中老年高血压人群颈动脉内膜-中膜厚度及斑块与血压的关联性

摘要

目的 探讨农村社区中老年高血压患者颈动脉内膜-中膜厚度(CIMT)及斑块与血压的关联性.方法 采用区组随机抽样,对连云港赣榆县农村社区45 ～ 75岁原发性高血压患者进行流行病学调查,测量血压,彩色超声仪测定CIMT和颈动脉斑块,应用多元线性回归、logistic回归模型分析CIMT、颈动脉斑块数(或检出率)与血压之间的关系.结果 共调查524人(男242人,女282人).男性CIMT为(0.7±0.1)mm,斑块检出率46.3％,女性CIMT为(0.7 ±0.1)mm,斑块检出率34.0％.调整相关变量后,收缩压每升高l mm Hg(1 mm Hg =0.133 kPa),男性患者CIMT增加0.001 12 mm(P＜0.001),而女性患者CIMT增加不明显;与高血压1级相比,高血压3级患者中检出1个以上斑块的风险明显增大,多因素校正后增加2.136倍(OR:2.136,95％ CI:1.138 ～4.012,P=0.018).结论 在中老年高血压人群中,特别在男性患者中颈动脉CIMT与收缩压呈正比,且血压水平越高,颈动脉斑块形成风险越大;高血压是动脉粥样硬化的独立危险因子.%Objective To analyze the associations of blood pressure (BP) level with carotid intimamedia thickness (CIMT) and plaque in a middle-aged and elderly hypertensive population.Methods By block randomized sampling,an epidemiological investigation was conducted among hypertensives aged 45-75 years in the northeru rural area of Jiangsu Province.Blood pressure was measured,and carotid CIMT and plaquc were determined using a coloured ultrasonograph.The relationship between blood pressure level and CIMT or plaque was analyzed using a multivariable linear regression or logistic regression model.Results A total of 524 subjects (male 242) were enrolled.CIMT and plaque prevalence were (0.7 ± 0.1) mm and 46.3％ in males and (0.7 ± 0.1)mm and 34.0％ in females.After adjustment for relevant variables,CIMT increased 0.001 12 mm with 1 mmHg systolic BP increase in males (P ＜ 0.001) but this trend was not significant in females.The risk of plaque number ＞ 1 was significantly higher in those with grade Ⅲ hypertension compared to grade I hypertensives (OR:2.136,95％ CI:1.138-4.012,P =0.018).Conclusion In this middle-aged and elderly hypertensive population,carotid CIMT is positively in relation to systolic BP,especially for male patients.Higher BP is associated with higher risk of plaque occurrence.Hypertension is thus an independent risk factor for the formation of atherosclerosis.