老年人体位性血压变异与颈动脉粥样硬化的相关性研究

摘要

目的 观察老年社区人群颈动脉粥样硬化斑块形成与体位性血压变异的相关性. 方法 采用横断面研究设计,通过现场标准问卷、体格检查、静脉血生化检查获得受试者基本临床资料,并行颈动脉超声检查明确其是否存在颈动脉斑块及分布情况.分别测定受试者卧、立位血压,根据1996年美国自主神经学会和美国神经病学协会制定标准,诊断体位性低血压(OH)和体位性高血压(OHT). 结果 本研究最终纳入老年社区人群377例,其中OH 101例(26.8％),OHT 33例(8.8％).Logistic回归分析在校正多个潜在危险因素后,颈动脉斑块者OH患病风险增加(OR=2.27,95％ CI:1.32～3.90,P=0.003),且存在双侧斑块者OH患病风险增加显著(OR=3.45,95％ CI:1.74～6.84,P=0.001),存在单侧斑块者OH风险并未增加(OR=1.71,95％ CI:0.88～3.32,P=0.112);而无论存在双侧或单侧颈动脉斑块,其OHT的患病风险均未增加. 结论 颈动脉斑块,尤其是双侧颈动脉斑块是社区老年人群发生OH而非OHT的独立危险因素.%Objective To investigate association between postural changes of blood pressure and carotid atherosclerosis in the elderly.Methods Standardized questionnaires,physical examination and biochemical blood tests were performed to acquire clinical characteristics of the participants.Presences of carotid plaques were identified by carotid ultrasound examination.Orthostatic hypotension (OH) and orthostatic hypertension (OHT) were defined according to the international consensus.Multivariable logistic regression analysis was performed to analyze the associations of carotid plaques with OH and OHT.Results 377 old people were finally included,of which 101 had OH and 33 had OHT.After full adjustment for possible confounders,old people with carotid plaques had significantly increased risk for OH as compared with those without carotid plaques (OR=2.27,95％ CI:1.32-3.90,P=0.003).Participants with bilateral carotid plaques were associated with significantly increased risk for OH (OR=3.45,95％CI:1.74 6.84,P=0.001),while the association between unilateral carotid plaques and OH was not significant (OR=1.71,95％ CI:0.88-3.32,P=0.112).No significant association was identified between carotid plaques (bilateral or unilateral) and OHT.Conclusions Presence of carotid plaques,particularly bilateral plaques,may be an independent risk factor for OH.