心电图P波增宽及P波双峰与隐匿性高血压患者早期心脏损伤的关系研究
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摘要
目的探讨心电图P波增宽及P波双峰与隐匿性高血压(MH)患者早期心脏损伤的关系。方法选取2015年7月—2017年7月徐州医科大学第二附属医院心内科门诊及住院的92例MH患者作为MH组,96例真性高血压患者作为高血压组。比较两组患者早期心脏损伤发生率及P波增宽、P波双峰检出率,有无早期心脏损伤的MH患者一般资料及P波增宽、P波双峰检出率;P波增宽、P波双峰与MH患者早期心脏损伤的关系分析采用多因素Logistic回归分析。结果 (1)MH组患者早期心脏损伤发生率低于高血压组(P<0.05);两组患者P波增宽、P波双峰检出率比较,差异无统计学意义(P>0.05)。(2)有无早期心脏损伤的MH患者性别、年龄、体质指数(BMI)比较,差异无统计学意义(P>0.05);有无早期心脏损伤的MH患者高血压家族史、吸烟史、P波增宽及P波双峰检出率比较,差异有统计学意义(P<0.05)。(3)多因素Logistic回归分析结果显示,P波增宽[OR=2.793,95%CI(1.243,6.274)]、P波双峰[OR=3.074,95%CI(1.474,6.411)]是MH患者早期心脏损伤的独立危险因素(P<0.05)。结论 MH对心脏的早期损伤小于真性高血压;心电图P波增宽及P波双峰是MH患者早期心脏损伤的独立危险因素,应引起临床重视。
Objective To relationship between P-wave broadening,bimodal P-wave in ECG and early cardiac damage in patients with masked hypertension. Methods From July 2015 to July 2017,a total of 92 outpatients and in patients with masked hypertension were selected as A group in the Department of Cardiology,the Second Affiliated Hospital of Xuzhou Medical University,meanwhile a total of 96 patients with true hypertension were selected as B group. Incidence of early cardiac damage,detection rates of P-wave broadening and bimodal P-wave in ECG were compared between the two groups,meanwhile general information,detection rates of P-wave broadening and bimodal P-wave in ECG were compared in masked hypertension patients with early cardiac damage or not;multivariate Logistic regression analysis was used to analyze the relationship between P-wave broadening,bimodal P-wave in ECG and early cardiac damage in patients with masked hypertension. Results(1)Incidence of early cardiac damage in A group was statistically significantly lower than that in B group(P<0.05),while no statistically significant differences of detection rate of P-wave broadening or bimodal P-wave in ECG was found between the two groups(P>0.05).(2)No statistically significant differences of gender,age or BMI was found in masked hypertension patients with early cardiac damage or not(P>0.05),while there were statistically significant differences of familial history of hypertension,smoking history,detection rates of P-wave broadening and bimodal P-wave in ECG in masked hypertension patients with early cardiac damage or not(P<0.05).(3)Multivariate Logistic regression analysis results showed that,P-wave broadening[OR=2.793,95%CI(1.243,6.274)]and bimodal P-wave[OR=3.074,95%CI(1.474,6.411)]in ECG were independent risk factors of early cardiac damage in patients with masked hypertension(P<0.05). Conclusion Risk of early cardiac damage is relativity low than that in patients with true hypertension;P-wave broadening and bimodal P-wave in ECG were independent risk factors of early cardiac damage in patients with masked hypertension,which should pay attention to.
Objective To relationship between P-wave broadening,bimodal P-wave in ECG and early cardiac damage in patients with masked hypertension. Methods From July 2015 to July 2017,a total of 92 outpatients and in patients with masked hypertension were selected as A group in the Department of Cardiology,the Second Affiliated Hospital of Xuzhou Medical University,meanwhile a total of 96 patients with true hypertension were selected as B group. Incidence of early cardiac damage,detection rates of P-wave broadening and bimodal P-wave in ECG were compared between the two groups,meanwhile general information,detection rates of P-wave broadening and bimodal P-wave in ECG were compared in masked hypertension patients with early cardiac damage or not;multivariate Logistic regression analysis was used to analyze the relationship between P-wave broadening,bimodal P-wave in ECG and early cardiac damage in patients with masked hypertension. Results(1)Incidence of early cardiac damage in A group was statistically significantly lower than that in B group(P<0.05),while no statistically significant differences of detection rate of P-wave broadening or bimodal P-wave in ECG was found between the two groups(P>0.05).(2)No statistically significant differences of gender,age or BMI was found in masked hypertension patients with early cardiac damage or not(P>0.05),while there were statistically significant differences of familial history of hypertension,smoking history,detection rates of P-wave broadening and bimodal P-wave in ECG in masked hypertension patients with early cardiac damage or not(P<0.05).(3)Multivariate Logistic regression analysis results showed that,P-wave broadening[OR=2.793,95%CI(1.243,6.274)]and bimodal P-wave[OR=3.074,95%CI(1.474,6.411)]in ECG were independent risk factors of early cardiac damage in patients with masked hypertension(P<0.05). Conclusion Risk of early cardiac damage is relativity low than that in patients with true hypertension;P-wave broadening and bimodal P-wave in ECG were independent risk factors of early cardiac damage in patients with masked hypertension,which should pay attention to.
