老老年高血压患者颈动脉斑块危险因素研究

A study on the risk factors for carotid plaque in the very elderly hypertensive patients

目的探讨老老年原发性高血压(高血压)患者与普通老年高血压患者颈动脉斑块发生危险因素的差异。方法选取中山大学第一附属医院及番禺区中心医院2015年1月至2015年12月年龄≥80岁高血压患者117例为观察组,年龄65~79岁高血压患者108例为对照组,采集包括冠状动脉粥样硬化性心脏病(冠心病)、糖尿病、脑卒中及肾功能不全病史,降压药及他汀类药物使用情况,记录血压、心率、生化、颈动脉超声检查结果。采用单因素和多因素Logistic回归分析,比较2组患者颈动脉斑块化发生的危险因素的异同。结果观察组冠心病患病率较高,基础心率较慢,载脂蛋白A浓度较高,差异有统计学意义(P<0.05);2组使用降压药的种类比较,差异有统计学意义(P<0.05)。观察组使用钙通道拮抗剂患者比例较高,对照组使用β受体阻断药患者比例较高,差异有统计学意义(P<0.05)。2组颈动脉斑块检出率比较,差异无统计学意义(81.2%vs.74.1%,P=0.199),2组患者之间未显示颈动脉斑块随年龄增长而进一步增加趋势。对2组人群共同多因素的Logistic回归分析结果显示,颈动脉斑块发生的相关因素有年龄、缺血性脑卒中病史与内膜中层厚度(OR=0.046、0.020、0.016,均P<0.05)。对观察组及对照组分别作影响颈动脉斑块的多因素Logistic回归分析结果显示,观察组与缺血性脑卒中病史相关(OR=3.03,P=0.034),对照组与内膜中层厚度相关(OR=14.39,P=0.003)。结论老老年高血压患者颈动脉斑块发生相关因素与普通老年高血压患者有差异;与普通老年高血压患者比较,老老年高血压患者颈动脉斑块发生率无进一步增加,提示颈动脉斑块多在80岁以前发生,应重视早期对危险因素干预。

Objectives To investigate the differences in the risk factors for carotid plaque between very elderly and old hypertensive patients. Methods A total of 225 old hypertensive patients hospitalized or admitted to outpatient clinic in the First Affiliated Hospital of Sun Yat-sen University and Guangzhou Panyu Central Hospital between January 2015 and December 2015 with the detailed medical record were included. The patients were grouped into old group(aged 65 to 79,n=108)and very elderly group(aged over 80,n=117). The medical history including coronary heart disease, diabetes,stroke and renal insufficiency,use of antihypertensive drugs and use of statins were collected. The blood pressure,heart rate,biochemical and carotid ultrasound examination results were recorded. Univariate and multivariate Logistic regression analyses were used to compare the risk factors for carotid plaque between the two groups. Results Very elderly group had a higher prevalence of coronary heart disease,a lower basic heart rate and a higher concentration of apolipoprotein(Apo)A comparing with old group(P<0.05). There was a difference in the proportion of use of antihypertensive drugs between the two groups(P<0.05). There was no difference in the incidence of carotid plaque between the two groups(81.2% vs. 74.1%,P=0.199),indicating that the incidence of carotid plaque did not further increase with age. The multivariate Logistic regression analysis in the two groups showed that factors associated with carotid plaque included age,ischemic stroke history and intima-media thickness(IMT)[odds ratio(OR)= 0.046,0.020 and 0.016 respectively,all P<0.05]. The multivariate Logistic regression analysis indicated that there were differences in the risk factors for carotid plaque between old and very elderly groups. IMT was the risk factor for old group(OR=14.39,P=0.003),while ischemic stroke history was the risk factor for very elderly group(OR=3.03, P=0.034). Conclusions There are differences in the risk factors for carotid plaque between old and very elderly hypertensive patients. Compared to old group,there is no further increase in the incidence of carotid plaque in very elderly group,indicating that carotid plaque mainly occurs before the age of 80,and it should be paid attention to the early intervention for the risk factors.