诊室、随诊间及24h动态收缩压与老年人群血管损害的关联

Association between the office, visit-to-visit and 24-hour ambulatory systolic blood pressure andvascular damages in the elderly

目的探讨诊室、随诊间、24h动态收缩压与老年人群血管损害的关联。方法2006年6月至2007年10月、2008年6月至2009年10月和2010年6月至2011年10月分别对开滦集团公司在职及离退休职工进行第1、2、3次健康体检，并于第3次体检时整群随机抽取年龄／〉60岁的开滦集团离退休员工2814名进行动态血压监测、颈部血管彩色超声、脉搏波波速测定等检查。符合入选标准的人群共2146例。采用多因素线性回归分别分析诊室、随诊间、24h、日间和夜间收缩压与颈动脉内膜中层厚度（CIMT）和肱踝脉搏波传导速度（baPWV）的关联。结果（1）入选者的一般情况：2146名研究对象平均年龄为（67．3±6．0）岁，其中男性1438名（67．0％），平均收缩压和舒张压分别为（137．0±20．4）和（83．5±11．0）mmHg（1mmHg=0．133kPa），平均CIMT和baPWV分别为（0．92±0．18）mm和（1781．7±353．2）cm／s。（2）不同收缩压分组CIMT和baPWV的检测结果：研究对象的诊室、随诊间、24h、日间和夜间收缩压中位数分别为140．0、137．0、127．8、130．0和120．7mmHg，按照中位数分别将研究对象分为高水平收缩压组和低水平收缩压组，诊室、随诊间、24h、日间和夜间高水平收缩压组的CIMT、baPWV均明显高于低水平收缩压组（P均〈0．01）。（3）不同收缩压与CIMT和baPWV的偏相关分析结果：校正年龄、性别后的偏相关分析结果为诊室、随诊问、24h、日间和夜间收缩压与CIMT和baPWV均呈正相关（P均〈0．001）。（4）影响CIMT和baPWV的多因素线性回归分析结果：分别以连续性CIMT、baPWV作为因变量，以诊室、随诊间、24h、日间和夜间收缩压作为自变量，采用多因素线性回归分别分析不同收缩压对二者的影响。校正年龄、性别、体重指数、空腹血糖、总胆固醇、甘油三酯、C反应蛋白、吸烟、饮酒、体育锻炼和服降压药后结果显示，诊室、随诊间、24h、日间和夜间收缩压均与CIMT、baPWV呈线性正相关（P均〈0．01），标准化回归系数（B值）分别为0．157、0．208、0．175、0．169、0．163、0．479、0．420、0．401、0．389和0．354。鉴于男女比例差异较大，故将总人群按性别分层后再进行上述回归分析，结果发现除女性人群的夜间收缩压与CIMT的线性相关差异无统计学意义（P〉0．05），其余均与总人群结果一致。结论诊室、随诊间、24h、日间和夜间收缩压均与老年人群血管损害有关，其中诊室收缩压与血管功能损害的关联最强。临床试验注册中国临床试验注册中心，ChiCTR．TNC．11001489。

Objective To investigate the association between different kinds of systolic blood pressure （SBP, including office, visit-to-visit, 24-hour ambulatory） and vascular damages （represented by carotid intima-media thickness, CIMT; brachial-ankle pulse wave velocity, baPWV ） in the elderly. Methods A total of 2 814 participants aged of t〉60 years old and retired employees were selected withrandom sampling method from the individuals who took part in 2006 - 2007, 2008 - 2009, 2010 - 2011 health examination in Tangshan Kailuan Hospital, Kailuan Linxi Hospital, Kailuan Zhaogezhuang Hospital and with 24-hour ambulatory blood pressure monitoring data, CIMT and baPWV. Finally, 2 146 participants （1 438 males, average age （67.3 ±6. 0） years old） were included to the analysis. Multivariable regression analysis was used to analyze association between the office, visit-to-visit, 24-hour, day-time, night-time SBP amt CIMT and baPW, respectively. Results （I） The average SBP, DBP, CIMT and baPW were （137.0±20.4） mmHg（1 mmHg =0.133 kPa）, （83.5 ± 11.0） mmHg, （0.92 ±0.18） mm and （ 1 781.7 ± 353.2）cm/s. （2） The participants were divided into high and low level groups according to the median of different SBPs, respectively. The results indicated that CIMT and baPWV were significantly higher in high level groups than in low level groups （ all P 〈 0. 01 ）. （3） After adjusting for gender and age, the partial correlate analysis showed that the office, visit-to-visit, 24-hour, day-time, night-time SBP positively associated with CIMT and baPWV （all P 〈 0. 01 ）. （4） After adjusting for confounding factors, multivariable regression analysis showed that the office, visit-to-visit, 24-hour, day-time, night-time SBP were positively and linearly associated with CIMT and baPWV in total cohort, and standard regression coefficients were 0. 157, 0. 208, 0. 175, 0. 169, 0. 163,0. 479, 0. 420, 0. 401,0. 389 and 0. 354, respectively. In addition, similar results were observed in male and female participants but there was no significance between night- time SBP and CIMT in female participants. Conclusions Office, visit-to-visit, 24-hour, day-time, night- time SBP arc associated with vascular damages, and the best associations are observed between visit-to-visit SBP and vascular function damage. Clinical Trial Registry Chinese Clinical Trial Registry, ChiCTR- TNC-1100 1489.