高血压患者大动脉弹性与冠状动脉事件的关系

Relationship between large arterial elasticity and coronary events in hypertension patients

目的探讨高血压患者大动脉弹性与冠状动脉事件的关系。方法选取2011年2月至2012年1月首都医科大学宣武医院高血压门诊就医的高血压患者252例,大动脉弹性由颈-股动脉脉搏波传播速度(cfPWV)评估,随访时间5.5(5.1~5.8)年,按冠状动脉事件发生与否将患者分为冠状动脉事件组与非冠状动脉事件组。分析2组间基线资料及临床指标差异。采用SPSS 17.0软件进行统计处理。根据数据类型,组间比较采用t检验、χ~2检验或秩和检验。多因素分析采用logistic回归法。结果 252例高血压患者中,有20例患者随访失败,随访成功率92.06%;232例随访成功的患者中,25例发生冠状动脉事件,207例未发生冠状动脉事件。与非冠状动脉事件组相比,冠状动脉事件组患者年龄、糖尿病、收缩压(SBP)及>10年高血压病程比例显著增加,cfPWV[(11.02±2.45)vs(9.27±2.16)m/s,P=0.014]亦显著增加,差异具有统计学意义。多因素logistic回归分析显示,高血压患者cfPWV(OR=2.033,95%CI 1.047~5.536,P=0.012)、糖尿病(OR=2.626,95%CI 1.065~6.471,P=0.032)是冠状动脉事件发生的独立危险因素。结论高血压患者cfPWV及糖尿病对冠状动脉事件的发生具有预测价值,具有一定的临床意义。

Objective To explore the relationship between large arterial elasticity and coronary events in patients with hypertension. Methods A total of 252 outpatients with hypertension admitted in Xuanwu Hospital from February 2011 to January 2012 were enrolled in this study. Their large arterial elasticity was assessed by the velocity of pulse wave propagation in the carotid and femoral arteries（ cfPWV）. All of them were followed up for average 5. 5（ 5. 1 to 5. 8） years. The patients were divided into coronary events group（ n = 25） and non-coronary events group（ n = 207） according to whether coronary events occurred or not. The differences of baseline data and clinical indices between the 2 groups were analyzed. SPSS statistics 17. 0 was used to process the data. According to the data type,Student＇s t test,Chi-square test or rank sum test were used for comparison between groups. Logistic regression analysis was carried out for multiple factors. Results In the 252 patients with hypertension,20 cases were lost during follow-up,and the success rate of follow-up was 92. 06%. In the successfully followed-up 232 patients,coronary events occurred in 25 cases. Compared with the non-coronary event group,the coronary event group had significantly older age,higher systolic blood pressure（ SBP）,more diabetes,and bigger ratio of hypertension（ 10 years）. They also had higher morbidity of cfPWV [（ 11. 02 ± 2. 45） vs（ 9. 27 ± 2. 16） m/s,P = 0. 014]. Multivariate logistic regression analysis showed that cfPWV（ OR = 2. 033,95% CI 1. 047-5. 536,P = 0. 012） and diabetes（ OR = 2. 626,95% CI 1. 065-6. 471,P = 0. 032） were independent risk factors of coronary events in hypertensive patients（ P〈0. 05）. Conclusion cfPWV and diabetes mellitus have predictive value for coronary events in hypertensive patients and has a certain clinical significance.