诊室血压和动态血压与糖尿病人群心血管疾病的相关性研究

Correlation among clinic blood pressure,ambulatory blood pressure and cardiovascular diseases in diabetic populations

目的:探讨诊室血压和动态血压与糖尿病人群心血管疾病的相关性。方法:入选在门诊行24h动态血压监测且合并2型糖尿病患者336例,根据是否合并冠心病或脑卒中,所有患者被分为心血管疾病组(122例)和无心血管疾病组(214例),比较两组患者血脂、血糖、诊室血压、动态血压等一般资料;又根据全天收缩压平均值中位数(122mmHg)分为<122mmHg(168例)和≥122mmHg组(168例),进行心血管疾病比较。结果:(1)与无心血管疾病组相比,心血管疾病组年龄较大,吸烟、高血压比例及血浆hsCRP水平明显升高(P<0.05或<0.01);动态血压:心血管疾病组全天SBP平均值[(119.8±8.7)mmHg比(124.4±9.6)mmHg]、白天SBP平均值(dSBP)[(121.4±9.3)mmHg比(128.0±10.3)mmHg]和夜间SBP平均值(nSBP)[(114.4±4.2)mmHg比(120.8±4.7)mmHg]均明显升高(P均<0.01);两组患者诊室血压无明显差别;(2)与<122mmHg组相比,≥122mmHg组脑卒中(20.2%比25.0%)和总心血管疾病(32.7%比39.9%)比例明显升高(P均<0.01);(3)Logistic回归分析显示,不管糖尿病患者是否合并高血压,全天平均SBP值均是心血管疾病的独立危险因素(OR=1.83、1.36,P均<0.05)。结论:对于糖尿病患者,采用动态血压预测其心血管风险优于传统诊室血压;全天SBP平均值可能是一个用于预测患者心血管风险的较好的动态血压指标。

Objective： To explore correlation among clinic blood pressure （CBP）, ambulatory blood pressure （ABP） and cardiovascular diseases in diabetic populations. Methods： A total of 336 patients complicated with type 2 diabetes mellitus, who received 24h ambulatory blood pressure monitoring, were selected. According to complicated with coronary heart dis- ease or stroke or not, they were divided into cardiovascular disease group （CVD group, n = 122） and no cardiovascular disease group （NCVD group, n = 214）. Blood lipids, blood pressure, CBP and ABP etc. were compared between two groups; according to median of 24h mean SBP （122mmHg）, they were divided into G122mmHg group （n = 168） and ≥122mmHg group （n = 168）, incidence of cardiovascular diseases was compared between these two groups. Results： （1） Compared with NCVD group, there were significant rise in age, percentages of smoking and hypertension, and plasma hsCRP level in CVD group （P〈0. 05 or 〈0.01） ; for ambulatory blood pressure, there were significant rise in levels of 24h mean SBP （mSBP） [ （119.8±8.7） mmHg vs. （124.4±9.6） mmHg], daytime SBP （dSBP） [-（121.4±9.3） mmHg vs. （128.0±10.3） mm- Hg] and nighttime SBP （nSBP） [- （114. 4 ± 4. 2） mmHg vs. （120. 8 ± 4. 7） mmHg] in CVD group, PG0. 01 all; there was no significant difference in CBP between two groups; （2） compared with G122mmHg group, there were significant rise in percentages of stroke （20.2% vs. 25. 0%） and total cardiovascular diseases （32. 7% vs. 39. 9%） in ≥122mmHg group, P 〈0. 01 both; （3） Logistic regression analysis indicated that diabetic patients no matter complicated with hypertension or not, 24h mean SBP was always an independent risk factors of diabetic patients complicated cardiovascular diseases （OR = 1.83, 1.36, P〈0.05 all）. Condasion： ABP is superior to CBP in predicting cardiovascular risk in patients with diabetes, and 24h mean SBP may be a good ABP index to predict cardiovascular risk.