社区高血压患者心血管危险因素调查及与颈动脉内中膜增厚或斑块相关性研究

Cardiovascular risk factors and correlation with intima-media thickness and plaque of carotid artery in patients with hypertension of community

目的调查社区高血压患者合并的心血管危险因素现况及与颈动脉内中膜增厚或粥样斑块的相关性。方法 2013年3月—2014年5月在山西省大同矿区某社区卫生服务中心及其社区卫生服务站开展40岁以上高血压患者的调查,共收集824例,内容包括问卷调查病史、体格检查、血生化检查,及双侧颈动脉血管彩超。计量资料采用t检验;计数资料采用χ2检验;采用二分类多因素Logistic回归分析颈动脉内中膜增厚或粥样斑块的相关影响因素。P〈0.05为差异有统计学意义。结果男性吸烟率为58.12%（229/394）,女性为1.86%（8/430）;超重为52.9%（436/824）,肥胖为14.8%（122/824）;合并血脂异常为60.19%（496/824）;高HCY为64.20%（529/824）;合并空腹血糖调节受损（impaired fasting glucose,IFG）为12.62%（104/824）;合并有糖尿病为27.43%（226/824）;彩超显示颈动脉内中膜增厚或斑块为48.79%（402/824）;使用单一降压药的为70.39%（580/824）,使用两种以上降压药的为20.63%（170/824）。高血压患者合并心血管危险因素0种,1～2种,≥3种上分别为3.52%（29/824）、38.71%（319/824）、30.34%（250/824）。Logistic回归显示,年龄越大,发生颈动脉内中膜增厚或粥样斑块的风险越高（OR=4.631,95%CI为2.163～9.916;OR=5.610,95%CI为2.537～12.406）;合并≥3种危险因素是发生颈动脉内中膜增厚或粥样斑块的危险因素（OR=1.785,95%CI为1.611～4.634）。结论年龄越大、合并多种心血管危险因素、合并糖尿病,是发生颈动脉内中膜增厚或粥样斑块的危险因素。

Objective To investigate the clustering of cardiovascular risk factors of community hypertension patients and correla- tion with intima-media thickness and plaque of carotid artery.Methods The cross-sectional study surveyed 824 community hy- pertension patients（≥40 years old） in Datong coal mine area of Shanxi province.The patients were examined by face-to-face inter- view,physical examination,biochemical analyses and bilateral carotid color doppler.Measurement data was processed by t test,count data was used by Chi-squared test,related influencing factors of carotid intimal thickening or atheromatous plaque by Logistic re- gression analysis,P〈0.05 was considered statistically significant.Results Smoking rate of male was found in 58.1%（229/394）,fe- male in 1.9%（8/430）,over-weighted in 52.9%（436/824）,obesity in 14.8%（122/824）,dyslipidemia in 60.2%（496/824）,hyperhomo- cysteinemia in 64.2%（529/824）,impaired fasting glycaemia in 12.6%（ 104/824）,diabetes mellitus in 27.4%（226/824）,blood pres- sure control rate was found in 53.6%（442/824）,IMT〉~0.gmm or one or more atheromatous plaques in 48.8%（402/824）.Community hypertension patients with 0,1-2, ≥3 cardiovascular risk factors were found in 3.5% （29/824）,38.7%（319/824）,30.3% （250/824）. With the older age,the risk of carotid intimal thickening or atheromatous plaque was higher（OR=4.631,95%CI 2.163-9.916;OR= 5.610,95%CI 2.537--12.406）. ≥3 cardiovascular risk factors was risk factor of carotid intimal thickening or atheromatous plaque （0R=1.785,95%CI 1.611-4.634）.Conclusion The older, clustering of risk factors and diabetes mellitus were the risk factors of intima-media thickness and plaque of carotid artery.