高血压合并糖尿病患者脉压与颈动脉重构的相关性研究

Correlation study of the ambulatory pulse pressure and the carotid remodeling in the patients with hypertension and diabetes

目的探讨高血压合并糖尿病患者24h动态脉压与颈动脉结构和功能间的关系。方法对高血压合并糖尿病患者120例、高血压2～3级患者100例、糖尿病患者100例以及健康对照者50例进行动态血压监测,作颈动脉血管超声测量颈总动脉内膜-中层厚度(IMT)、斑块积分、颈总动脉收缩期和舒张期内径;计算颈动脉扩张性和僵硬度。结果高血压合并糖尿病患者组的24h脉压均值、白天脉压均值、夜间脉压均值及颈动脉粥样硬化(IMT及斑块积分)、僵硬度均较高血压组、糖尿病组明显升高(P<0.05或P<0.01);多因素相关分析发现:脉压尤其是夜间脉压增高与颈动脉粥样硬化(IMT及斑块积分)、僵硬度密切相关。结论高血压、糖尿病患者均存在脉压增大和颈动脉重构,当高血压病合并糖尿病时,颈动脉重构更明显;脉压与颈动脉重构呈正相关,对高血压合并糖尿病患者应重视脉压的监测及治疗。

Objective To study the relation between the 24-hour dynamic ambulatory pulse pressure and carotid remodeling in patients with hypertension complicated with diabetes. Methods 120 patients with hypertension complicated with diabetes, 100 patients with Ⅱ to Ⅲ grade of hypertension, 100 patients with diabetes and 50 people as the normal control group were included the study, all the cases were received dynamic ambulatory blood pressure monitor, carotid artery intima-media thickness （IMT）, the incidence of plaque, common carotid artery systolic and diastolic diameter were measured with the carotid artery ultrasound. Results The 24-hour mean pulse pressure,mean pulse pressure during the daytime, mean pulse pressure at night, carotid artery carotid atherescleresis （IMT and plaque score） and the degree of the stiffness in the patients with hypertension and diabetes were higher than the results in the patients with hypertension and the patients with diabetes （ P 〈 0.05 or P 〈 0.01 ）. Multivariate correlation analysis showed that close correlation between carotid artery carotid atherescleresis （ IMT and plaque score） and the degree of the stiffness and the pulse pressure especially the pulse pressure at night. Conclusions Increased pulse pressure and carotid remodeling exists in patients with hypertension and patients with diabetes, but the carotid remodeling are more apparent in the patients with hypertension complicated with diabetes. The pulse pressure has a positive relation with carotid remodeling, so we should pay attention to the monitoring and curing of the pulse pressure.