老年原发性高血压患者合并无症状性心肌缺血的相关因素分析
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摘要
目的:了解血压控制达标的老年原发性高血压患者无症状性心肌缺血(SMI)的发病情况,并探讨与其相关的主要危险因素。
方法:回顾性分析584例住院期间血压控制达标的老年高血压病患者24小时动态心电图、动态血压监测、心脏超声、颈动脉超声及相关实验室检查的临床资料,并根据24小时动态心电图检查结果将病例分为两组无症状性心肌缺血发生组(SMI组)和无缺血性ST段改变组(NSMI组),比较两组患者年龄、性别、血糖、糖化血红蛋白(HbA1c)、血脂、血尿酸、左室肥厚(LVH)、颈动脉粥样硬化及动态血压各项参数的结果,并对这些危险因素与SMI的相关性进行评估。
结果:1.检出SMI138例(23.63%),SMI组中低密度脂蛋白胆固醇(LDL-C)、空腹血糖、HbA1c水平高于NSMI组(均P<0.01),SMI组中血尿酸水平高于NSMI组(P<0.05)。
2.两组患者共有LVH 141例(占所有入选患者的24.14%),其中SMI组有LVH78例,占本组56.52%,NSMI组63例,占本组14.13%,两组患者LVH的发生率比较差异有统计学意义(P<0.01)。检出颈动脉粥样硬化413例(70.72%),两组颈动脉粥样硬化的发生率分别为70.29%(SMI组)和70.85%(NSMI组),差异无统计学意义(P>0.05)。
3. SMI组24hPP、24h心率、昼间PP、夜间SBP、夜间PP及夜间心率均高于NSMI组,差异有统计学意义(均P<0.05);SMI组24hDBP、昼间DBP和夜间DBP低于NSMI组,差异有统计学意义(均P<0.05)。SMI组中有76例患者血压昼夜节律消失(占本组的55.07%),NSMI组中有114例(占25.56%),两者比较差异有统计学意义(P<0.01)。4. Logistic回归分析结果显示血压控制达标的老年高血压病患者SMI的独立相关因素为空腹血糖、糖化血红蛋白、左室肥厚、动态脉压升高和血压昼夜节律异常。
结论:老年高血压病患者中多种危险因素的集簇增加了无症状性心肌缺血的发生率,在积极有效控制血压达标的同时应尽早发现并全面干预多种危险因素,以减少无症状性心肌缺血的发生。
Objective To evaluate the occurrence of silent myocardial ischemia (SMI) in elderly essential hypertensive patients and the related main risk factors. Metbods 584 elderly hypertensive patients under blood pressure being controlled well were divided into SMI group and NSMI group, with or without SMI based on the results of the 24-hour dynamic electrocardiogram test. The correlativity between SMI and age, gender, fasting blood glucose (FPG), glycosylated hemoglobin(HbA1c), blood lipid level, blood uric acid level, Left Ventricular Hypertrophy(LVH), carotid atherosclerosis, the index of dynamic electrocardiography were analyzed.
Result 1. Among 584 patients, the number of SMI was 138(23.63%). Low-density lipoprotein cholesterol (LDL-C), fasting blood glucose, HbA1c were higher in the SMI group than that in the NSMI group (P<0.01). Blood uric acid level were higher in the SMI group than that in the NSMI group (P<0.05).
2. 141 cases LVH (24.14%) was detected. the proportion of LVH in the SMI group (56.52%) was higher than that in the NSMI group (14.13%)(P<0.01). Carotid atherosclerosis 413 cases(70.72%), the incidence of carotid atherosclerosis was 70.29% in patients with SMI and 70.85% in patients with NSMI, which in the two groups have no significant difference(P>0.05).
3. 24hPP, 24hHR, dPP, nSBP, nPP, nHR were higher in the SMI group than that in the NSMI group (P<0.05). 24hDBP, dDBP, nDBP were lower in the SMI group than that in the NSMI group (P<0.05). 76 cases disappearance of circadian rhythm of blood pressure was detected in the SMI group and 114 cases in the NSMI group, the incidence of disappearance of circadian rhythm of blood pressure in the SMI group(55.07%) was higher than that in the NSMI group(25.56%)(P<0.01).
4. Logistic multivariate analysis showed that SMI significantly correlated with FPG, HbA1c, LVH, pulse pressure, disappearance of circadian rhythm of blood pressure. Conclusion The coexisting multiple risk factors in elderly hypertensive patients increase the incidence of silent myocardial ischemia. So blood pressure should be controlled actively, and the early detection and intervention for the risk factors should be strengthened.
