原发性高血压“杓型”与“非杓型”者的动态血压变异性特点及其微循环改变的临床研究

24h ambulatory blood pressure variablity (ABPV) character and microcirculation change in “dippers”and “non-dippers” in mild to molderate hypertension

我们研究了４８例轻中度原发性高血压患者的动态血压变异性（ＡＢＰＶ）特点及其甲皱微循环的改变，其中“杓型”者３０例（占６２．５％），“非杓型”者１８例（占３７．５％）。对二组日间ＡＢＰＶ（ｄ－ＡＢＰＶｓ、ｄ－ＡＢＰＶｄ）、夜间ＡＢＰＶ（ｎ－ＡＢＰＶｓ、ｎ－ＡＢＰＶｄ）、２４小时ＡＢＰＶ（２４－ＡＢＰＶｓ、２４－ＡＢＰＶｄ）进行研究。结果显示：“非杓型”组的ｎ－ＡＢＰＶｓ、ｎ－ＡＢＰＶｄ、２４－ＡＢＰＶｓ、２４－ＡＢＰＶｄ明显低于“杓型”组，二组间差异非常显著（Ｐ＜０．０１），但二组间的ｄ－ＡＢＰＶｓ、ｄ－ＡＢＰＶｄ差异无显著性（Ｐ＞０．０５）。这种ＡＢＰＶ的差异，可能是导致“非杓型”者的靶器官损害程度较“杓型”者严重的缘由之一，也为高血压病个体化治疗提供了客观依据。此外，对二组的甲皱微循环观察结果表明：“非杓型”组微循环的恶化程度较“杓型”组高，二组甲皱微循环加权积分值比较，“非杓型”组在管襻形态积分、血流流态积分值和总积分值均高于“杓型”组，二组差异显著（Ｐ＜０．０５），而二组间襻周状态积分值差异无显著性（Ｐ＞０．０５），提示微循环的恶化可能是“非杓型”组内中风发生率增高的原因之一。

We studid ABPV character and microcirculation change in “dippers” and “non-dippers” in 48 cases mild to molderate hypertension patients.Among them 30 cases(62.5%) were “dippers”,18 cases(37.5%) were “non-dippers”.The results showed that n-ABPVs,n-ABPVd、24-ABPVs、24-ABPVd in “dippers” group were obviously higher than those in “non-dippers”group.Difference between the two groups was very significant ( P <0 01).But no significant difference between the two groups was found in CBPs,CBPd,d-ABPVs,d-ABPVd( P >0.05).The special difference between the two groups was offered to the objective data for treatment of hypertension.In the other hand,compared with the “dippers”group,the shape,flow state and total integral value of nailfold mrocirculation in the “non-dippers”group were higher than those in the “dippers”group ( P<0.05 ),but no significant difference between the two groups was found in the perivascular value( P >0.05).It showed that the bad of microcirculation in the “non-dippers” may be one of reasons for a higher risk cerecbrovascular complications.