中国循证心血管医学杂志
中國循證心血管醫學雜誌
중국순증심혈관의학잡지
CHINESE JOURNAL OF EVIDENCE-BASES CARDIOVASCULAR MEDICINE
2014年
3期
267-270
,共4页
王吉%尹双艳%秦爱梅%王浩%朱兵%孙玉青%赵晓茜%孙洪良%胡智%杜凯音%骆雷鸣
王吉%尹雙豔%秦愛梅%王浩%硃兵%孫玉青%趙曉茜%孫洪良%鬍智%杜凱音%駱雷鳴
왕길%윤쌍염%진애매%왕호%주병%손옥청%조효천%손홍량%호지%두개음%락뢰명
老年%高血压%血压节律%动脉粥样硬化%左心室肥厚
老年%高血壓%血壓節律%動脈粥樣硬化%左心室肥厚
노년%고혈압%혈압절률%동맥죽양경화%좌심실비후
Elderly%Hypertension%Rhythm of blood pressure%Atherosclerosis%Left ventricular hypertrophy
目的：探讨老年原发性高血压病患者血压昼夜节律异常对颈动脉内中膜厚度（IMT）及左心室肥厚（LVH）的影响。方法连续入选280例老年原发性高血压病患者，采集24h动态血压监测（ABPM）、颈动脉超声和超声心动图指标，根据血压昼夜节律及收缩压昼夜差百分比（ΔSBP%）分为4组，杓型组（n=125）：ΔSBP%≥10%但＜20%；非杓型组（n=92）：ΔSBP%≥0%但＜10%；反杓型组（n=41）：ΔSBP%＜0%；超杓型组（n=22）：ΔSBP%≥20%。比较分析4组患者间双侧颈动脉IMT增厚及左心室肥厚发生率。结果4组患者颈动脉IMT增厚发生率由低到高依次为杓型组44.0%、非杓型组58.7%、超杓型组77.3%、反杓型组80.5%，组间比较有显著统计学差异（P＜0.01）。4组患者左心室肥厚发生率由低到高依次为杓型组30.4%、非杓型组44.6%、超杓型组50.0%、反杓型组61.0%，组间比较有显著统计学差异（P＜0.01）。4组间颈动脉IMT增厚合并左心室肥厚发生率由低到高依次为杓型组20.8%、非杓型组34.8%、超杓型组40.9%、反杓型组48.8%比较，组间比较有显著统计学差异（P＜0.01）。多因素logistic回归分析显示低密度脂蛋白胆固醇、空腹血糖对血压昼夜节律形态学特征具有独立预测的能力（P＜0.05）。结论老年高血压患者随形态节律异常严重程度增加，颈动脉硬化、左心室肥厚发生率显著增高。
目的：探討老年原髮性高血壓病患者血壓晝夜節律異常對頸動脈內中膜厚度（IMT）及左心室肥厚（LVH）的影響。方法連續入選280例老年原髮性高血壓病患者，採集24h動態血壓鑑測（ABPM）、頸動脈超聲和超聲心動圖指標，根據血壓晝夜節律及收縮壓晝夜差百分比（ΔSBP%）分為4組，杓型組（n=125）：ΔSBP%≥10%但＜20%；非杓型組（n=92）：ΔSBP%≥0%但＜10%；反杓型組（n=41）：ΔSBP%＜0%；超杓型組（n=22）：ΔSBP%≥20%。比較分析4組患者間雙側頸動脈IMT增厚及左心室肥厚髮生率。結果4組患者頸動脈IMT增厚髮生率由低到高依次為杓型組44.0%、非杓型組58.7%、超杓型組77.3%、反杓型組80.5%，組間比較有顯著統計學差異（P＜0.01）。4組患者左心室肥厚髮生率由低到高依次為杓型組30.4%、非杓型組44.6%、超杓型組50.0%、反杓型組61.0%，組間比較有顯著統計學差異（P＜0.01）。4組間頸動脈IMT增厚閤併左心室肥厚髮生率由低到高依次為杓型組20.8%、非杓型組34.8%、超杓型組40.9%、反杓型組48.8%比較，組間比較有顯著統計學差異（P＜0.01）。多因素logistic迴歸分析顯示低密度脂蛋白膽固醇、空腹血糖對血壓晝夜節律形態學特徵具有獨立預測的能力（P＜0.05）。結論老年高血壓患者隨形態節律異常嚴重程度增加，頸動脈硬化、左心室肥厚髮生率顯著增高。
목적：탐토노년원발성고혈압병환자혈압주야절률이상대경동맥내중막후도（IMT）급좌심실비후（LVH）적영향。방법련속입선280례노년원발성고혈압병환자，채집24h동태혈압감측（ABPM）、경동맥초성화초성심동도지표，근거혈압주야절률급수축압주야차백분비（ΔSBP%）분위4조，표형조（n=125）：ΔSBP%≥10%단＜20%；비표형조（n=92）：ΔSBP%≥0%단＜10%；반표형조（n=41）：ΔSBP%＜0%；초표형조（n=22）：ΔSBP%≥20%。비교분석4조환자간쌍측경동맥IMT증후급좌심실비후발생솔。결과4조환자경동맥IMT증후발생솔유저도고의차위표형조44.0%、비표형조58.7%、초표형조77.3%、반표형조80.5%，조간비교유현저통계학차이（P＜0.01）。4조환자좌심실비후발생솔유저도고의차위표형조30.4%、비표형조44.6%、초표형조50.0%、반표형조61.0%，조간비교유현저통계학차이（P＜0.01）。4조간경동맥IMT증후합병좌심실비후발생솔유저도고의차위표형조20.8%、비표형조34.8%、초표형조40.9%、반표형조48.8%비교，조간비교유현저통계학차이（P＜0.01）。다인소logistic회귀분석현시저밀도지단백담고순、공복혈당대혈압주야절률형태학특정구유독립예측적능력（P＜0.05）。결론노년고혈압환자수형태절률이상엄중정도증가，경동맥경화、좌심실비후발생솔현저증고。
