脉压、收缩压与冠状动脉病变程度相关性研究

Association between pulse pressure,systolic blood pressure,and severity of coronary artery disease

目的 探讨冠心病患者脉压（PP）、收缩压（SBP）与冠状动脉病变程度相关性。方法选择心内科行冠状动脉造影的患者241例，根据冠状动脉造影结果分为冠状动脉狭窄组（n=135）与非冠状动脉狭窄组（n=106）。比较冠状动脉狭窄组与非冠状动脉狭窄组以及不同病变支数患者的血压参数。分析各血压参数与冠状动脉狭窄发生率的关系，各血压参数与冠状动脉病变程度的相关性。结果 ①冠状动脉狭窄组冠状动脉狭窄评分、年龄、收缩压、脉压显著高于非冠状动脉狭窄组（P〈0．05～0．01），且年龄、冠状动脉狭窄评分、SBP、PP随着狭窄支数的增加而逐渐增高，尤其以3支病变患者更为显著（P〈0．05）。而DBP低于非冠状动脉狭窄组（P〈0．05）。且随着狭窄支数的增加有逐渐降低趋势，但没有统计学意义（P〉0．05）。②Pearson直线相关分析：年龄、糖尿病史、吸烟、SBP、PP、总胆固醇、低密度脂蛋白胆固醇与冠状动脉病变支数、冠状动脉狭窄记分呈正相关（r分别为：0．325，0．241，0．227，0．385，0．517，0．087，0．053，P〈0．05～0．01）。③多因素Logistic逐步回归分析：SBP、PP、年龄、糖尿病史、吸烟与冠状动脉3支病变的发生有相关性（OR分别为：1、283，1．787，1．535，1、950，1．779，P〈0．05）。④多元线性回归分析显示：年龄、SBP、PP、吸烟、与冠状动脉狭窄记分呈正相关（β=0．301，1．955，0．107，0．240，P〈0．05～0．01）。结论 PP、SBP增高，冠状动脉狭窄性病变的发生率增加，冠状动脉狭窄程度加重。冠状动脉狭窄程度与PP、SBP呈正相关，PP是冠状动脉病变程度的独立预测因子。

Objective To determine the respective influences of pulse pressure（PP）, systolic blood pressure （SBP） on severity of coronary artey stenosis（CAS）. Methods Having undergone coronary artery angiography, 241 subjects were divided into two groups according to the results of coronary artery angiography. One group was the patients with CAS（ n = 135）, and the other group was those without CAS（none CAS, NCAS n = 106）. Then, the relations between blood parameters, the incidence of CAS, the associations between PP, SBP and the severity of CAS were analyzed among the groups. Results O CAS score, age, SBP, PP in CAS group were significantly higer than those in NCAS group, and they increased with the number of CAS, especially more significantly three-branch lesion patients（ P〈0.05）. While diastolic blood pressure in the former group was lower than that in the latter group and had tendency of inversely decreased with the number of CAS, but it had no significance in statistics（ P〉0.05）. O Pearson linear correlational analysis showed that age, diabetes mellitus history,smoke, SBP, PP, total cholesterol（TC） and low-density liporotein cholesterol（LDL-C） positively correlated with the number of CAS and CAS score （ r = 0. 325, 0. 241,0. 227,0. 385,0. 517,0. 087,0. 053, P 〈 0.05 - 0.01 ）. ③ Multivariate logistic stepwise regression analysis revealed that SBP, PP, age, smoke and diabeted mellitus history were positively correlated with the incidence of threebranch CAS （OR = 1.283,1.787,1.535,1.950,1.779, P 〈 0.05 ）. Q Multivariate linear stepwise regression analysis showed that age, SBP, PP and smoke were posos[tively correlated with CAS score （β=0. 301, 1. 955, 0. 107, 0. 240, P〈0. 05-0.01）. Conclusion Increased PP and SBP were associated with severity and incidence of CAS. The severity of CAS was positive correlated with PP, SBP. PP is an independent predictor for CAS.