each group was subdivided into normal coronary artery group and coronary artery disease group, to explore the correlation between AASI and coronary artery disease at blood pressure level. Ambulatory blood pressure monitoring was carried out every 15 minutes during the day (08: 00-20: 00) and every 30 minutes at night (20: 00-08: 00). The effective number of measurements was 85%. Effective blood pressure measure and abandonment criteria: systolic blood pressure 70-260mm Hg (1mm Hg=0.133k Pa), diastolic pressure 40-150mm Hg, pulse pressure 20-150mm Hg, exclusion of patients who do not meet the above criteria: systolic blood pressure 260mm Hg or 70mm Hg, diastolic blood pressure 150mm Hg or 40mm Hg, pulse pressure difference 150mm Hg or 20mm Hg. An observational measure of 24 hours mean systolic blood pressure (24 h SBP) / mean diastolic blood pressure (24 h DBP).) Dynamic arteriosclerosis index (AASI) 1-slope of linear regression between systolic and diastolic blood pressure. The statistical analysis was conducted by SPSS 17.0 software, and the measurement data were expressed as mean 卤standard deviation (x 卤s). The homogeneity test of normal distribution variance was carried out, the t test was used for the comparison between the two groups, and the single factor analysis of variance was used for the comparison between the two groups. Index correlation analysis using Spearman correlation analysis (P0.05) was statistically significant. Results: the AASI of coronary artery lesion group in each blood pressure group was higher than that of normal coronary artery group in each blood pressure level group (p0. 05). With the increase of blood pressure, AASI increased gradually in the coronary artery lesion group and the normal coronary artery group in each blood pressure level group, the difference was statistically significant (p0. 05). Age, normal blood pressure and AASI were positively correlated with coronary heart disease (P0.05). Conclusion 1. At the same blood pressure level, AASI in the coronary lesion group was higher than that in the normal coronary artery group. 2. 2. With the increase of blood pressure, the dynamic arteriosclerosis index (AASI) increased in both the coronary artery lesion group and the normal coronary artery group, and the risk of coronary artery lesion increased.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1
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