目的 探讨高血压前期体检人群血压水平与体质量之间的关系,为临床防治高血压提供参考.方法 选择2007年1月-2011年12月我院体检中心体检者共243例,根据体质指数分为正常体质量组(18.5 kg/m2≤体质指数＜ 24.0 kg/m2)、超重组(24.0 kg/m2≤体质指数＜ 28.0 kg/m2)和肥胖组(体质指数≥28.0kg/m2).采用日立7600-120全自动生化仪检测其血糖、肌酐(Cr)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)；SECA身高体质量检测仪测量身高和体质量,体质指数=体质量(kg)/身高2(m2)；标准汞柱血压计测量白天静息15 min后的坐位血压；美林公司Accuwin 2.0血压监测仪监测24h动态血压,记录仪自动记录并统计分析以下指标:24h平均血压、白天平均血压、夜间平均血压、白天和夜间血压负荷、白天和夜间血压变化标准差.结果 3组体质指数、血糖、TG及HDL-C水平比较,差异均有统计学意义(P＜0.01),Cr、TC、LDL-C水平比较,差异均无统计学意义(P＞0.05).3组24 h平均舒张压、白天平均舒张压、夜间平均舒张压、白天舒张压变化标准差、白天舒张压负荷、夜间舒张压负荷比较,差异均有统计学意义(P＜0.05),24 h平均收缩压、白天平均收缩压、夜间平均收缩压、白天收缩压变化标准差、夜间收缩压变化标准差、夜间舒张压变化标准差、白天收缩压负荷、夜间收缩压负荷比较,差异均无统计学意义(P＞0.05).Pearson相关分析显示,体质指数与24h平均收缩压(r=0.128)和舒张压(r=0.188)、白天平均收缩压(r=0.154)和舒张压(r=0.186)、夜间平均舒张压(r =0.148)、白天收缩压负荷(r=0.126)和舒张压负荷(r=0.146)、白天舒张压变化标准差(r=0.253)、夜间舒张压变化标准差(r =0.190)均呈正相关(P＜0.05).调整年龄、性别、吸烟、饮酒、血糖、Cr、TC、TG、HDL-C、LDL-C等因素后进行多元线性回归分析发现,体质指数与24h平均舒张压、白天平均舒张压、白天舒张压变化标准差、夜间舒张压变化标准差独立相关.结论 24h动态血压监测提示超重与肥胖可使高血压前期体检人群血压水平、血压负荷及血压变异性明显增加,高血压前期人群可通过改善饮食结构、加强体育锻炼、减轻体质量而防止进展为高血压.%Objective To investigate relationship between body mass index (BMI) and parameters from ambulatory blood pressure monitoring in population who underwent pre - hypertension examination. Methods Totally 243 persons who underwent pre - hypertension examination form January 2007 to December 2011 in our physical examination center were recruited. They were divided based on their BMI as normal group (18. 5 kg/m2 ≤BMI <24. 0 kg/m2) , overweight group (24. 0 kg/m2≤ BMI <28. 0 kg/m2) and obesity group (BMI≥28. 0 kg/m2) . The parameters of blood sugar, creatine ( Cr) , total cholesterol (TC) , triglyceride ( TG) , high - density lipoprotein cholesterol ( HDL - C) and low - density lipoprotein cholesterol ( LDL -C) were assyed by Hitachi 7600 - 120 automatic biochemistry analyzer. The body height and BMI were measured by SECA height and BMI meter, BMI = weight ( kg) /height2 ( m2 ). The blood pressure at setting position was taken by Standard mercury sphygmomanometer 15 min after rest in daytime. The ambulatory blood pressure monitoring was conducted by using Accuwin 2. 0 of Merrill Lynch. Results Among the three groups there were no significant differences in BMI, blood sugar, TG and HDL - C ( P < 0. 01) , but there were in Cr, TC, LDL - C ( P > 0. 05 ) . And there were significant differences in 24 h average diagnostic blood pressure, average diagnostic blood pressure in daytime and at night, standard deviation of daytime diagnostic blood pressure , loads of daytime and night diagnostic blood pressure ( P < 0. 05 ) ; but no significant difference was found in 24 h average systolic blood pressure, systolic blood pressure in daytime and at night, standard deviations of daytime and night systolic blood pressure, standard deviation of night diagnostic blood pressure, and loads of daytime and night systolic blood pressure ( P > 0. 05). Pearson correlation analysis showed that the BMI was positively correlated with the 24 h average systolic and diagnostic blood pressure (r =0. 128, r =0. 188) , daytime average systolic and diastolic blood pressure (r =0. 154, r =0. 186) , night average diagnostic blood pressure (r =0. 148) , loads of daytime systolic and diastolic blood pressure (r = 0. 126, r =0. 146) , and standard deviations of daytime and night (r =0.253, r =0.190) (P<0. 05). After regulating age, sex, smoking, alcohol drinking, blood sugar, Cr, TC, TG, HDL - C and LDL -C, the multiple linear regression analysis showed that the BMI was still correlated with 24 h average diagnostic blood pressure, daytime average diagnostic blood pressure, standard deviations of daytime and night diagnostic blood pressure independently. Conclusion The ambulatory blood pressure monitoring indicates that the overweight and obesity may obviously increase blood pressure level, blood pressure load and blood pressure variability in population with pre - hypertension examination. This population can prevent the onset of hypertension through improving dietary structure, enhancing physical exercise, and reducing body mass.
展开▼