引文
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[9]黄慕坚,梁华静,刘靖,等.隐匿性高血压患者心电图P波特点及其价值分析[J].现代电生理学杂志,2017,24(2):91-94.DOI:10.3969/j.issn.1672-0458.2017.02.007.
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[11]鹿秀云,樊小农,王舒.24 h动态血压监测与家庭血压自测在原发性高血压诊治中的应用[J].中国医药导报,2015,12(24):44-47,52.
[12]AFSAR B.Comparison of demographic,clinical,and laboratory parameters between patients with sustained normotension,white coat hypertension,masked hypertension,and sustained hypertension[J].J Cardiol,2013,61(3):222-226.DOI:10.1016/j.jjcc.2012.11.003.
[13]安花丽.隐匿性高血压的研究新进展[J].医学综述,2014,20(22):4056-4058.DOI:10.3969/j.issn.1006-2084.2014.22.010.
[14]SOBRINO J,DOMENECH M,CAMAFORT M,et al.Prevalence of masked hypertension and associated factors in normotensive healthcare workers[J].Blood Press Monit,2013,18(6):326-331.DOI:10.1097/MBP.0000000000000002.
[15]FRANKLIN S S,THIJS L,LI Y,et al.Masked hypertension in diabetes mellitus:treatment implications for clinical practice[J].Hypertension,2013,61(5):964-971.DOI:10.1161/HYPERTENSIONAHA.111.00289.
[16]赵林蔚,高传玉.白大衣高血压和隐匿性高血压研究进展[J].中华实用诊断与治疗杂志,2015,29(12):1151-1153.DOI:10.13507/j.issn.1674-3474.2015.12.003.
[17]雷莉.同步动态心电图、动态血压监测分析在老年冠心病及高血压的临床应用价值[J].中国现代药物应用,2014,8(21):45-46.
[18]黄健强,莫新,李艳庄,等.隐匿性高血压患者心脏早期损害与心电图改变的研究[J].实用心电学杂志,2015,24(6):437-439.DOI:10.13308/j.issn.2095-9354.2015.06.011.
[19]聂连涛,郭琳,李世锋,等.隐匿性高血压患者心电图P波改变分析[J].中国全科医学,2015,18(9):1042-1045.DOI:10.3969/j.issn.1007-9572.2015.09.014.
[20]郭琳,王品,许伟.动态血压监测联合心电图在隐匿性高血压诊治过程中的临床评价[J].实用中西医结合临床,2017,17(3):96-97.DOI:10.13638/j.issn.1671-4040.2017.03.062.
[21]李海明,段淼,陈念,等.高血压家族史对隐形高血压发病及心脏损害的影响[J].中国循环杂志,2016,31(7):654-658.DOI:10.3969/j.issn.1000-3614.2016.07.008.
[22]徐先静,张丹丹,黄改荣,等.核素门控心肌灌注显像在高血压前期患者心脏靶器官损害评估中的应用[J].中国卫生检验杂志,2017,27(7):920-922.
[23]鄂小青,王秀娟,郭纪群,等.心电图P波增宽与双峰对隐匿性高血压患者心脏损害的预测价值[J].心血管康复医学杂志,2016,25(6):626-628.DOI:10.3969/j.issn.1008-0074.2016.06.19.
[2]周言,罗偶,黄红光.隐匿性高血压与靶器官损害的研究进展[J].中国心血管杂志,2014,19(1):62-65. DOI:10.3969/j.issn.1007-5410.2014.01.018.
[3]AUNGSM,GüLERA,GüLERY,etal.Two-dimensional speckle-tracking echocardiography-based left atrial strain parameters predict masked hypertension in patients with hypertensive response to exercise[J].Blood Press Monit,2017,22(1):27-33.DOI:10.1097/MBP.0000000000000226.
