正常高值血压人群动脉硬化情况及血清尿酸水平对其的影响研究

Condition of Atherosclerosis in People with High-normal Blood Pressure and Effect of Serum Uric Acid on Their Atherosclerosis

目的探讨正常高值血压人群的动脉硬化情况及血清尿酸(UA)水平对其的影响,从而为临床早期管理高血压提供新思路。方法选取2015年1月—2016年1月在皖南医学院附属弋矶山医院体检中心体检者803例,根据血压值分为高血压患者(n=212)、正常高值血压者(n=270)、正常血压者(n=321)。根据无创血管功能检查结果,以臂踝脉搏波传导速度(baPWV)≥1 400 cm/s为存在动脉硬化,采用多元线性逐步回归分析探讨正常高值血压者baPWV的影响因素。结果正常高值血压者的动脉硬化发生率为47.8%(129/270)。正常高值血压者的男性比例、年龄、BMI、收缩压(SBP)、舒张压(DBP)、脉压(PP)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、UA、胱抑素C(Cys C)、baPWV高于正常血压者,C反应蛋白(CRP)低于正常血压者,差异有统计学意义(P<0.05);正常高值血压者与正常血压者心率(HR)、空腹血糖(FPG)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、肌酐(Cr)、踝臂指数(ABI)比较,差异无统计学意义(P>0.05)。相关分析结果显示,正常高值血压者baPWV与年龄、HR、SBP、DBP、PP、TC、LDL-C、CRP、UA呈线性正相关(P<0.05),与性别、BMI呈负相关(P<0.05),与FPG、TG、HDL-C、Cr、Cys C无线性相关(P>0.05)。多元线性逐步回归分析结果显示,年龄、BMI、SBP、LDL-C、UA是正常高值血压者baPWV的影响因素(P<0.05);校正其他因素后,UA仍是正常高值血压者baPWV的影响因素(P<0.05)。结论正常高值血压者存在明显动脉硬化倾向,除传统高危因素外,高血清UA水平也是其独立危险因素,社区慢性病管理应对UA控制给予更多重视。

Objective To investigate the condition of atherosclerosis in people with high - normal blood pressure and effect of serum uric acid （UA） on their atherosclerosis, and so as to provide new ideas for early management of hypertension in clinical practice. Methods A total of 803 people undergoing physical examination in Medical Examination Center of the First Affiliated Hospital of Wannan Medical College from January 2015 to January 2016 were selected and divided into people with hypertension （ n = 212 ）, people with high - normal blood pressure （ n = 270 ）, people with normal blood pressure （ n = 321 ） according to their blood pressure value. According to the results of noninvasive vascular function tests, there existed atherosclerosis if the pulse wave velocity of brachial ankle （baPWV） I〉 1 400 env/s, and multivariate linear stepwise regression analysis was used to investigate the influencing factors of baPWV among people with high - normal blood pressure. Results The incidence of atherosclerosis of people with high - normal blood pressure was 47.8% （129/270） . The ratio of men, age, BMI, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, pulse pressure （PP）, total cholesterol （TC）, low density lipoprotein cholesterol （LDL-C） , UA, Cystatin C （CysC） and baPWV of people Wi^h high - normal blood pressure were higher than those of people with normal blood pressure, while their C - reactive protein （CRP） was lower than that of people with normal blood pressure （ P 〈 0. 05 ） . There was no significant difference in heart rate （HR） , fasting plasma glucose （ FPG）, triglyeeride （TG）, high density lipoprotein cholesterol （HDL-C）, creatinine （Cr） and ankle brachial index （ABI） between people with high - normal blood pressure and people with normal blood pressure （ P 〉 0. 05 ） . The correlation analysis showed that baPWV was linear positively correlated with age, HR, SBP, DBP, PP, TC, LDL-C, CRP and UA （P 〈0. 05）, and negatively correlated with gender and BMI （ P 〈 0. 05 ） , but not linear correlated with FPG, TG, HDL-C, Cr and CysC （ P 〉 0. 05 ） . Multivariate linear stepwise regression afialysis showed that age, BMI, SBP, LDL-C and UA were the risk factors of baPWV among people with normal high blood pressure （ P 〈 0. 05 ） . After correction of other factors, UA was still the influencing factor of baPWV among people with high - normal blood pressure （ P 〈 0. 05 ） . Conclusion There is a clear tendency of arteriosclerosis among people with high - normal blood pressure. In addition to the traditional risk factors, the high serum UA level is also an independent risk factor, community chronic disease management should pay more attention to UA control.