心衰患者动态血压参数与心衰分级及颈动脉内—中膜厚度的关系研究

The prediction value of the ambulatory blood pressure monitoring parameters on different degree heart damage and carotid artery intima-media thickness in heart failures

目的探讨心衰患者动态血压参数对心衰分级及颈动脉内一中膜厚度检测的意义。方法将初诊的86例心衰患者按心功能分级分为A组(心功能Ⅱ级42例),B组(心功能Ⅲ级、Ⅳ级44例),行24h动态血压监测(ABPM)、超声心动图和颈动脉检查。心衰A组(n=42例心功能Ⅱ级EF45%～35%)、心衰B组(n=44例心功能Ⅲ级、Ⅳ级EF<35%),颈动脉内一中膜增厚组(n=58例)和非内一中膜增厚但(n=28例)、经询问病史、体检、测定动态血压参数、血脂、血糖等生化指标进行比较。结果(1)心衰A组(心功能Ⅱ级EF45%～35%)与心衰B组(心功能ⅢⅣ级EF<35%)临床指标比较差异无统计学意义(P>0.05);(2)心衰A组(心功能Ⅱ级EF45～35%)与心衷B组(心功能ⅢⅣ级EF<35%)动态血压参数的比较分别为:24h平均收缩压(128.3±10.3):(106.7±9.3)mm Hg(1 mm Hg=0.133 kPa),24h平均舒张压(83.4±6.0):(80.2±8.8)mm Hg;白昼平均收缩压(130.2±12.8):(110.2±10.1);白昼平均舒张压(84.9±8.9):(82.1±9.0)mm Hg;夜间平均收缩压(120.1±10.2):(98.2±10.8);夜间平均舒张压(80.2±7.8):(79.3±10.1)mm Hg,24h脉压(40.2±10.2):(36.8±9.6)mm Hg,白昼脉压(42.8±9.6):(38.2±8.8)mm Hg;夜间脉压(38.2±9.8):(34.9±10.1)mm Hg;24 h收缩压变异系数(8.0±2.0):(7.2±1.9),24 h舒张压变异系数(9.3±2.0):(8.0±2.1),动态血压非勺型昼夜节律55.6%:87.7%,其差异有统计学意义(P<0.05);(3)颈动脉内-中膜增厚组与非内-中膜增厚组的上述临床指标比较,差异无统计学意义(P>0.05)与动态血压参数比较差异有统计学意义(P<0.05)。结论心衰患者血压昼夜节律有明显变化,在心功能受损程度较重的患者中,其动态血压参数异常及颈动脉内-中膜增厚的发生率增多。

Objective To explore the relationship between change of ambulatory blood pressure monitoring （ABPM） ,carotid artery intima-media thickness （IMT） and different damage of heart function in patients with heart failure. Methods We evaluated 86 heart failure patients who were never treated regularly before. All patients underwent ultrasound examinations of the heart and the IMT of carotid arteries. We divided them into two groups ： group A（n =42,heart function class Ⅱ , EF45 -35% ） , group B （ n =44,heart function class Ⅲ Ⅳ , EF 〈 35% ） The record of medical history, physical examination and 24 h ambulatory blood pressure monitoring （ABPM） were performed in all the patients. The biochemical parameters such as blood lipids glucose and so on were tested. Then the data comparison was made . Results （ 1 ） there were no significant differences in clinical manifestations and biochemical parameters between the group A （ heart function class Ⅱ , EF45 - 35% ） and groupB （ heart function class Ⅲ, Ⅳ EF 〈 35% and P 〉 0.05. Age（ 62.1 ±5.8） yearvs （65.6±6.2） year , male 72.3% vs62.7%,body mass index（22.3 ±4.7） vs（23.2 ± 4.1 ） kg/m, diabetes mellitus and （or） impaired glucose tolerance 40.0% vs38.2% , angina pectoris 42.3% vs 39.0% ,cerbral vascular diseases 19.2% vs 14.3% ,total cholestero （5.3 ± 1.5） vs （5.4 ± 1.37） mmol/l, triglycerides（ 1.8 ± 1.02） vs （86 ± 1.01 ） mmol/l, low-density lipoprotein cholesterol（4.06 ± 1.48） vs （4.02 ± 1.49） mmol/l, high-density lipoprotein cholesterol （0.89 ± 0.21 ） vs（ 1.00 ± 0.30） mmol/l（2） The parameter of ABPM in group A （ heart function class Ⅱ , EF45 - 35% ） and groupB （ heart function classⅢ, Ⅳ EF 〈 35% ） ,There were singnificant differences（P 〈 0.05 ） , in 24h mean systolic blood pressure （ 128.3 ± 10.3 ） vs （ 106.7 ± 9.3 ） mmHg ,24 h mean diastolic blood pressure （ 83.4 ± 6.0 ） vs （ 80.2 ± 8.8 ） mm Hg, daytime mean systolic blood pressure （ 130.2 ± 12.8 ） vs （ 110.2 ± 10.1 ） mm Hg, daytime mean diastolic blood pressure （ 84.9 ± 8.9 ） vs （ 82. 1 ± 9.0 ） mm Hg, , nighttime mean systolic blood pressure（ 120.1 ± 10.2） vs （98.2 ± 108 ） mm Hg, nighttime pulse pressure （ 38.2 ± 9.8 ） vs （34.9 ± 10.1 ） mm Hg; daytime pulse pressure（42.8 ± 9.6） vs（38.2 ± 8.8 ） mm Hg;24 h systolic blood pressure variance （ 8.0 ± 2.0） vs （7.2 ± 1.0） ;24 h diastolic blood pressure variance （ 8.0 ± 2.1 ） vs （ 9.3 ± 2.0 ） , the non-dipper rhythm of ambulatory blood pressure55.6% vs 87.7% , （3）There were also no significant difference in clinical manifestations between the IMT increased and no IMT increased group in those parameters of ABPM （P 〈 0.0 5 ） , while there were significant differences between the IMT increased and no IMT increased group in those parameters of ABPM（ P 〈 0.05 ）. Conclusion The prevalence of ABPM abnormality and IMT were correlated with the degree of heart failure . ABPM and IMT act as valuable parameters in heart function class.