【作者】 汪文娟；

【导师】 袁洪；

【作者基本信息】 中南大学 ， 内科学， 2010， 硕士

【摘要】 目的：1.了解原发性高血压(EH)患者动脉硬化的流行状况。2.研究心血管危险因素与原发性高血压患者脉搏波传导速度的关系,探讨影响动脉弹性和僵硬度改变的主要因素。方法：从中南大学湘雅三医院及湘潭市中心医院健康管理中心2007年1月至2008年12月的体检人群中随机抽取EH患者1671例和非高血压患者3179例作为研究对象,均未经降血糖、降血脂、利尿、降压、抗尿酸药物治疗,所有对象均接受问卷调查和医学体检。应用日本欧姆龙／科林动脉硬化检测仪(BP203RPⅡ,VP-1000)测定肱-踝脉搏波传导速度(brachial-ankle PWV, baPWV),同时测量血压、身高、体重、腰围、空腹血糖(FBS)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、肌酐(Cr)、尿酸(UA)等指标,比较高血压患者和血压正常人群baPWV指标的差异,探讨合并吸烟、高脂血症、糖尿病、冠心病、肥胖等危险因素的EH患者的baPWV指标的变化情况,并分析EH患者PWV相关影响因素。应用SPSS16.0软件包进行统计分析。结果：1.高血压组baPWV值及异常率均显著高于血压正常组(1689.59±331.83比1311.42±171.20 cm／s,P=0.000；83.60%比24.24%,P=0.000)。2.心血管危险因素与EH患者baPWV关系的研究中发现：高血压不同血压分级的baPWV值和异常率存在显著差异(P=0.000),3级高血压baPWV值及异常率(1984.70±425.60 cm／s,97.22%)明显高于2级高血压(1788.04±314.17 cm／s,93.54%),而2级高血压患者baPWV值及异常率则明显高于1级高血压(1590.32±274.49 cm／s,76.46%)；老年EH患者的baPWV值及异常率明显高于非老年高血压患者(1928.28±371.97比1572.80±234.19 cm／s,P=0.000；96.54%比77.27%,P=0.000)；但不同性别组的baPWV值及异常率无明显差异(1694.33±333.93比1678.91±327.11cm／s,P=0.381；84.28%比82.21%,P=0.283)。3.合并糖尿病(1835.15±409.04比1656.83±302.50cm／s,P=0.000；90.88%比81.96%,P=0.000),冠心病(1985.38±395.35比1665.88±313.87cm／s,P=0.000；92.97%比82.83%,P=0.002),高脂血症(1711.76±342.30比1616.03±282.62cm／s,p=0.000；85.51%比77.26%,P=0.000),肥胖(1718.02±345.75比1630.86±292.71cm／s,p=0.000；86.00%比78.72%,P=0.000),吸烟(1723.81±355.38比1664.79±312.76cm／s,P=0.000；87.03%比81.17%,p=0.002)等危险因素的高血压患者其baPWV值和异常率均高于对照组。Logistic多元回归分析表明：年龄、血压、腰围、TC、HDL-C、LDL-C、FBS、Cr、吸烟史、糖尿病史、冠心病史与PWV相关,且年龄(r=0.598,P=0.000；OR=8.204，P=0.000)、收缩压(r=0.566,P=0.000；OR=7.401，P=0.000)与baPWV关系最为密切；TC(r=0.268,P=0.000；OR=2.170,P=0.000)、FBS(r=0.228,P=0.000；OR=2.306,P=0.000)、冠心病史(r=0.257,P=0.000；OR=2.742,P=0.002)、糖尿病史(r=0.208,P=0.000；OR=2.192,P=0.000)与PWV关系亦较为密切。结论：1.高血压患者的动脉僵硬度较健康人明显增高,PWV可作为高血压患者动脉硬化改变的检测指标之一2.年龄、血压、高血脂、高血糖,血肌酐升高,糖尿病史、冠心病史、吸烟史为高血压患者发生PWV异常的独立危险因素,且年龄、血压是影响PWV的主要危险因素。更多还原

