高龄老年人体位性血压改变与动脉粥样硬化的相关性

摘要

目的 探讨高龄老年人体位性血压变化与动脉粥样硬化的相关性.方法 连续收集2014年6月～2015年12月在新疆医科大学第一附属医院住院的高龄老年人227例.按照体位性血压的改变分为正常组151例,体位性低血压组52例和体位性高血压组24例.所有入选者均进行四肢血流多普勒超声测定.比较3组体位性血压变化与肱踝脉搏波传导速度(baPWV)和踝臂指数(ABI)的关系.结果 与正常组比较,体位性高血压组年龄明显增高[(83.93±2.99)岁vs (82,32±3.15)岁,P＜0.05],体位性低血压组跌倒评分明显增高[(57.40±17.92)分vs(49.37±17.25)分,P＜0.01];右侧ABI和左侧ABI明显降低(0.97±0.14 vs 1.18±0.09,P＜0.01;0.89±0.21vs 1.15±0.12,P＜0.01).经多因素非条件logistic回归分析显示,ABI降低是发生体位性低血压的独立危险因素之一(OR=20.776,95％CI:7.449～57.947,P=0.000).跌倒评分升高发生体位性低血压风险是正常人群的1.035倍(95％ CI:1.013～1.057,P=0.002).年龄是导致体位性高血压发生的独立危险因素之一(OR=1.169,95 ％CI:1.014～1.348,P=0.031).结论 ABI降低是高龄老年人发生体位性低血压的独立危险因素之一.年龄是导致体位性高血压发生的独立危险因素之一.跌倒评分值可能预测体位性低血压的发生风险.%Objective To study the relationship between orthostatic blood pressure and atheriosclerosis in very old people.Methods Two hundred and twenty-seven very old people admitted to our hospital from June 2014 to December 2015 were randomly divided into orthostatic normotension (ONT) group (n =151),orthostatic hypotension (OH) group (n =52),and orthostatic hypertension (OHT) group (n=24) according to their postural blood pressure.Their blood flow in 4 extremities was measured by Doppler ultrasonography.Their orthostatic blood pressure,brachialankle pulse wave velocity (baPWV) and ankle brachial index (ABI) were compared.Results The age was older and the fall score was significantly higher in OHT group than in ONT group (P＜0.05,P＜0.01).The right and left ABI were significantly lower in OH group than in ONT group (P＜0.01).Multivariate logistic regreassion analysis showed that low ABI was one of the independent risk factors for OH (OR=20.776,95 ％CI:7.449-57.947,P=0.000).The incidence of OH was 1.035-fold higher in patients with a high fall score than in those with a normal fall score (95％CI:1.013-1.057,P=0.002).Age was one of the independent risk factors for OHT in very old people (OR=1.169,95％CI:1.014-1.348,P=0.031).Conclusion Low ABI is one of the independent risk factors for OH and age is one of the independent risk factors for OHT in very old people.Fall score can predict the risk of OH.