中华老年多器官疾病杂志
中華老年多器官疾病雜誌
중화노년다기관질병잡지
CHINESE JOURNAL OF MULTIPLE ORGAN DISEASES IN THE ELDERLY
2014年
3期
210-214
,共5页
老年人%夜间血压模式%可重复性
老年人%夜間血壓模式%可重複性
노년인%야간혈압모식%가중복성
elderly%nocturnal blood pressure%reproducibility
目的：通过分析老年高血压患者动态血压监测（ABPM）夜间血压模式的可重复性，评估其在临床应用中的实际意义。方法对入住上海交通大学附属第六人民医院老年科70名老年高血压患者[男45例，女25例，年龄（83.57±5.37）岁]于4周内进行两次24hABPM，根据夜间血压下降率分为杓型（D）、非杓型（ND）、反杓型（RD）3种血压模式，把夜间下降率分别作为连续性变量和分类变量来分析血压模式的短期可重复性，并探究可重复的不同模式间的差异。结果作为连续性变量，Bland-Altman图示夜间下降率可重复性较好；作为分类变量，第2次ABPM维持原来血压模式不变的受试者共占65.7%（46/70），其中50.0%（14/28）维持原来RD，76.5%（13/17）维持原来D，76.0%（19/25）维持原来ND，kappa值为0.482。第1次ABPM为RD、D和ND在第2次ABPM转变为其他模式的分别有20.0%，5.7%和8.6%。可重复的RD（组1）、D（组2）、ND（组3）与模式变换型（组4）两两之间比较的主要临床特点无明显差异。结论老年高血压患者的夜间血压模式无论是作为分类变量还是连续变量，可重复性都尚好，且RD血压模式相比D或ND的变异性更高，因此，临床上我们不可以仅凭一次ABPM就评定患者的血压模式。本研究尚未发现可能影响血压模式重复性的因素。
目的：通過分析老年高血壓患者動態血壓鑑測（ABPM）夜間血壓模式的可重複性，評估其在臨床應用中的實際意義。方法對入住上海交通大學附屬第六人民醫院老年科70名老年高血壓患者[男45例，女25例，年齡（83.57±5.37）歲]于4週內進行兩次24hABPM，根據夜間血壓下降率分為杓型（D）、非杓型（ND）、反杓型（RD）3種血壓模式，把夜間下降率分彆作為連續性變量和分類變量來分析血壓模式的短期可重複性，併探究可重複的不同模式間的差異。結果作為連續性變量，Bland-Altman圖示夜間下降率可重複性較好；作為分類變量，第2次ABPM維持原來血壓模式不變的受試者共佔65.7%（46/70），其中50.0%（14/28）維持原來RD，76.5%（13/17）維持原來D，76.0%（19/25）維持原來ND，kappa值為0.482。第1次ABPM為RD、D和ND在第2次ABPM轉變為其他模式的分彆有20.0%，5.7%和8.6%。可重複的RD（組1）、D（組2）、ND（組3）與模式變換型（組4）兩兩之間比較的主要臨床特點無明顯差異。結論老年高血壓患者的夜間血壓模式無論是作為分類變量還是連續變量，可重複性都尚好，且RD血壓模式相比D或ND的變異性更高，因此，臨床上我們不可以僅憑一次ABPM就評定患者的血壓模式。本研究尚未髮現可能影響血壓模式重複性的因素。
목적：통과분석노년고혈압환자동태혈압감측（ABPM）야간혈압모식적가중복성，평고기재림상응용중적실제의의。방법대입주상해교통대학부속제륙인민의원노년과70명노년고혈압환자[남45례，녀25례，년령（83.57±5.37）세]우4주내진행량차24hABPM，근거야간혈압하강솔분위표형（D）、비표형（ND）、반표형（RD）3충혈압모식，파야간하강솔분별작위련속성변량화분류변량래분석혈압모식적단기가중복성，병탐구가중복적불동모식간적차이。결과작위련속성변량，Bland-Altman도시야간하강솔가중복성교호；작위분류변량，제2차ABPM유지원래혈압모식불변적수시자공점65.7%（46/70），기중50.0%（14/28）유지원래RD，76.5%（13/17）유지원래D，76.0%（19/25）유지원래ND，kappa치위0.482。제1차ABPM위RD、D화ND재제2차ABPM전변위기타모식적분별유20.0%，5.7%화8.6%。가중복적RD（조1）、D（조2）、ND（조3）여모식변환형（조4）량량지간비교적주요림상특점무명현차이。결론노년고혈압환자적야간혈압모식무론시작위분류변량환시련속변량，가중복성도상호，차RD혈압모식상비D혹ND적변이성경고，인차，림상상아문불가이부빙일차ABPM취평정환자적혈압모식。본연구상미발현가능영향혈압모식중복성적인소。
Objective To analyze the reproducibility of nocturnal blood pressure pattern in the elderly hypertensive patients by ambulatory blood pressure monitoring (ABPM) and evaluate its significance in clinical practice. Methods A total of 70 elderly essential hypertensive patients [45 males and 25 females, aged (83.57±5.37) years] admitted in the Department of Geriatrics from the Sixth People’s Hospital of Shanghai Jiaotong University were enrolled in this study. They underwent ABPM over two 24-hour periods within 4 weeks and other routine examinations. Their dipping patterns were classified as dippers (D), non-dippers (ND) and reverse-dipper (RD) according to their average systolic blood pressure at night compared to daytime. The short-term reproducibility was evaluated when above 3 different patterns used as continuous variables or categorical variables, and the differences among the reproducible and variable modes were analyzed. Results When the dipping patterns used as continuous variables, Bland-Altman’s plot showed that the reproducibility was good. While as categorical variables, overall 65.7% of the total 70 subjects (46/70) showed consistent dipping pattern during the 2 periods of ABPM, including 50.0%(14/28) confirming the identical RD, 76.5%(13/17) the identical D, and 76.0%(19/25) the identical ND (kappa=0.482). Subjects who had RD, D and ND on the first ABPM but changed to another pattern on the second time accounted for 20.0%, 5.7%, and 8.6%, respectively. No significant difference was found among the persistent RD (group 1), D (group 2), ND (group 3) and those with variable dippers (group 4) in main clinical characteristics. Conclusion The nocturnal blood pressure pattern is moderately reproducible in the elderly hypertensive patients, regardless of as continuous or categorical variable, but the reverse-dippers have higher variability when compared to dippers and non-dippers. Therefore, we should not confirm the dipping status based on single period of ABPM. This study has not found any factor that may affect the noctunal dipping pattern.
