高血压患者血压变异性与冠状动脉病变严重程度的相关性研究

摘要

Objective To discuss the relation between blood pressure variability and severity of coronary artery lesion.Methods A total of 124 hypertension patients had coronary artery angiography.The degree of coronary artery stenosis and the coronary lesions integral (CAS) were analyzed.According to the coronary artery angiography results,the patients were divided into four groups:group A (0-4),group B (＞ 4-29),group C (＞ 29-63) and group D(＞ 63).All patients had 24 hours ambulatory blood pressure monitory.The blood pressure variability including 24 h systolic blood pressure coefficient of variation (24 h SCV),day systolic blood pressure coefficient of variation (dSCV),night systolic blood pressure coefficient of variation (nSCV),24 h diastolic blood pressure coefficient of variation (24 h DCV),day diastolic blood pressure coefficient of variation (dDCV) and night diastolic blood pressure coefficient of variation (nDCV) were analyzed.The correlation between the blood pressure variability and severity of coronary artery lesion were analyzed.Results The levels of 24 h SCV,dSCV and nSCV increased with the degree of CAS[24 h SCV of four groups were (11.7 ± 2.3),(13.8 ± 2.1),(14.9 ± 3.3) and (16.5 ± 3.9) ; dSCV of four groups were (13.2 ± 2.7),(15.0 ± 2.7),(16.9 ± 3.8) and (18.8 ± 4.3) ; nSCV of four groups were(10 ±4),(13 ±4),(14 ± 3) and(15 ± 3)] ; the differences of same index in four groups were statistically significant (P ＜ 0.05).The levels of 24 h DCV in group B,C,D were significantly higher than those in the group A ; the difference were statistically significant [(9.2 ± 3.0),(9.4 ± 2.7),(9.4 ± 2.9) vs (8.6 ± 2.5),P ＜ 0.05].Compared CAS with Spearman,CAS was positively correlated with 24 h SCV,dSCV and nSCV (r =0.493,0.465,0.390,P ＜0.05).By the multiple linear regression between CAS and paramenters,CAS was independently correlated with 24 h SCV and dSCV (P ＜ 0.01).Conclusions The levels of blood pressure variability increasewith the degree of CAS.24 h SCV and dSCV are independent risks factor for CAS.%目的 探讨高血压患者血压变异性与冠状动脉病变严重程度的相关性.方法 选择拟诊冠状动脉粥样硬化性心脏病(冠心病)并择期行冠状动脉造影的高血压患者124例,行24 h动态血压监测,以Gensini积分法对冠状动脉狭窄程度进行量化得到冠状动脉病变积分(GAS),将患者根据CAS的四分位水平分为4组,A组(0～4分)31例、B组(＞4 ～ 29分)34例、C组(＞29～63分)30例、D组(＞63分)29例.分析血压变异性指标,包括24 h收缩压变异系数(24 h SCV)、白昼收缩压变异系数(dSCV)、夜间收缩压变异系数(nSCV)、24 h舒张压变异系数(24 h DCV)、白昼舒张压变异系数(dDCV)及夜间舒张压变异系数(nDCV)与CAS关系.结果 A、B、C、D组患者24 h SCV、dSCV及nSCV分别为(11.7±2.3)、(13.8±2.1)、(14.9±3.3)、(16.5±3.9),(13.2±2.7)、(15.0±2.7)、(16.9±3.8)、(18.8±4.3),(10±4)、(13±4)、(14±3)、(15±3),相同指标各组间差异均有统计学意义(均P＜0.05);B、C、D组的24 h DCV均明显高于A组,差异有统计学意义[(9.2±3.0)、(9.4±2.7)、(9.4±2.9)比(8.6±2.5),P＜0.05];CAS与各变量间的Spearman相关分析显示24 h SCV、dSCV、nSCV与CAS呈明显正相关(r=0.493,r =0.465,r=0.390,均P＜0.05);CAS的多元线性回归分析提示24 h SCV、dSCV与CAS独立相关.结论 血压变异性随CAS的增高而增高,其中24 h SCV及dSCV与CAS独立相关,对预测冠心病患者血管受损程度有一定价值.