老年高血压患者动态血压曲线下面积与颈动脉硬化关系的探讨
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摘要
目的研究老年高血压患者动态血压监测参数-曲线下面积与颈动脉粥样硬化的关系。
方法选择1、2级老年高血压患者各30例为研究对象,并以30例健康体检者作为对照,对所有入选者行动态血压监测,做颈动脉血管超声测量颈总动脉内膜-中层厚度、颈总动脉内径,局限性内膜-中层厚度增厚≥1.3mm定义为斑块。
结果老年高血压患者24小时、白天、夜间收缩压曲线下面积,舒张压曲线下面积及脉压差曲线下面积均较对照组明显升高(P＜0.05),且2级高血压组收缩压和脉压差曲线下面积大于1级高血压组(P＜0.05),而两组舒张压曲线下面积无统计学差异(P＞0.05);老年高血压患者内膜-中层厚度较对照组明显增厚(P＜0.05),且随着内膜-中层厚度逐渐增厚,斑块级别显著增加(P＜0.05);直线相关分析显示:收缩压和脉压差曲线下面积尤其是夜间收缩压和脉压差曲线下面积与内膜-中层厚度及斑块级别明显正相关,内膜-中层厚度与斑块级别正相关。
结论动态曲线下面积是真正的代表血压增高的持续时间和血压增高值的综合二维参数,收缩压和脉压差曲线下面积尤其是夜间收缩压和脉压差曲线下面积的增加会加重颈动脉硬化的程度。颈动脉内膜-中层增厚是动脉粥样硬化的早期表现,内膜-中层厚度在预测高血压患者粥样斑块发生方面有着一定作用。
Objective To describe the relationship between the parameter of the ambulatory blood pressure monitoring(ABPM):area under the curve(AUC)and atherosclerosis of common carotid arteries.
Methods 60 untreated essential hypertension subjects(30 were in stage 1,30 were in stage 2) and 30 control subjects were selected.24-hour ambulatory blood pressure monitoring was used to examine area under the curve of ambulatory blood pressure.Intimae media thickness(IMT) of common carotid arteries,diameter and plaque were evaluated by ultrasonography,Intimae media thickness≥1.3mm was defined as plaque.
Results area under the curve of systolic blood pressure(including 24h,day time,night time SBP-AUC),area under the curve of diastolic blood pressure(including 24h,day time,night time DBP-AUC),and area under the curve of pulse pressure(including 24h,day time,night time PP-AUC)were obviously increased in essential hypertension subjects than that in control(P＜0.05),and SBP-AUC,PP-AUC were increased significantly in stage 2 than that in stage 1(P＜0.05),but DBP-AUC was no significance in two stages of hypertensive subjects(P＞0.05);IMT were thicker in essential hypertension than that in control(P＜0.05),there was a increased trend for the grade of plaque with the increasing for IMT(P＜0.05).There were positive correlation between SBP-AUC(especially night time SBP-AUC),IMT and the grade of plaque; There were positive correlation between PP-AUC(especially night time PP-AUC),IMT and the grade of plaque.
Conclusion AUC were exactly composite two dimensional parameter,there was a increased trend for the degree of atherosclerosis with the increasing for SBP-AUC,and PP-AUC (especially night time SBP-AUC,and PP-AUC).IMT of common carotid arteries was early manifestation of atherosclerosis;atheromatous plaque can be predicted by IMT in essential hypertension subjects.
方法选择1、2级老年高血压患者各30例为研究对象,并以30例健康体检者作为对照,对所有入选者行动态血压监测,做颈动脉血管超声测量颈总动脉内膜-中层厚度、颈总动脉内径,局限性内膜-中层厚度增厚≥1.3mm定义为斑块。
结果老年高血压患者24小时、白天、夜间收缩压曲线下面积,舒张压曲线下面积及脉压差曲线下面积均较对照组明显升高(P＜0.05),且2级高血压组收缩压和脉压差曲线下面积大于1级高血压组(P＜0.05),而两组舒张压曲线下面积无统计学差异(P＞0.05);老年高血压患者内膜-中层厚度较对照组明显增厚(P＜0.05),且随着内膜-中层厚度逐渐增厚,斑块级别显著增加(P＜0.05);直线相关分析显示:收缩压和脉压差曲线下面积尤其是夜间收缩压和脉压差曲线下面积与内膜-中层厚度及斑块级别明显正相关,内膜-中层厚度与斑块级别正相关。
结论动态曲线下面积是真正的代表血压增高的持续时间和血压增高值的综合二维参数,收缩压和脉压差曲线下面积尤其是夜间收缩压和脉压差曲线下面积的增加会加重颈动脉硬化的程度。颈动脉内膜-中层增厚是动脉粥样硬化的早期表现,内膜-中层厚度在预测高血压患者粥样斑块发生方面有着一定作用。
Objective To describe the relationship between the parameter of the ambulatory blood pressure monitoring(ABPM):area under the curve(AUC)and atherosclerosis of common carotid arteries.