方法:回顾性分析584例住院期间血压控制达标的老年高血压病患者24小时动态心电图、动态血压监测、心脏超声、颈动脉超声及相关实验室检查的临床资料,并根据24小时动态心电图检查结果将病例分为两组无症状性心肌缺血发生组(SMI组)和无缺血性ST段改变组(NSMI组),比较两组患者年龄、性别、血糖、糖化血红蛋白(HbA1c)、血脂、血尿酸、左室肥厚(LVH)、颈动脉粥样硬化及动态血压各项参数的结果,并对这些危险因素与SMI的相关性进行评估。
结果:1.检出SMI138例(23.63%),SMI组中低密度脂蛋白胆固醇(LDL-C)、空腹血糖、HbA1c水平高于NSMI组(均P<0.01),SMI组中血尿酸水平高于NSMI组(P<0.05)。
2.两组患者共有LVH 141例(占所有入选患者的24.14%),其中SMI组有LVH78例,占本组56.52%,NSMI组63例,占本组14.13%,两组患者LVH的发生率比较差异有统计学意义(P<0.01)。检出颈动脉粥样硬化413例(70.72%),两组颈动脉粥样硬化的发生率分别为70.29%(SMI组)和70.85%(NSMI组),差异无统计学意义(P>0.05)。
3. SMI组24hPP、24h心率、昼间PP、夜间SBP、夜间PP及夜间心率均高于NSMI组,差异有统计学意义(均P<0.05);SMI组24hDBP、昼间DBP和夜间DBP低于NSMI组,差异有统计学意义(均P<0.05)。SMI组中有76例患者血压昼夜节律消失(占本组的55.07%),NSMI组中有114例(占25.56%),两者比较差异有统计学意义(P<0.01)。4. Logistic回归分析结果显示血压控制达标的老年高血压病患者SMI的独立相关因素为空腹血糖、糖化血红蛋白、左室肥厚、动态脉压升高和血压昼夜节律异常。
结论:老年高血压病患者中多种危险因素的集簇增加了无症状性心肌缺血的发生率,在积极有效控制血压达标的同时应尽早发现并全面干预多种危险因素,以减少无症状性心肌缺血的发生。
Objective To evaluate the occurrence of silent myocardial ischemia (SMI) in elderly essential hypertensive patients and the related main risk factors. Metbods 584 elderly hypertensive patients under blood pressure being controlled well were divided into SMI group and NSMI group, with or without SMI based on the results of the 24-hour dynamic electrocardiogram test. The correlativity between SMI and age, gender, fasting blood glucose (FPG), glycosylated hemoglobin(HbA1c), blood lipid level, blood uric acid level, Left Ventricular Hypertrophy(LVH), carotid atherosclerosis, the index of dynamic electrocardiography were analyzed.
Result 1. Among 584 patients, the number of SMI was 138(23.63%). Low-density lipoprotein cholesterol (LDL-C), fasting blood glucose, HbA1c were higher in the SMI group than that in the NSMI group (P<0.01). Blood uric acid level were higher in the SMI group than that in the NSMI group (P<0.05).
2. 141 cases LVH (24.14%) was detected. the proportion of LVH in the SMI group (56.52%) was higher than that in the NSMI group (14.13%)(P<0.01). Carotid atherosclerosis 413 cases(70.72%), the incidence of carotid atherosclerosis was 70.29% in patients with SMI and 70.85% in patients with NSMI, which in the two groups have no significant difference(P>0.05).
3. 24hPP, 24hHR, dPP, nSBP, nPP, nHR were higher in the SMI group than that in the NSMI group (P<0.05). 24hDBP, dDBP, nDBP were lower in the SMI group than that in the NSMI group (P<0.05). 76 cases disappearance of circadian rhythm of blood pressure was detected in the SMI group and 114 cases in the NSMI group, the incidence of disappearance of circadian rhythm of blood pressure in the SMI group(55.07%) was higher than that in the NSMI group(25.56%)(P<0.01).
4. Logistic multivariate analysis showed that SMI significantly correlated with FPG, HbA1c, LVH, pulse pressure, disappearance of circadian rhythm of blood pressure. Conclusion The coexisting multiple risk factors in elderly hypertensive patients increase the incidence of silent myocardial ischemia. So blood pressure should be controlled actively, and the early detection and intervention for the risk factors should be strengthened.
引文
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