目的：探讨老年高血压病患者脉压及血压昼夜节律异常对颈动脉粥样硬化斑块形成的影响。方法150例老年原发性高血压患者根据24 h动态血压检测结果，按照昼夜血压下降率分为2组，＜10%为非杓型组（72例），≥10%为杓型组（78例）。超声检测颈动脉粥样硬化斑块程度及性质，并对斑块进行分级。计算不同脉压水平[≤60 mmHg（1 mmHg=0.133 kPa）、61~89 mmHg、≥90 mmHg]高血压患者颈动脉斑块检出率。结果杓型组高血压病患者中检出斑块61例，位于双侧20例，右侧15例，左侧26例，斑块检出率为78%（61/78）；非杓型组高血压病患者中检出斑块68例，位于双侧38例，右侧14例，左侧16例，斑块检出率为94%（68/72）。非杓型组斑块检出率高于杓型组，差异有统计学意义（χ2=8.07，P＜0.01）。杓型组中硬斑30例、软斑13例、混合斑8例，非杓型组中硬斑12例、软斑24例、混合斑32例；杓型组中斑块分级为0级、1级、2级、3级的患者分别为17、33、13、15例，非杓型组中0级、1级、2级、3级的患者分别为6、8、25、33例。2组患者斑块性质及斑块分级的差异均有统计学意义（χ2=5.29、8.75，P均＜0.01）。43例患者脉压≤60 mmHg，斑块检出率为72%（30/43）；65例脉压为61~89 mmHg，斑块检出率为88%（57/65）；42例脉压≥90 mmHg，斑块检出率为98%（41/42）。脉压≤60 mmHg、61~89 mmHg、≥90 mmHg的高血压病患者斑块检出率间差异有统计学意义（χ2=11.65，P=0.00）。结论脉压增大及血压昼夜节律异常是颈动脉粥样硬化斑块形成的危险因素。%Objective To observe the impact of pulse pressure (PP) and blood pressure (BP) circadian rhythm abnormality of aged hypertension patients on carotid atherosclerosis. Methods One hundred and fifty cases of elderly patients with essential hypertension based on 24 h ambulatory blood test results, according to the circadian blood pressure rates were divided into two groups,<10% in the non-dipper type hypertension group (72 cases),≥10%in the dipper type hypertension group (78 cases). Carotid ultrasound was performed to detect the extent, nature and classification of atherosclerotic plaques. The detection rate of carotid artery plaque in patients with hypertension was calculated based on their pulse pressure levels:≤60 mmHg (1 mmHg=0.133 kPa), 61~89 mmHg, ≥90 mmHg. Results Ultrasonography showed 61 cases of carotid artery plaques in the dipper type hypertension group, 20 cases were located bilaterally, 15 cases were in the right, 26 cases were in the left, the detection rate of plaque was 78%(61/78). Ultrasonography showed 68 cases of carotid artery plaques in the non-dipper type hypertension group, 38 cases were located bilaterally, 14 cases were in the right, 16 cases were in the left, the detection rate of plaque was 94%(68/72). The detection rate of plaque in the dipper type hypertension group was less than that in the non-dipper type hypertension group, the difference was statistically significant (χ2=8.07, P<0.01). There were 30 cases of hard plaque,13 cases of soft plaque, 8 cases of mixed plaque, and the plaques graded as 0, 1, 2, 3 were 17, 33, 13, 15 cases in dipper type hypertension group. There were 12 cases of hard plaque, 24 cases of soft plaque, 32 cases of mixed plaque, and the plques graded as 0, 1, 2, 3 were 6, 8, 25, 33 cases in non-dipper type hypertension group. The difference was statistically signiifcant (χ2=5.29, 8.75, both P < 0.01). Forty three patients with pulse pressure≤60 mmHg, the plaque detection rate was 72%(30/43);the pulse pressure of 65 cases was 61~89 mmHg, the plaque detection rate was 88%(57/65);42 cases with vein pressure ≥ 90 mmHg, the plaque detection rate was 98%(41/42). The difference was statistically signiifcant (χ2=11.65, P=0.00). Conclusion Pulse pressure increased and BP circadian rhythm abnormality are risk factors for the formation of carotid atherosclerosis.
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