【Abstract】 Objective:1. To investigate the distribution of arterial pathological changes in essential patients with hypertension.2. To study the relationship between cardiovascular risk factors and Pulse Wave Velocity in Patients with essential Hypertension and research the main factors which change arterial elasticity and stiffness.Methods:To select a cohort of 1671 patients with essential hypertension and 3179 non-hypertensive subjects who took an annual physical examination in the Third Xiangya Hospital and Xiangtan Hospital Health Care Center between Jan.2007 and Oct.2008 in random. All the research objects without any medication were documented on standardised case report forms, including brachial-ankle pulse wave velocity (baPWV), blood pressure (BP), height, weight, Waist circumference(WC), fasting blood sugar(FBS), triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), creatinine (Cr), uric acid (UA) and so on. Their characteristics and the related factors of PWV were analyzed. We applied SPSS 16.0 for Windows to analyze the datas.Results:1. The patients with essential hypertension had significantly higher baPWV values(1689.59±331.83 cm/s vs 1311.42±171.20 cm/s, P=0.000) than the non-hypertensive subjects. The prevalence of the hypertensive patients with abnormal PWV values was significantly higher than that of the non-hypertensive subjects (83.60% vs 24.24%, P=0.000).2. Mean value and abnormal rate of baPWV in the different Classification of high blood pressure were significant differences (P=0.000), that is,Ⅲdegreehy hypertension (1984.70±425.60 cm/s,97.22%) was evidently higher thanⅡdegreehy hypertension (1788.04±314.17 cm/s, 93.54%), as the same as,Ⅱdegreehy hypertension was obviously higher than I degreehy hypertension(1590.32±274.49 cm/s,76.46%). Compared with the patients without complications, there were higher baPWV value and abnormal rate in the patients who combined with cardiovascular disease risk factors, that is, the agedness is higher than non-elderly (1928.28±371.97 vs 1572.80±234.19 cm/s, P=0.000.96.54% vs 77.27%,P=0.000), however, there was no difference between male and female(1694.33±333.93 vs 1678.91±327.11cm/s, P=0.381.84.28% vs 82.21%, P=0.283).3. Compared with the patients without those factors, there were higher baPWV value and abnormal rate in the patients with complications or cardiovascular risk factors, such as diabetes (1835.15±409.04 vs 1656.83±302.50cm/s,P=0.000.90.88% vs 81.96%, P=0.000), coronary heart disease(1985.38±395.35 vs 1665.88±313.87cm/s, P=0.000.92.97% vs 82.83%,P=0.002), hyperlipoidemia (1711.76±342.30 vs 1616.03±282.62cm/s,p=0.000.85.51% vs 77.26%, P=0.000), and obesity or abdomen obesity (1718.02±345.75 vs 1630.86±292.71 cm/s,p=0.000.86.00% vs 78.72%, P=0.000), as well as the smoking patients (1723.81±355.38 vs 1664.79±312.76cm/s, P=0.000.87.03% vs 81.17%, p=0.002). Multiple logistic regression analyses showed that Age, blood pressure, Waist circumference, TC, FBS, HDL-C, LDL-C, Cr, history of diabetes, coronary heart disease and smoking were independently associated with abnormal PWV, and age (r=0.598, P=0.000. OR=8.204,P=0.000), systolic blood pressure (r=0.566,P=0.000. OR=7.401, P=0.000) were most closely related to PWV, and TC (r=0.268,P=0.000. OR=2.170,P=0.000), FBS (r=0.228, P=0.000. OR=2.306, P=0.000), coronary heart disease (r=0.257, P=0.000. OR=2.742, P=0.002), history of diabetes (r=0.208,P=0.000. OR=2.192,P=0.000) were also more closely related to PWVConclusions:1. Arterial stiffness of hypertensive patients was significantly higher compared with that of healthy people, and PWV can be used as the indicator of atherosclerosis in patients with hypertension.2. Age, blood pressure, hyperlipidemia, hyperglycaemia, high serum creatinine, diabetes, coronary heart disease and smoking were as independent risk factors for abnormal PWV of the hypertensive patients, and Age, systolic blood pressure were the most major risk factors of baPWVV values.更多还原