【作者】 陈明；

【导师】 徐岩； 戴光厚；

【作者基本信息】 安徽医科大学 ， 内科学， 2008， 硕士

【摘要】 目的:通过对原发性高血压患者颈动脉内膜中层厚度(IMT)的超声检测,分析颈动脉IMT与血压、空腹血糖(FBG)、体重指数(BMI)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、C反应蛋白(CRP)等心血管危险因素聚集性的关系,以便为临床高血压患者动脉粥样硬化疾病的防治提供依据。方法:选择126例原发性高血压患者应用彩色多普勒超声检查仪测定颈动脉IMT,同时检测患者血压、血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、身高、体重、腰围及C反应蛋白,按照颈动脉IMT厚度将高血压患者分为IMT正常组和IMT增厚组,IMT＜0.9mm为IMT正常组,≥0.9mm为IMT增厚组。对两组收缩压、舒张压、血糖、血脂、体重指数(RMI)、CRP进行比较,并比较两组心血管危险因素异常检出率。同时对高血压患者分级,对不同级别原发性高血压患者与IMT、CRP进行比较。结果:1.两组间心血管危险因素水平的比较:IMT增厚患者与IMT正常组比较,SBP明显增高,差异有统计学意义(P＜0.05)。而DBP、BMI、WC、HDL—C两组差别无统计学意义(P＞0.05),FBG、TC、TG、LDL—C在α=0.05水平上,两组有统计学意义(P＜0.05),并且可见血压、血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平升高,颈动脉IMT增厚。2.不同级别原发性高血压患者与IMT、CRP的比较:结果表明,原发性高血压级别越高,IMT越厚,CRP浓度越高。3.两组间心血管危险因素异常检出率比较:从表3可见,经x~2检验,超重、腹型肥胖、低HDL—C、高甘油三酯组间比较无显著性差异(P＞0.05),高血糖、高胆固醇血症、高LDL-C血症组间比较有统计学意义(P＜0.05),随颈动脉IMT加重,高血压、高血糖、高胆固醇血症、高LDL-C血症、高CRP异常检出率明显升高。4.颈动脉IMT与心血管危险因素的相关分析:在双变量Spearsman相关分析中,颈动脉内中膜厚度与各危险因素呈显著相关(P＜0.05),在调整性别、年龄进行偏相关分析中,IMT与DBP、HDL-C的相关性无统计学意义(P＞0.05),与SBP、FBG、TC、TG、LDL-C存在显著相关性(P＜0.01)。结论:高血压患者颈动脉IMT与多种心血管危险因素的聚集有显著的相关性。心血管危险因素的聚集,提示颈动脉粥样硬化程度严重。更多还原

【Abstract】 Objective:Through ultrasonography of carotid intima-media thickness(IMT) in patients with essential hypertension,to analyze the relativity between carotid IMT and some cardiovascular risk factors,such as Systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),body mass index(BMI),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),C-reative protein(CRP),etal.in order to provide proof of prevention and cure of clinical EH patients’ AS.Methods:To select a total of 126 subjects of hyperpietic applying on Doppler ultrasound instrument,and to mensurate carotid IMT.Meanwhile,to measure blood pressure,FBG,TC,TG,HDL-C,LDL-C,stature,avoirdupois,kummerbund,CRP of patients,which,then,be classified into IMT natural group(IMT＜0.9mm) and IMT incrassation group(IMT＞0.9mm) by the thickness of carotid IMT.To compare two groups of SBP,DBP,FBG,TC,TG,HDL-C,LDL-C,RMI,CRP,and to compare the frequencies distribution of abnormal cardiovascular risk factors between two groups, and to give different levels of EH patients and compare different levels of EH patients with IMT and CRP.Results:1.The different levels of cardiovascular risk factor between two groups: comparing IMT incrassation group with IMT normal group,SBP has been heightened clearly with a sense of statistics(p＜0.05),while the differences of two groups in DBP, BMI,WC,HDL-C has no meaning in statistics(p＞0.05).FBG,TC,TG,LDL-C has a sense in statistics with a level of a=0.05,and,carotid IMT has been increased while the level of blood pressure,blood sugar,TC,TG,LDL-C was heightened.2.The difference between different levels of hyperpietic and IMT,CRP:the result indicated that the higher of level of hyperpietic,the thicker of IMT and the higher of CRP.3.The frequencies distribution of abnormal cardiovascular risk factors among two groups:As table 3 showed,analyzied by chi-square test,The percentage of overweight,abdominal fatty,high blood TG,low blood HDL-L were compared.There were no statistical significant(P＞0.05).But the percentage of hypertention,diabetes, high blood TC,high blood LDL-L were compared.There were statistical significant (P＜0.05).The ratio of hypertention,diabetes,high blood TC,high blood LDL-L, high CRP trend to increase with the development of carotid IMT.4.The correlation analysis of carotid intima-media thickness and cardiovascular risk factors:In double variable Spearsman correlation,the carotid IMT was associated with SBP、FBG、TC、TG and LDL-C significantly(P＜0.01).Sex and age were adjusted,we use partial correlation.Carotid IMT was not concerned with DBP and HDL-L(P＞0.05).Conclusion:There is a clear relativity between carotid IMT of EH patients and ’cardiovascular risk factor.The conglomeration of cardiovascular risk factor indicates that the greater serious symptom of carotid AS.更多还原