中老年高血压患者肱踝脉搏波速度与颈动脉斑块形成的相关性研究

摘要

目的 探讨肱踝脉搏波传导速度(BaPWV)的变化与颈动脉斑块发生的相关性. 方法 本研究为横断面研究,选择2013年1月至2013年9月在北京安贞医院高血压科住院患者409例为研究对象,年龄35～75岁,平均(53.2±15.0)岁,并行颈动脉超声和BaPWV检查,根据其有无颈动脉斑块分为斑块组和对照组,分析两组患者的一般临床资料比较;再根据BaPWV水平分为两组,正常组(BaPWV＜1400 cm/s)和升高组(BaPWV≥1400 cm/s),将BaPWV正常与BaPWV升高者颈动脉斑块检出率比较;再采用多因素Logistic回归分析的方法,进行BaPWV与颈动脉斑块的相关性分析. 结果 与对照组比较,斑块组随着年龄(t=11.0,P=0.00)、收缩压(t=3.87,P=0.00)、舒张压(t=3.70,P=0.00)、脉压(t=-6.13,P=0.00)、总胆固醇(t=2.57,P=0.01)的升高颈动脉斑块的发生增加(P＜0.05);BaPWV正常与BaPWV升高者颈动脉斑块检出率比较:BaPWV正常组155例,检出斑块患者67例(43.2％),BaPWV升高组254例,检出斑块患者159例(62.6％),BaPWV升高者颈动脉斑块检出率高于BaPWV正常者(x2=14.61,P=0.0,0);影响左心室肥厚的多因素Logistic回归分析显示,在调整了年龄、血压等心血管危险因素后,BaPWV升高仍然是颈动脉斑块的独立危险因素(OR=2.06,P=0.05),年龄、吸烟、收缩压、舒张压、脉压、总胆固醇、低密度脂蛋白胆固醇、三酰甘油也与颈动脉斑块呈正相关. 结论 BaPWV是颈动脉斑块的独立影响因素之一,对血管病变具有早期诊断和筛查的作用.%Objective To explore the relationship between brachial ankle pulse wave velocity (BaPWV) change and carotid artery plaque formation in middle-aged and elderly patients with essential hypertension(EH).Methods A cross sectional study was conducted in 409 patients who were admitted in Hypertension Department in our hospital from January to September 2013.Their age ranged from 35 to 75 years,with mean aged(53.2±15.0) years.Parallel carotid artery ultrasound and BaPWV examination were performed in all patients.According to whether carotid plaques were present,patients were divided into two groups:carotid plaque group and control group.And carotid plaque group was sub-grouped into normal BaPWV group (BaPWV ＜ 1400cm/s) and increased BaPWV group(BaPWV≥1400 cm/s) according to BaPWV levels.The detection rate of carotid plaque was compared between normal BaPWV group and increased BaPWV group.The correlation between BaPWV and carotid plaques was analyzed by multivariate logistic regression analysis.Results Compared with the control group,carotid plaque group showed the prevalence of carotid plaques was increased along with the increases of age(t=11.0,P=11.0),systolic blood pressure (t=3.87,P=3.87),diastolic blood pressure(t=3.70,P=0.00),pulse pressure(t=6.13,P 6.13),total cholesterol levels(t=2.57,P=0.01).The detection rate of carotid plaque was higher in increased BaPWV group than in normal BaPWV group [62.6％(159/254) vs.43.2％(67/155),x2=14.61,P=0.00].After adjusting for age,blood pressure and other cardiovascular risk factors,the multivariate logistic regression analysis showed that increased BaPWV was an independent risk factor for carotid plaques(OR=2.06,P=0.05),and age,smoking,systolic pressure,diastolic pressure,pulse pressure,total cholesterol,low-density lipoprotein cholesterol,triglyceride levels were positively correlated with carotid plaques.Conclusions BaPWV is one of the independent impact factors for carotid plaques,which plays an important role in early diagnosis and screening for subclinical vascular lesions.