正常高值血压与颈动脉粥样硬化斑块形成：来自山东东营卒中筛查人群的结果

High-nonnal blood pressure and carotid atherosclerotic plaque formation： The results from stroke population screening in Dongying, Shandong province

目的探讨不同血压水平与颈动脉粥样斑块形成的相关性。方法从2012年9月至2013年1月期间参加东营市卒中筛查的人群中，选取符合理想血压[收缩压（systolic blood pressure，SBP）〈120mmng且舒张压（diastolic blood pressure，DBP）〈80mmng，1mmHg=0．133kPa]、正常血压[SBP120～129mmHg和（或）DBP80～84mmHg]和正常高值血压[SBP130～139mmHg和（或）DBP85～89mmHg]诊断标准的人群为研究对象，进行问卷调查、体格检查、血生化检查及颈部血管超声检查。比较正常血压组、正常高值血压组与理想血压组之间颈动脉斑块检出率，进行多变量logistic回归分析确定颈动脉斑块的独立危险因素。结果正常血压组和正常高值血压组男性和糖尿病的构成比以及体质指数（bodymassindex，BMI）和空腹血糖（fastingbloodglucose，FBG）水平均显著性高于理想血压组（P均〈0．05）。理想血压组、正常血压组和正常高值血压组颈动脉斑块检出率分别为12．41％、38．14％和49．45％。颈动脉斑块形成组男性构成比以及年龄、SBP、FBG和高半胱氨酸（homocysteine，Hcy）水平均显著性高于无颈动脉斑块形成组（P均〈0．05）。多变量logistic回归分析显示，年龄、SBP、FBG和Hcy为颈动脉粥样斑块形成的独立危险因素，女性为独立保护因素。在校正性别、年龄、FBG和Hcy等危险因素后，正常高值血压组斑块形成风险显著性高于理想血压组（优势比1．354，95％可信区间1．028～1．783；P=0．031），而正常血压组与理想血压组无显著性差异。结论正常高值血压与颈动脉斑块形成风险增高显著相关，是颈动脉斑块形成的独立危险因素。

Objective To investigate the correlation between different blood pressure levels and carotid atherosclerotic plaque formation. Methods The population participated in stroke screening were selected from September 2012 to January 2013 in Dongying, Shandong province. The subjects met the diagnostic criteria of ideal blood pressure （systolic blood pressure [ SBP] 〈 120 mm Hg and diastolic blood pressure[DBP] 〈80 mm Hg, 1 mm Hg =0. 133 kPa）, normotensive （SBP 120 - 129 mm Hg and/or DBP 80 -84 mm Hg）, and high-normal blood pressure （SBP 130 - 139 mm Hgand/or DBP 85 - 89 mm Hg） were selected. The questionnaires, physical examinations, blood biochemical tests, and neck vascular ultrasound examination were performed. The detection rates of carotid plaque among the normotensive, high-normal blood pressure and ideal blood pressure groups were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for carotid plaque. Results The proportions of men and diabetes, as welt as the levels of body mass index （BMI） and fasting blood glucose （FBG） of the normotensive and high-normal blood pressure groups were significantly higher than those of the ideal blood pressure group （all P 〈0. 05）. The detection rates of carotid plaque of the normotensive, high-normal blood pressure and ideal blood pressure groups were 12.41%, 38.14% and 49.45%, respectively. The proportions of men and age, as well as the levels of SBP, FBG, and homocysteine （Hcy） of the carotid plaque formation group were significant higher than those of the non-carotid plaque formation group （all P 〈 0. 05）. Multivariable logistic regression showed that age, SBP, FBG, and Hcy were the independent risk factors for carotid atherosclerotic plaque formation, while female gender was an independent protective factor. After adjusting the risk factors such as age, FBG, and Hey, etc, the risk of plaque formation of the high-normal blood pressure group was significantly higher than that of the ideal blood pressure group （odds ratio 1. 354, 95% confidence interval 1. 028 - 1. 783; P =0. 031）, while there was no significant difference between the normotensive group and the ideal blood pressure group. Conclusions High-normal blood pressure was significantly associated with the increased risk of carotid plaque formation, which was an independent risk factor for carotid plaque formation.