原发性高血压患者脉压指数联合血尿酸检测对冠心病严重程度的预测价值

Predictive value of combining detection of pulse pressure and serum uric acid level on severe degree of coronary heart disease in patients with hypertension

目的探讨原发性高血压(EH)患者脉压指数(PPI)、血清尿酸(UA)水平与其冠心病(CHD)严重程度的关系。方法收集2011年4月至2012年4月心内科422例诊断为EH且行冠状动脉(冠脉)造影的患者。根据冠脉造影结果分成正常组、单支病变组、两支病变组及三支病变组,根据PPI分为PPI<0.4、0.4≤PPI<0.5及PPI≥0.5组,根据UA水平分为UA<420μmol/L和UA≥420μmol/L组。根据冠脉狭窄程度计算冠脉积分(Gensini积分)。结果以单因素分析筛选出P<0.05的变量为自变量,分别以平方根转化后的Gensini积分为因变量,进行多因素直线逐步回归分析,结果显示在排除多种因素的交互影响后,血清UA、PP、PPI、吸烟史、糖尿病史、TG、CHOL对冠脉病变的严重程度有独立的预测价值(P<0.05或P<0.01)。各组Gensini积分的组间比较显示,随着PPI和UA的升高,Gensini积分增高,即冠脉狭窄程度逐渐加重(P<0.05或P<0.01)。结论 PPI联合UA检测对于EH患者CHD严重程度具有良好的预测价值。

Objective To explore the relationship between serum uric acid （UA） level, pulse pressure index（PPI） and the severe degree of the coronary heart disease in patients with hypertension. Methods A total of 422 patients who were diagnosed as hypertension and underwent coronary angiography between April 2011 and April 2012 were enrolled in present study. According to the results of coronary angiography, the patients were divided into normal group, singe-branch lesion group, double-branch lesion group and triple-branch lesion group;according to the PPI values, the patients were divided into PPI 〈 0.4 group, 0.4≤ PPI 〈 0.5 group and PPI ≥ 0.5 group; according to UA level,the patients were divided into UA 〈420 umol/L group and UA≥420umol/L group. The Gensini score was calculated by stenosis degree of coronary artery. Results Taking the variables of P 〈 0.05 screened by single factor analysis as independent variable and the square root value of Gensini score as dependent variable, the muhi-factor linear step regression analysis was conducted. The result showed that after excluding influences of deferent factors with each other, serum UA, pulse pressure, PPI, smoking history, diabetes history, triglyceride and cholesterol had independent predictive value for judging the severe degree of coronary artery lesions （P 〈0.05 or P 〈 0.01 ）. The comparison of Gensini scores among groups showed that with the increase of PPI, serum UA level and the Gensini scores, the stenosis degree of coronary artery gradually aggravated （P 〈 0.05 or P 〈 0.01 ）. Conclusion The combining detection of PP! and serum UA has a good predictive value for judging the severe degree of coronary heart disease in patients with hypertension.