社区高血压患者血管病变情况及影响因素研究
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摘要
背景随着社会经济的发展和人口老龄化的加剧,我国人群高血压的患病率逐年升高。对高血压患者的动脉血管弹性度、硬化度进行监测与干预,可以延缓心血管事件进程、预防心血管疾病发生。目的探讨社区高血压患者的血管病变情况及其影响因素,为动脉硬化的早期发现和预防提供理论依据。方法选取2018年5—7月于佛山市顺德区乐从社区卫生服务中心门诊体检的高血压患者411例,按照血压水平分成3组:血压控制理想组(A组)45例、血压控制良好组(B组)142例、血压控制不良组(C组)224例。评估各组血管病变情况,包括肱踝脉搏波传导速度(baPWV)、颈股脉搏波传导速度(cfPWV)及踝臂指数(ABI)。各组血管病变的影响因素采用多因素Logistic回归分析。结果 A、B、C 3组的baPWV、cfPWV比较,差异有统计学意义(P<0.05),而ABI在3组间差异无统计学意义(P>0.05)。血压控制情况与baPWV(rs=0.406,P<0.001)和cfPWV(r_s=0.381,P<0.001)呈正相关。多因素Logistic回归分析结果显示:年龄〔OR=1.102,95%CI(1.069,1.136)〕、血清丙氨酸氨基转移酶〔OR=0.966,95%CI(0.934,0.999)〕及总胆红素〔OR=1.065,95%CI(1.023,1.110)〕水平为baPWV的独立影响因素;年龄〔OR=1.106,95%CI(1.071,1.141)〕、血清丙氨酸氨基转移酶〔OR=0.952,95%CI(0.917,0.988)〕及天冬氨酸氨基转移酶〔OR=1.052,95%CI(1.007,1.100)〕水平为cfPWV的独立影响因素。结论社区高血压患者的血压控制情况与血管硬化水平相关,社区卫生服务机构应加强对高血压人群的血压管理,从而有效地预防和延缓心脑血管疾病的发生和发展。
Background With the development of social economy and the aggravation of aging,the prevalence of hypertension is increasing.Monitoring the elasticity and sclerosis of arteries and giving corresponding interventions in hypertensive patients,can prevent,and delay the progression of cardiovascular disease.Objective To explore the prevalence of vascular lesions and its influencing factors in patients with hypertension in the community,providing a theoretical basis for early detection and prevention of arteriosclerosis.Methods The enrolled 411 hypertensive patients were sampled from individuals undergoing physical examination in the outpatient clinic of Shunde Lecong Community Health Center between May and July 2018,including45 with ideal blood pressure control(group A),142 with good blood pressure control(group B) and 224 with poor blood pressure control(group C).The brachial-ankle pulse wave velocity(baPWV),carotid-femoral pulse wave velocity(cfPWV) as well as ankle-brachial index(ABI) were analyzed comparatively.Influencing factors of the detected vascular lesion were analyzed by using multivariate Logistic regression.Results Mean baPWV and cfPWV differed significantly between the groups(P<0.05),while mean ABI did not(P>0.05).There was a significantly positive correlation between blood pressure control and baPWV(r_s=0.406,P<0.001),as well as cfPWV(rs=0.381,P<0.001).Multivariate Logistic regression model indicated age〔OR=1.102,95% CI(1.069,1.136)〕,serum ALT〔OR=0.966,95% CI(0.934,0.999)〕 and serum total bilirubin〔OR=1.065,95% CI(1.023,1.110)〕 were independent influencing factors of baPWV;and age〔OR=1.106,95% CI(1.071,1.141)〕,serum ALT〔OR=0.952,95% CI(0.917,0.988)〕and serum AST〔OR=1.052,95% CI(1.007,1.100)〕were independent influencing factors of cfPWV.Conclusion Blood pressure control is associated with vascular sclerosis in hypertensive patients.So community-based hypertension management should be strengthened to effectively prevent or delay the occurrence and development of cardiovascular diseases.
Background With the development of social economy and the aggravation of aging,the prevalence of hypertension is increasing.Monitoring the elasticity and sclerosis of arteries and giving corresponding interventions in hypertensive patients,can prevent,and delay the progression of cardiovascular disease.Objective To explore the prevalence of vascular lesions and its influencing factors in patients with hypertension in the community,providing a theoretical basis for early detection and prevention of arteriosclerosis.Methods The enrolled 411 hypertensive patients were sampled from individuals undergoing physical examination in the outpatient clinic of Shunde Lecong Community Health Center between May and July 2018,including45 with ideal blood pressure control(group A),142 with good blood pressure control(group B) and 224 with poor blood pressure control(group C).The brachial-ankle pulse wave velocity(baPWV),carotid-femoral pulse wave velocity(cfPWV) as well as ankle-brachial index(ABI) were analyzed comparatively.Influencing factors of the detected vascular lesion were analyzed by using multivariate Logistic regression.Results Mean baPWV and cfPWV differed significantly between the groups(P<0.05),while mean ABI did not(P>0.05).There was a significantly positive correlation between blood pressure control and baPWV(r_s=0.406,P<0.001),as well as cfPWV(rs=0.381,P<0.001).Multivariate Logistic regression model indicated age〔OR=1.102,95% CI(1.069,1.136)〕,serum ALT〔OR=0.966,95% CI(0.934,0.999)〕 and serum total bilirubin〔OR=1.065,95% CI(1.023,1.110)〕 were independent influencing factors of baPWV;and age〔OR=1.106,95% CI(1.071,1.141)〕,serum ALT〔OR=0.952,95% CI(0.917,0.988)〕and serum AST〔OR=1.052,95% CI(1.007,1.100)〕were independent influencing factors of cfPWV.Conclusion Blood pressure control is associated with vascular sclerosis in hypertensive patients.So community-based hypertension management should be strengthened to effectively prevent or delay the occurrence and development of cardiovascular diseases.
