腹内脂肪堆积与动态血压的相关性研究

Correlation study of intra-abdominal fat accumulation and ambulatory blood pressure

目的探讨腹内脂肪堆积对动态血压的影响。方法选择2004年1月-2011年4月448例心血管代谢疾病住院患者,男235例,女213例,年龄20～85(55±12)岁,超声测量腹内脂肪厚度,动态血压仪监测24h动态血压。根据腹内脂肪厚度切点(男性≥38.5mm,女性≥34.7mm)将患者分为腹内脂肪厚度超标组和正常组,再按五分位数将患者分为五分位数亚组,观察动态血压各指标在不同组间的差异。结果腹内脂肪厚度超标组全天、日间和夜间的收缩压、舒张压、平均压均高于正常组(P<0.05);随腹内脂肪厚度增加,动态血压并不是单纯的逐渐增加,而是呈近似"U"形的变化趋势。Pearson相关分析显示,腹内脂肪厚度与24h动态血压的各指标(全天、日间和夜间的收缩压、舒张压、平均压)均呈显著正相关,校正性别、年龄后的偏相关分析显示,腹内脂肪厚度与全天收缩压、全天平均压、日间平均压、夜间平均压呈显著正相关。结论腹内脂肪厚度与动态血压呈"U"形曲线关系,可能为临床通过减肥控制血压提供了新的启示。

Objective To explore the influence of intra-abdominal fat （IAF） accumulation on ambulatory blood pressure （ABP）. Methods Four hundred and forty-eight hospitalized patients with cardiovascular and metabolic diseases, including 235 males and 213 females, aged 20-85 （55±12） years old, were enrolled in this study. The abdominal fatty thickness was measured with B-mode ultrasound. Simultaneously the patient received 24hABP monitoring. The patients were divided into excessive IAF group, normal group, and quintile subgroups according to the cut-off points （male 38.5mm, female 34.7mm） for observing the difference in indexes of ambulatory blood pressure between different groups/subgroups. Results The 24h mean systolic BP （24hMSBP）, 24h mean BP （24hMBP）, 24h mean diastolic BP （24hMDBP）, daytime MSBP （dMSBP）, daytime MBP （dMBP）, daytime MDBP （dMDBP）, nighttime MSBP （nMSBP）, nighttime MBP （nMBP）, night MDBP （nMDBP） were significantly higher in the excessive IAF group than in the normal group （P0.05）. However, the elevation of ABP was not a simple gradual linear elevation corresponding to a gradual increase in IAF thickness, but manifested an approximately U-shaped trend. Pearson correlation analysis showed IAF thickness was positively correlated with all the indexes of 24hABP, while partial correlation analysis after adjustment for age and sex showed IAF thickness was positively correlated with 24hSBP, 24hMBP, dMBP and nMBP. Conclusion The relationship between IAF thickness and ABP presents a U-shaped curve, which may provide an enlightenment in controlling blood pressure by weight loss in clinical work.