中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2013年
7期
611-615
,共5页
朱颖%陈长香%李晓庆%周永%黄玮%刘秀荣%安利杰%赵性泉%吴寿岭
硃穎%陳長香%李曉慶%週永%黃瑋%劉秀榮%安利傑%趙性泉%吳壽嶺
주영%진장향%리효경%주영%황위%류수영%안리걸%조성천%오수령
高血压%动脉硬化%危险因素
高血壓%動脈硬化%危險因素
고혈압%동맥경화%위험인소
Hypertension%Arterosclerosis%Risk factor
目的 探讨不同血压水平对颈动脉粥样斑块形成的影响.方法 从开滦(集团)有限责任公司2006-2007年度健康体检的101 510名在职及离退休职工中随机分层抽取5852名作为观察对象,符合入选标准的(年龄≥40岁、既往无缺血性脑卒中、短暂性脑缺血发作、心肌梗死者)5440名纳入研究队列,其中16例颈动脉斑块资料、35例血压资料缺失,最终纳入统计分析的有5389名.根据2010年中国高血压防治指南血压水平分类标准按2006年收缩压、舒张压值和服用降压药物情况将观察队列分成3组,正常血压组1377名、正常高值血压组1971例、高血压组2041例,其中男性3235例,女性2154例；年龄40 ～94(54.7±11.8)岁.对所有观察对象进行统一问卷调查、血液生化及颈动脉超声检查,并对颈动脉粥样斑块的危险因素进行多因素logistic回归分析.结果 正常高值血压组的高龄、男性、体质指数(BMI)、颈动脉内中膜厚度(IMT)、甘油三酯(TG)、空腹血糖(FBG)值、吸烟、饮酒者比例高于正常血压组,两组比较差异有统计学意义(P＜0.05)；而低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、高敏C反应蛋白(hs-CRP)、总胆固醇(TC)两组间比较差异无统计学意义(P＞0.05).正常血压组、正常高值血压组、高血压组颈动脉粥样斑块检出率分别为24.8％,37.4％,60.2％；正常高值血压组、高血压组发生颈动脉粥样斑块的风险分别比正常血压组增加38％和163％,其OR值分别为1.38(95％ CI:1.15 ～ 1.66) 、2.63(95％ CI:2.18～3.18).进一步将正常高值血压组按不同血压水平分为正常高值血压1组[收缩压/舒张压121 ～ 129/80～84 mm Hg(1 mm Hg =0.133 kPa)]和正常高值血压2组(收缩压/舒张压130 ～ 139/85 ～ 89 mm Hg),校正性别、年龄、吸烟、饮酒,TG、TC、HDL-C、FBG、hs-CRP、BMI等危险因素后,正常高值血压1组、正常高值血压2组、高血压组发生颈动脉斑块的风险均增加,其OR值分别为1.24(95％ CI:1.01 ～1.52)、1.69(95％ CI:1.34～2.15)、2.66(95％CI:2.20 ～3.21).结论 随血压水平的增高,颈动脉粥样斑块的检出率增加.在正常高值血压阶段,颈动脉粥样斑块的检出率已显著增加.
目的 探討不同血壓水平對頸動脈粥樣斑塊形成的影響.方法 從開灤(集糰)有限責任公司2006-2007年度健康體檢的101 510名在職及離退休職工中隨機分層抽取5852名作為觀察對象,符閤入選標準的(年齡≥40歲、既往無缺血性腦卒中、短暫性腦缺血髮作、心肌梗死者)5440名納入研究隊列,其中16例頸動脈斑塊資料、35例血壓資料缺失,最終納入統計分析的有5389名.根據2010年中國高血壓防治指南血壓水平分類標準按2006年收縮壓、舒張壓值和服用降壓藥物情況將觀察隊列分成3組,正常血壓組1377名、正常高值血壓組1971例、高血壓組2041例,其中男性3235例,女性2154例；年齡40 ～94(54.7±11.8)歲.對所有觀察對象進行統一問捲調查、血液生化及頸動脈超聲檢查,併對頸動脈粥樣斑塊的危險因素進行多因素logistic迴歸分析.結果 正常高值血壓組的高齡、男性、體質指數(BMI)、頸動脈內中膜厚度(IMT)、甘油三酯(TG)、空腹血糖(FBG)值、吸煙、飲酒者比例高于正常血壓組,兩組比較差異有統計學意義(P＜0.05)；而低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)、高敏C反應蛋白(hs-CRP)、總膽固醇(TC)兩組間比較差異無統計學意義(P＞0.05).正常血壓組、正常高值血壓組、高血壓組頸動脈粥樣斑塊檢齣率分彆為24.8％,37.4％,60.2％；正常高值血壓組、高血壓組髮生頸動脈粥樣斑塊的風險分彆比正常血壓組增加38％和163％,其OR值分彆為1.38(95％ CI:1.15 ～ 1.66) 、2.63(95％ CI:2.18～3.18).進一步將正常高值血壓組按不同血壓水平分為正常高值血壓1組[收縮壓/舒張壓121 ～ 129/80～84 mm Hg(1 mm Hg =0.133 kPa)]和正常高值血壓2組(收縮壓/舒張壓130 ～ 139/85 ～ 89 mm Hg),校正性彆、年齡、吸煙、飲酒,TG、TC、HDL-C、FBG、hs-CRP、BMI等危險因素後,正常高值血壓1組、正常高值血壓2組、高血壓組髮生頸動脈斑塊的風險均增加,其OR值分彆為1.24(95％ CI:1.01 ～1.52)、1.69(95％ CI:1.34～2.15)、2.66(95％CI:2.20 ～3.21).結論 隨血壓水平的增高,頸動脈粥樣斑塊的檢齣率增加.在正常高值血壓階段,頸動脈粥樣斑塊的檢齣率已顯著增加.
