老年高血压合并不同程度下肢动脉粥样硬化危险因素的分析

Risk factors in elderly patients with hypertension complicating lower extremity atherosclerosis in varying degrees

目的探讨老年高血压合并不同程度下肢动脉粥样硬化(LEAD)的危险因素。方法纳入2010年1月至2012年1月在本院就诊的老年原发性高血压合并LEAD患者129例,依照肱踝血压比(ABI)的检测结果分为轻度组(n=60,0.7<ABI<0.9)、中度组(n=33,0.4<ABI<0.7)、重度组(n=36,ABI<0.4),观察高血压患者发生LEAD的可能危险因素(血压、血糖、血脂)。结果三组在高血压病程、脉压、糖尿病病程、甘油三酯(TG)、血浆纤维蛋白原(FIB)存在统计学差异(P均<0.05)。在逐步logistic回归中发现高血压病程(OR=3.455,95%CI:1.024～19.231)、TG(OR=2.489,95%CI:0.845～13.481)及糖尿病病程(OR=2.330,95%CI:0.667～9.340)是导致ABI显著减低的主要危险因素。结论随着老年高血压患者高血压病程延长、糖尿病时间的延长、高TG血症的严重程度增加及脉压增大,老年高血压患者发生LEAD的危险性显著增加,并且与LEAD病情严重程度密切相关。

Objective To discuss the risk factors in elderly patients with hypertension complicating lower extremity atherosclerosis （LEAD） in varying degrees. Methods The elderly patients （n=129） with hypertension complicating LEAD were chosen from Jan. 2010 to Jan. 2012, and then divided, according to ankle-brachial index （ABI）, into mild group （n=60, 0.7〈ABI〈0.9）, moderate group （n=33, 0.4〈ABI〈0.7） and severe group （n=36, ABI〈0.4）. The possible risk factors （blood pressure, plasma glucose and blood fat） were observed in the patients. Results There was statistical difference in disease course of hypertension, pulse pressure, disease course of diabetes, TG and FIB （all P〈0.05） among 3 groups. The stepwise Logistic regression found that the disease course of hypertension （0R=3.455, 95%CI=1.024-19.231）, TG （OR=2.489, 95%CI=0.845-13.481） and disease course of diabetes （OR=2.330, 95%CI=0.667-9.340） were main risk factors inducing significant decrease of ABI. Conclusion The risk of LEAD will significantly increase as the prolonging of disease courses of hypertension and diabetes, and increases of severity of high TG and pulse pressure in elderly patients with hypertension, which is closely correlated to the severe of LEAD.