引文
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[2]张曼,王皓翔,杨志鹏,等.珠江三角洲地区社区高血压患者服药依从性及其影响因素分析[J].中华健康管理学杂志,2018,12(2):97-102.DOI:10.3760/cma.j.issn.16 74-0815.2018.02.001.ZHANG M,WANG H X,YANG Z P,et al.Community hypertension in pearl river delta of Guangdong Province:medication adherence and its influential factors[J].Chinese Journal of Health Management,2018,12(2):97-102.DOI:10.3760/cma.j.issn.1674-0815.2018.02.001.
[3]吕晨芳,王瑞杰,李伟.高血压脑出血患者开颅血肿清除术后镇静治疗效果及其预后影响因素研究[J].实用心脑肺血管病杂志,2018,26(4):32-36.DOI:10.3969/j.issn.1008-5971.2018.04.y02.LYU C F,WANG R J,LI W.Sedative treatment outcome and influencing factors of prognosis in postoperative hypertensive cerebral hemorrhage patients treated by craniotomy for evacuation of hematoma[J].Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease,2018,26(4):32-36.DOI:10.3969/j.issn.1008-5971.2018.04.y02.
[4]胡明昕,于力,吴媛媛,等.不同血压水平血管病变情况评估及相关危险因素分析[J].中国实验诊断学,2017,21(7):1221-1225.HU M X,YU L,WU Y Y,et al.Assess of blood vessel condition on different levels of blood pressure and analysis of the risk factors[J].Chinese Journal of Laboratory Diagnosis,2017,21(7):1221-1225.
[5]王明建,徐新娟.原发性高血压患者血压分级与脉搏波速度的关系[J].中华高血压杂志,2008,16(12):1132-1133.DOI:10.16439/j.cnki.1673-7245.2008.12.009.WANG M J,XU X J.Relationship between blood pressure and pulse wave velocity in patients with essential hypertension[J].Chinese Journal of Hypertension,2008,16(12):1132-1133.DOI:10.16439/j.cnki.1673-7245.2008.12.009.
[6]JANG S Y,JU E Y,HUH E H,et al.Determinants of brachialankle pulse wave velocity and carotid-femoral pulse wave velocity in healthy Koreans[J].J Korean Med Sci,2014,29(6):798-804.DOI:10.3346/jkms.2014.29.6.798.
[7]王柳,陆士娟,陈海荣,等.踝臂指数联合脉搏波速度对冠状动脉狭窄严重程度的临床预测[J].岭南心血管病杂志,2017,23(5):542-546.DOI:10.3969/j.issn.1007-9688.2017.05.10.WANG L,LU S J,CHEN H R,et al.Clinical prediction of ankle brachial index united with pulse wave velocity on the severity of coronary artery stenosis[J].South China Journal of Cardiovascular Diseases,2017,23(5):542-546.DOI:10.3969/j.issn.1007-9688.2017.05.10.
[8]王柳,陆士娟.踝臂指数联合脉搏波速度检测诊断动脉粥样硬化的研究进展[J].内科,2016,11(6):865-866.DOI:10.16121/j.cnki.cn45-1347/r.2016.06.15.WANG L,LU S J.Advances in the diagnosis of atherosclerosis by ankle brachial index combined with pulse wave velocity detection[J].Internal Medicine,2016,11(6):865-866.DOI:10.16121/j.cnki.cn45-1347/r.2016.06.15.
[9]厉婷,陈小敏,吴秀娟,等.臂踝脉搏波传导速度和踝臂指数对下肢动脉粥样硬化的诊断价值[J].中风与神经疾病杂志,2016,33(11):1021-1024.LI T,CHEN X M,WU X J,et al.The diagnostic value of baPWVand ABI to lower extremity atherosclerosis[J].Journal of Apoplexy and Nervous Diseases,2016,33(11):1021-1024.
[10]SANTOS A B,GUPTA D K,BELLO N A,et al.Prehypertension is associated with abnormalities of cardiac structure and function in the atherosclerosis risk in cummunities study[J].Amer JHypertension,2016,29(5):568-574.DOI:10.1093/ajh/hpv156.
[11]王文,张维忠,孙宁玲,等.中国血压测量指南[J].中华高血压杂志,2011,19(12):1101-1115.DOI:10.16439/j.cnki.1673-7245.2011.12.004.WANG W,ZHANG W Z,SUN N L,et al.China blood pressure measurement guide[J].Chinese Journal of Hypertension,2011,19(12):1101-1115.DOI:10.16439/j.cnki.1673-7245.2011.12.004.
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