不同肥胖类型的中青年原发性高血压患者血压水平及血压控制率与踝臂指数的关系分析

The relationship between the level of blood pressure and blood pressure control and the ankle brachial index in young and middle-aged patients with different obesity types and primary hypertension

目的：通过回顾性分析原发性高血压患者的相关资料，探讨不同肥胖类型的中青年原发性高血压患者血压水平及血压控制率与踝臂指数的关系 方法：从我院高血压科2013年1月1日-2015年6月1日的已出院患者中随机筛选符合条件的原发性高血压患者320例。记录患者入院时性别、年龄、身高、体重、腰围、吸烟情况、病程、24小时动态血压、踝臂指数、空腹血糖、血脂。采用OMRON BP-203RPEⅢ动脉硬度测定仪测定踝臂指数，美国太空90217型动态血压仪监测患者24小时动态血压，日立（苏州）有限公司生产的型号为 HITACHI 7600-020的生化自动分析仪。先按照体重指数（BMI）分为BMI正常、BMI超重或肥胖两组，再按照腰围分为BMI正常/腰围正常、BMI正常/腹型肥胖、BMI超重或肥胖/腰围正常、BMI超重或肥胖/腹型肥胖四组。这四组样本人群分别使用卡方检验判断ABI正常和ABI降低组血压控制率是否存在差异，使用相关分析和线性回归分析高血压控制组和未控制组收缩压和舒张压分别与ABI是否相关。 结果：在BMI正常的患者中，腹型肥胖患者的空腹血糖（FPG）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、尿酸（UA）、24小时平均舒张压（24hDBP）高于腰围正常的患者，血压控制率、踝臂指数（ABI）、和高密度脂蛋白（HDL-C）低于腰围正常的患者；在BMI超重或肥胖的患者中，腹型肥胖患者的24小时平均舒张压高于腰围正常的患者，血压控制率低于腰围正常的患者，空腹血糖、甘油三酯、低密度脂蛋白胆固醇、尿酸、ABI无显著差异；无论BMI是否正常，伴有腹型肥胖的患者中，ABI与血压的控制情况相关，且ABI降低组血压控制率低，而在腰围正常的患者中，差异不显著；在BMI和腰围均正常的患者中，ABI仅与24h平均收缩压（24hSBP）相关；无论BMI是否正常，在存在腹型肥胖的患者中，ABI不仅与24h平均收缩压相关，同时与24h平均舒张压相关；在BMI超重或肥胖但是腰围正常的患者中，ABI与24h平均收缩压或舒张压均不相关。 结论：腹型肥胖的患者舒张压升高明显，更易出现高血脂和高血糖心血管疾病危险因素，ABI降低不仅与收缩压升高相关，也与舒张压升高相关，ABI降低可以反应出腹型肥胖人群的血压控制情况。

Objective Through retrospective analysis of the relevant information of the patients with es- sential hypertension, the relationship between the level of blood pressure and blood pressure control and the ankle brachial index in young and middle-aged patients with different obesity types was discussed. Methods 320 cases of patients with essential hypertension discharged from our hospital during January 1 2013 to June l 2015 were se- lected. The gender, age, height, weight, waist circumference （WC）, smoking status, duration, 24-hour ambula-tory blood pressure, ankle brachial index（ABI）, fasting blood glucose（FBG）and blood lipids were recorded. Ar- terial hardness measurement of ankle-brachial index was measured by OMRON BP-203RPE Ⅲ, ambulatory blood pressure was monitored in patients with type 90217 US space 24-hour ambulatory blood pressure, type Hitachi （Suzhou） Co., Ltd. for HITACHI 7600-020 automatic biochemical analyzer. The patients were divided into nor- mal BMI/Waist normal（N-obese/Normal-WC ）, BMI normal/abdominal obesity（N-obese/High-WC ）, BMI over- weight and obese/normal waist circumference （obese/Normal-WC） and BMI overweight and obesity^abdominal obesity （obese/High-WC） group. This four sample population using chi-square tests were normal and ABI ABI judge reduced group rate if there are differences in blood pressure control, using correlation analysis and linear regression analysis of hypertension control group and uncontrolled systolic and diastolic blood pressure, respec- tively, ABI is relevant. Results N-obese patients, the presence of High-WC fasting plasma glucose （FPG）, triglyceride （TG）, low density lipoprotein cholesterol （ LDL-C ）, uric acid （ UA ）, 24-hour average diastolic blood pressure （24 h DBP） compared Normal-WC of high blood pressure control rate, ankle-brachial index （ABI）（P= 0.001-0.030 ）, and high density lipoprotein （ HDL- C ） lower than the Normal-WC group （ P= 0.003-0.016 ） ; obese patient, 24 h DBP in patients with High-WC was higher than that with the Normal-WC （P=0.032）, and the pressure control rate lower than the Normal-WC （P=0.006）. There was no significant difference in FPG, TG, LDL-C, UA and ABI （P〉0.05）. In the N-obese/High-WC and obese/High-WC patients, blood pressure con- trol group, ABI higher blood pressure is not controlled group （P=0.000-0.006）, ABI lowering blood pressure control group was lower than the normal ABI group （P=0.000-0.006）, in patients with N-obese/Normal-WC＇s, 24 h SBP higher, the lower the ABI （P=0.017）, in the N-obese/High-WC and obese/High-WC patients, 24 h SBP and 24 h DBP higher（P=0.000-0.001 ）, the lower the ABI（P=0.002-0.003）. Conclusion Diastolic blood pressure in patients with abdominal obesity increased significantly, and more likely to have hyperlipidemia hyper- lipidemia and high blood glucose, etc cardiovascular risk factors. The decrease of ABI was not only related to the increase of systolic blood pressure, but also with the increase of diastolic blood pressure. ABI decreased can re- flect blood pressure control in patients with abdominal obesity.