Objective To investigate the influences of abnormal circadian rhythm of blood pressure (BP) on carotid artery intima-media thickness (CA-IMT) and left ventricular hypertrophy (LVH) in the elderly patients with primary hypertension. Methods The elderly patients (n=280) were chosen and their data were collected by using 24-h ambulatory blood pressure monitoring (ABPM), carotid ultrasound and echocardiography. All patients were divided, according to circadian rhythm of BP and percentage of systolic BP (ΔSBP%), into dipper group (n=125,ΔSBP%≥10%but<20%), non-dipper group (n=92,ΔSBP%≥0%but<10%), reverse-dipper group (n=41,ΔSBP%<0%) and extreme-dipper group (n=22,ΔSBP%≥20%). The incidence rates of bilateral CA-IMT thickening and LVH were compared and analyzed in 4 groups. Results The incidence rate of CA-IMT thickening was 44.0%in dipper group, 58.7%in non-dipper group, 77.3%in extreme-dipper group and 80.5%in reverse-dipper group (P<0.01). The incidence rate of LVH was 30.4%in dipper group, 44.6%in non-dipper group, 50.0%in extreme-dipper group and 61.0%in reverse-dipper group (P<0.01). The incidence rate of CA-IMT thickening complicating LVH was 20.8%in dipper group, 34.8%in non-dipper group, 40.9%in extreme-dipper group and 48.8% in reverse-dipper group (P<0.01). The multifactor logistic regression analysis showed that low-density lipoprotein-cholesterol (LDL-C) and fasting plasma glucose had independent predictive effects to the morphological features of BP circadian rhythm (P<0.05). Conclusion The incidence rates of CA-IMT thickening and LVH will significantly increase as the severity of abnormal BP circadian rhythm exacerbates in the elderly patients with hypertension.
