CAJ | 학술논문

目的探讨血压变异性与慢性房颤患者血栓前状态之间的相关性.方法入选对象分为房颤组(NHYA分级心功能正常的慢性房颤46例)和对照组(其他窦性心律患者51例).对比两组之间24 h平均收缩压变异性(24 h SSD)和24 h平均舒张压变异性(24 h DSD),以及血浆血管性假血友病因子(vWF)、血小板α颗粒膜蛋白-140(GMP-140)、纤维蛋白原和D-二聚体等血栓前状态指标的差异,并对各组血压变异性与血栓前状态的指标进行相关性分析.结果 1.房颤组24 h SSD和24 h DSD均显著高于对照组.2.房颤组vWF和GMP-140均显著高于对照组.两组纤维蛋白原、D-二聚体无显著差异.3.房颤组24 h SSD与vwF呈显著正相关(r=0.416,P<0.05),与GMP-140无显著相关性;24 h DSD与vwF和GMP-140均呈显著正相关(r=0.432,P<0.05和r=0.378,P<0.05);24 h SSD、24 h DSD与纤维蛋白原或D-二聚体均无显著相关性.4.对照组24 h SSD和24 h DSD与vwF、GMP-140、纤维蛋白原或D-二聚体均无显著相关性(P>0.05).结论血压变异增大的慢性房颤患者血管内皮损害和血小板激活更显著,提示房颤发生血栓性并发症的危险性可能随血压变异性的增大而增加.
목적탐토혈압변이성여만성방전환자혈전전상태지간적상관성.방법입선대상분위방전조(NHYA분급심공능정상적만성방전46례)화대조조(기타두성심률환자51례).대비량조지간24 h평균수축압변이성(24 h SSD)화24 h평균서장압변이성(24 h DSD),이급혈장혈관성가혈우병인자(vWF)、혈소판α과립막단백-140(GMP-140)、섬유단백원화D-이취체등혈전전상태지표적차이,병대각조혈압변이성여혈전전상태적지표진행상관성분석.결과 1.방전조24 h SSD화24 h DSD균현저고우대조조.2.방전조vWF화GMP-140균현저고우대조조.량조섬유단백원、D-이취체무현저차이.3.방전조24 h SSD여vwF정현저정상관(r=0.416,P<0.05),여GMP-140무현저상관성;24 h DSD여vwF화GMP-140균정현저정상관(r=0.432,P<0.05화r=0.378,P<0.05);24 h SSD、24 h DSD여섬유단백원혹D-이취체균무현저상관성.4.대조조24 h SSD화24 h DSD여vwF、GMP-140、섬유단백원혹D-이취체균무현저상관성(P>0.05).결론혈압변이증대적만성방전환자혈관내피손해화혈소판격활경현저,제시방전발생혈전성병발증적위험성가능수혈압변이성적증대이증가.
Objective The hypertension has been confirmed to be one of risk factors of thrombotic complications in atrial fibrillation. However the correlations between blood pressure variation and prothrombotic state in atrial fibrillation have not been reported. The study was designed to disclose the correlations between them. Methods 46 patients with chronic atrial fibrillation and 51 other patients with sinus rhythm as control were enrolled into the study. The indexes of vW factor (vWF), p-selectin (GMP-140), fibrinogen, d-dimer and 24 hrs systolic blood pressure variability (24 h SSD),24 hrs diastolic blood pressure variability (24 h DSD) in atrial fibrillation group were compared with control group. The partial correlations between indexes of prothrom-botic state and blood pressure variability in each group were analysed. Results 1. The 24 h SSD and 24 h DSD in atrial fibrillation group were significant higher than control group, (13.76±4.07mm Hg vs. 11.32±3.19mm Hg, P<0.05) and (10.18±2.57mm Hg vs. 8.47±1.91 mm Hg,P<0.01).2. The vWF and GMP-140 in atrial fibrillation group were significant higher than the control group, (132.00±27.09 iu/dl vs. 104.13±33.79 iu/dl,P<0.01) and (11.12±6.40 ng/ml vs. 7.44±5.73 ng/ml,P<0.05). But the fibrinogen and d-dimer were no significant difference between two groups. 3. In atrial fibrillation group, after controlled by facts of age, blood pressure, heart rate and blood fat, the 24 h SSD positive correlated with vWF(r=0.416, P<0.05),but without obvious correlation with GMP-140 and the 24 h DSD in this group positive correlated with both vWF (r=0.432, P<0.05) and GMP-140 (r=0.378, P<0.05).4. In control group, no significant correlations pres-ent between indexes of blood pressure variability and prothrombotic state. Conclusion Atrial fibrillation with higher blood pressure variability present more significant endothelic impairment and platelet activation. It sug-gests that the risk of thrombotic complications in atrial fibrillation might increase with the augmentation of blood pressure variability.