老年人非杓型高血压与动脉粥样硬化的相关性探讨

摘要

目的 探讨非杓型血压节律对老年高血压患者外周动脉硬化的影响. 方法 以2011年1月至2012年10月期间符合入组标准的199例老年高血压患者为研究对象,分别记录体质量指数(BMI),糖化血红蛋白(HbA1C)、血脂、尿酸、肌酐、踝臂脉搏波传导速度(baPWV)、臂踝指数(ABI)等.根据动态血压监测结果,将患者分为杓型高血压组(95例)和非杓型高血压组(104例)分析动脉硬化各相关影响因素与动脉硬化严重性之间的关系及特点. 结果 血压节律、年龄、胆固醇、三酰甘油、血肌酐水平、夜尿次数以及吸烟指数与动脉硬化相关.其中血压节律对baPWV的影响最大,标准化回归系数最高为0.439;血肌酐水平、夜尿次数、年龄对ABI产生线性影响.两组间baPWV(1746±246.9和2115.7±321.8,P＜0.05)及ABI(1.14±0.10和1.11±0.18,P＜0.001),吸烟指数(251.8±272.8和368.58±339.9,P＜0.05)差异有统计学意义,且多元线性回归吸烟指数对baPWV影响明显,吸烟指数和血压节律二者交互项系数无统计学意义;MAP差值百分比与baPWV诊断结果的接受者操作特征曲线(ROC),曲线下面积为0.8188,最佳截点为10.9％的灵敏度为62.5％,特异度为85.7％;平均动脉压(MAP)差值百分比与急性心肌梗死(AMI)诊断结果的ROC曲线,曲线下面积为0.7589,最佳截点为8.1％的灵敏度为88％,特异度为61％.提示MAP差值百分比截点与baPWV,ABI的结果有较好的一致性,间接地体现了MAP差值百分比与动脉硬化之间存在关联. 结论 改善老年高血压患者的不良生活习惯、控制收缩压的同时,还需根据老年高血压患者血压节律特点调整降压药物服药时间,尽可能恢复正常的血压昼夜节律,延缓动脉硬化进程.%Objective To investigate the influence of non-dipper blood pressure rhythm on peripheral atherosclerosis in elderly hypertensive patients.Methods The 199 elderly hypertensive patients with 24-hour average systolic blood pressure＜140 mmHg were selected.Body mass index (BMI),glycosylated hemoglobin,blood lipids,uric acid,creatinine,Brachial ankle pulse wave velocity (baPWV),ankle arm index(ABI) and 24-hour ambulatory blood pressure monitoring were tested and calculated.The elderly patients were divided into dipper hypertensive group (n=95),and non-dipper hypertensive group (n=104).The relationships of arteriosclerosis with lifestyle and the circadian rhythm of blood pressure (non-dipper hypertension) were analyzed.Results Circadian blood pressure rhythm,age,levels of total cholesterol,triglyceride and serum creatinine,nocturia times,and smoking index were significantly related with atherosclerosis.There was a relationship between circadian blood pressure rhythm and baPWV,with the greatest standardized regression coefficient of 0.439.There were obviously linear relationships between levels of serum creatinine,nocturia times,age and ABI.There were significant differences in baPWV,ABI and smoking index between dippers and non-dippers groups [(1746.0±246.9) vs.(2115.7±321.8),(1.14±0.10) vs.(1.11±0.18),(251.8±272.8) vs.(368.5±339.9),P＜0.05 or 0.001].The multiple linear regression analysis showed that smoking index was significantly correlated with baPWV,but not correlated with blood pressure rhythm.In the ROC curve of MAP difference percentage and baPWV diagnosis result,the area under the curve was 0.8188,the optimal cut-off was 10.9％,the sensitivity was 62.5％ and the specificity was 85.7％.In the ROC curve of MAP difference percentage and AMI diagnosis result,the area under the curve was 0.7589,the optimal cut-off was 8.1％,the sensitivity was 88％,and the specificity was 61％.These results reflected that there were better consistences between MAP difference percentage and baPWV,ABI,and indirectly indicted that there was a relationship between MAP difference percentage and atherosclerosis.Conclusions We advise the elderly patients to give up the bad habits,help them control the systolic blood pressure,and advise them to adjust the medication time according to the circadian rhythm of blood pressure of every elderly hypertensive patient in order to restore the normal circadian blood pressure rhythm and delay the atherosclerotic process.