臂踝脉搏波传导速度与清晨高血压患者下肢动脉硬化风险的相关性分析

摘要

目的：分析清晨高血压患者下肢动脉硬化与臂踝脉搏波传导速度（baPWV）以及踝肱指数（ABI）之间的相关性，为清晨高血压患者动脉硬化的早期预防，提供相关的研究依据。方法根据24h动态血压检测结果，随机抽取2010年11月至2015年11月在赤峰市医院血管外科检查出清晨高血压患者100例为研究对象。采用四肢多普勒彩色超声检测下肢动脉硬化情况测定baPWV和ABI，根据检查结果将患者分为4组，即正常组、轻度动脉硬化组、中度动脉硬化组和重度动脉硬化组。收集受试患者的病史、动态血压检查结果，对相关检测指标进行研究和分析，从而找出baPWV与清晨高血压患者动脉硬化风险的相关性。结果患有脑梗死、糖尿病、冠心病、高脂血症病史的患者下肢动脉硬化程度越严重（P＜0.05）；组间比较显示，24h平均收缩压（24hSBP）、日间平均收缩压（dSBP）、夜间平均收缩压（nSBP）与动脉硬化程度没有明显相关性（均P＞0.05），24h平均舒张压（24hDBP）、日间平均舒张压（dDBP）、夜间平均舒张压（nDBP）与动脉硬化存在相关性（均P＜0.05）。结论清晨高血压与下肢动脉粥样硬化密切相关，baPWV可作为评估清晨高血压患者前期动脉硬度有效且简便易行的指标；动脉的硬化程度与舒张压之间存在相关性，与收缩压之间关系不大。%Objective To analyze the correlation of brachial-ankle pulse wave velocity (baPWV) with the risk of lower limb arteriosclerosis in morning hypertensive patients in order to provide reference data for early prevention of arteriosclerosis in them. Methods According to the results of 24-hour ambulatory blood pressure monitoring, 100 patients with morning hypertension admitted in our hospital from November 2010 to November 2015 were randomly enrolled in the study. Color Doppler ultrasonography was used to observe lower extremity limb arteriosclerosis and measure baPWV and ankle-brachial index. Then the patients were accordingly divided into 4 groups, namely, normal group, and mild, moderate and severe arteriosclerosis groups. Medical history, biochemical indicators, and ambulatory blood pressures were analyzed for the correlation of risk for lower limb arteriosclerosis with baPWV. Results The patients having diabetes, hyperlipidemia, coronary heart disease and history of cerebral infarction had more severe lower limb arteriosclerosis (P<0.05). Parameters as mean 24-hour systolic blood pressure(24hSBP), mean daytime SBP(dSBP) and night SBP(nSBP) had no obvious correlation with the severity of atherosclerosis (P>0.05), but mean 24h diastolic blood pressure(24hDBP), mean daytime diastolic blood pressure (dDBP), and mean night DBP(nDBP) had the correlation (P<0.05). Conclusion Morning hypertension is closely related to lower extremity atherosclerosis. baPWV can be regarded as a simple and effective indicator to assess the early arterial stiffness in the patients with morning hypertension. The hardening of the arteries is correlated to DBP but not to SBP.