목적 탐토불동혈압수평대경동맥죽양반괴형성적영향.방법 종개란(집단)유한책임공사2006-2007년도건강체검적101 510명재직급리퇴휴직공중수궤분층추취5852명작위관찰대상,부합입선표준적(년령≥40세、기왕무결혈성뇌졸중、단잠성뇌결혈발작、심기경사자)5440명납입연구대렬,기중16례경동맥반괴자료、35례혈압자료결실,최종납입통계분석적유5389명.근거2010년중국고혈압방치지남혈압수평분류표준안2006년수축압、서장압치화복용강압약물정황장관찰대렬분성3조,정상혈압조1377명、정상고치혈압조1971례、고혈압조2041례,기중남성3235례,녀성2154례；년령40 ～94(54.7±11.8)세.대소유관찰대상진행통일문권조사、혈액생화급경동맥초성검사,병대경동맥죽양반괴적위험인소진행다인소logistic회귀분석.결과 정상고치혈압조적고령、남성、체질지수(BMI)、경동맥내중막후도(IMT)、감유삼지(TG)、공복혈당(FBG)치、흡연、음주자비례고우정상혈압조,량조비교차이유통계학의의(P＜0.05)；이저밀도지단백담고순(LDL-C)、고밀도지단백담고순(HDL-C)、고민C반응단백(hs-CRP)、총담고순(TC)량조간비교차이무통계학의의(P＞0.05).정상혈압조、정상고치혈압조、고혈압조경동맥죽양반괴검출솔분별위24.8％,37.4％,60.2％；정상고치혈압조、고혈압조발생경동맥죽양반괴적풍험분별비정상혈압조증가38％화163％,기OR치분별위1.38(95％ CI:1.15 ～ 1.66) 、2.63(95％ CI:2.18～3.18).진일보장정상고치혈압조안불동혈압수평분위정상고치혈압1조[수축압/서장압121 ～ 129/80～84 mm Hg(1 mm Hg =0.133 kPa)]화정상고치혈압2조(수축압/서장압130 ～ 139/85 ～ 89 mm Hg),교정성별、년령、흡연、음주,TG、TC、HDL-C、FBG、hs-CRP、BMI등위험인소후,정상고치혈압1조、정상고치혈압2조、고혈압조발생경동맥반괴적풍험균증가,기OR치분별위1.24(95％ CI:1.01 ～1.52)、1.69(95％ CI:1.34～2.15)、2.66(95％CI:2.20 ～3.21).결론 수혈압수평적증고,경동맥죽양반괴적검출솔증가.재정상고치혈압계단,경동맥죽양반괴적검출솔이현저증가.
Objective To explore the association between blood pressure level and incidence of carotid arterial plaque in middle-aged and elderly people.Methods A total of 5852 individuals were randomly stratified from the 101 510 health examination survey participants in Tangshan Kailuan Company community during 2006-2007.A total of 5440 people (age above 40 years old,free of stroke,TIA and myocardial infarction) were enrolled in the final analysis.A questionnaire survey,blood biochemical analysis and carotid artery ultrasound examination were finished by trained medical staff.Sixteen individuals without carotid artery plaques information and 35 individuals without blood pressure information were excluded.Finally,a total of 5389 participants [3235 male,mean age:(54.7 ± 11.8) years] were analyzed.According to 2010 Chinese guideline to prevention and treatment of hypertension and blood pressure level classification,participants were divided into normotensive group (n =1377),high normal blood pressure group (n =1971) and hypertensive group (n =2041).Multivariate logistic regression analysis was used to determine the risk factors of the carotid artery plaques.Results Age,male gender,BMI,IMT,TG,FBG,smoking and alcohol drinking rate were significantly higher in high normal blood pressure group than in normotensive group (all P ＜ 0.05),LDL-C,HDL-C,hs-CRP and TC were similar between these two groups.Incidence of carotid artery plaques in normotensive,high normal blood pressure and hypertensive groups was 24.8％,37.4％,60.2％ respectively.The risk of carotid artery plaques was increased to 38％ and 163％ in high normal and hypertensive groups compared to normotensive group,the OR ratio was 1.38 (95 ％ CI:1.15-1.66) and 2.63 (95 ％ CI:2.18-3.18),respectively.After adjusting gender,age,smoking,alcohol consumption,TG,TC,HDL-C,FBG,hs-CRP and BMI,the risk of developing carotid artery plague was increased in proportion to increasing blood pressure and the OR value was1.24(95％CI:1.01-1.52),1.69(95％CI:1.34-2.15) and 2.66 (95 ％ CI:2.20-3.21) in high normal group I [SBP/DBP 121-129/80-84 mm Hg(1 mm Hg =0.133 kPa)] and high normal group Ⅱ (SBP/DBP 130-139/85-89 mm Hg) and hypertensive group,respectively.Conclusions The cardiovascular risk factors and prevalence of carotid artery plague increase in proportion to blood pressure level in this cohort.The detection rate of carotid artery plague is already significantly increased in individuals with high normal blood pressure.