Methods 60 untreated essential hypertension subjects(30 were in stage 1,30 were in stage 2) and 30 control subjects were selected.24-hour ambulatory blood pressure monitoring was used to examine area under the curve of ambulatory blood pressure.Intimae media thickness(IMT) of common carotid arteries,diameter and plaque were evaluated by ultrasonography,Intimae media thickness≥1.3mm was defined as plaque.
Results area under the curve of systolic blood pressure(including 24h,day time,night time SBP-AUC),area under the curve of diastolic blood pressure(including 24h,day time,night time DBP-AUC),and area under the curve of pulse pressure(including 24h,day time,night time PP-AUC)were obviously increased in essential hypertension subjects than that in control(P＜0.05),and SBP-AUC,PP-AUC were increased significantly in stage 2 than that in stage 1(P＜0.05),but DBP-AUC was no significance in two stages of hypertensive subjects(P＞0.05);IMT were thicker in essential hypertension than that in control(P＜0.05),there was a increased trend for the grade of plaque with the increasing for IMT(P＜0.05).There were positive correlation between SBP-AUC(especially night time SBP-AUC),IMT and the grade of plaque; There were positive correlation between PP-AUC(especially night time PP-AUC),IMT and the grade of plaque.
Conclusion AUC were exactly composite two dimensional parameter,there was a increased trend for the degree of atherosclerosis with the increasing for SBP-AUC,and PP-AUC (especially night time SBP-AUC,and PP-AUC).IMT of common carotid arteries was early manifestation of atherosclerosis;atheromatous plaque can be predicted by IMT in essential hypertension subjects.
引文
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[5]崔剑,赵子彦,赵子婴,等。拟合动态血压波动曲线并计算曲线下面积的数学方法[J]。数理医药学杂志,2005,18(1):5-7。
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[8]张维忠,施海明,王瑞冬,等。动态血压参数正常参考值协作研究[J]。中华心血管病杂志,1995,23:325-328。
[9]李芳,陆文明,邓必俊,等。高血压伴颈动脉粥样硬化患者的动态血压[J]。岭南心血管病杂志,2006,12(4):251-253。
[10]林苗,黄旭梅,林斌,等。高血压伴颈动脉粥样硬化患者的动态血压分析[J]。浙江医学,2003,25(7):403-409。
[11]Su Wenjuan,Mei Shiping,Zhang Yiwen,etal.Relation between intimal media thickness of senial carotid and the relating cardiovascular factors[J].Geriatr Health Care,2003,9(3):165-167.
[12]孙刚,阎旭龙,王峰,等。动态血压监测与高血压病预后的关系[J]。心肺血管病杂志,2002,21(1):8-11。
[13]Redon J,Campos C,Nareiso M L,et al.Prognostic value of ambulatory blood pressure monitoring in refractory hypertension:Prospective study[J].Hypertension,1998,31:712.
[14]Wang JG,Staessen JA,Gong L,etal.Chinese trial on isolated systolic hypertension in the elderly.Systolic Hypertension in china Collaborative Group.Arch Intern Med,2000,160:200-211.
[15]刘力生。高血压。第一版。北京:人民卫生出版社,2001,759-760。
[16]马文英。动态血压监测在评价高血压靶器官损害中的预测价值[J]。临床心血管病杂志,2000,16(9):400-401。
[17]White W B,Dey H M,Schulman P,etal.Assessment of the daily blood pressure load as a determinant of Cardiac function in patients with mild to moderate hypertension.AM heart J,1987,118(18):78.
[18]唐智雄,李小波,李子强,等。动态血压监测在老年高血压病靶器官损害中的临床评价[J]。中国现代实用医学杂志,2005,4(7):26-27。
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