[4]李准.偶测血压与动态血压监测结果分析[J].实用心脑肺血管病杂志,2013,21(1):69-70.DOI:10.3969/j.issn.1008-5971.2013.01.036.
[5]黄东,陈曼华,于杨,等.原发性高血压患者心电图左室肥厚与心血管事件的相关性[J].重庆医学,2015,44(24):3360-3361,3364.DOI:10.3969/j.issn.1671-8348.2015.24.017.
[6]王靖炫,区文超,周志衡,等.广州民警谷氨酰转肽酶与高血压和心电图缺血性ST-T改变关系的研究[J].海南医学,2014,25(14):2088-2092.DOI:10.3969/j.issn.1003-6350.2014.14.0809.
[7]刘战旗.24小时动态心电图对原发高血压心肌缺血及心律失常的观察[J].中国医药导刊,2013,9(8):1326,1328.DOI:10.3969/j.issn.1009-0959.2013.08.023.
[8]赵静,韩卫星,胡华青.中老年高血压患者动态血压的昼夜节律分析[J].安徽医药,2013,17(12):2089-2090.
[9]黄慕坚,梁华静,刘靖,等.隐匿性高血压患者心电图P波特点及其价值分析[J].现代电生理学杂志,2017,24(2):91-94.DOI:10.3969/j.issn.1672-0458.2017.02.007.
[10]BOOTHJN3rd,DIAZKM,SEALSSR,etal.Masked HypertensionandCardiovascularDiseaseEventsina Prospective Cohort of Blacks:The Jackson Heart Study[J].Hypertension,2016,68(2):501-510.DOI:10.1161/HYPERTENSIONAHA.116.07553.
[11]鹿秀云,樊小农,王舒.24 h动态血压监测与家庭血压自测在原发性高血压诊治中的应用[J].中国医药导报,2015,12(24):44-47,52.
[12]AFSAR B.Comparison of demographic,clinical,and laboratory parameters between patients with sustained normotension,white coat hypertension,masked hypertension,and sustained hypertension[J].J Cardiol,2013,61(3):222-226.DOI:10.1016/j.jjcc.2012.11.003.
[13]安花丽.隐匿性高血压的研究新进展[J].医学综述,2014,20(22):4056-4058.DOI:10.3969/j.issn.1006-2084.2014.22.010.
[14]SOBRINO J,DOMENECH M,CAMAFORT M,et al.Prevalence of masked hypertension and associated factors in normotensive healthcare workers[J].Blood Press Monit,2013,18(6):326-331.DOI:10.1097/MBP.0000000000000002.
[15]FRANKLIN S S,THIJS L,LI Y,et al.Masked hypertension in diabetes mellitus:treatment implications for clinical practice[J].Hypertension,2013,61(5):964-971.DOI:10.1161/HYPERTENSIONAHA.111.00289.
[16]赵林蔚,高传玉.白大衣高血压和隐匿性高血压研究进展[J].中华实用诊断与治疗杂志,2015,29(12):1151-1153.DOI:10.13507/j.issn.1674-3474.2015.12.003.
[17]雷莉.同步动态心电图、动态血压监测分析在老年冠心病及高血压的临床应用价值[J].中国现代药物应用,2014,8(21):45-46.
[18]黄健强,莫新,李艳庄,等.隐匿性高血压患者心脏早期损害与心电图改变的研究[J].实用心电学杂志,2015,24(6):437-439.DOI:10.13308/j.issn.2095-9354.2015.06.011.
[19]聂连涛,郭琳,李世锋,等.隐匿性高血压患者心电图P波改变分析[J].中国全科医学,2015,18(9):1042-1045.DOI:10.3969/j.issn.1007-9572.2015.09.014.
[20]郭琳,王品,许伟.动态血压监测联合心电图在隐匿性高血压诊治过程中的临床评价[J].实用中西医结合临床,2017,17(3):96-97.DOI:10.13638/j.issn.1671-4040.2017.03.062.
[21]李海明,段淼,陈念,等.高血压家族史对隐形高血压发病及心脏损害的影响[J].中国循环杂志,2016,31(7):654-658.DOI:10.3969/j.issn.1000-3614.2016.07.008.
[22]徐先静,张丹丹,黄改荣,等.核素门控心肌灌注显像在高血压前期患者心脏靶器官损害评估中的应用[J].中国卫生检验杂志,2017,27(7):920-922.
[23]鄂小青,王秀娟,郭纪群,等.心电图P波增宽与双峰对隐匿性高血压患者心脏损害的预测价值[J].心血管康复医学杂志,2016,25(6):626-628.DOI:10.3969/j.issn.1008-0074.2016.06.19.