原发性高血压患者脉搏波传导速度的研究

Research of brachial-ankle pulse wave velocity in patients with essential hypertension

目的探讨并分析原发性高血压病患者心率、血压等相关参数与肱踝脉搏波传导速度(baPWV)的关系。方法选择2013年3月至2015年3月在北京航天总医院和北京航空总医院门诊或住院诊断为原发性高血压病的患者280例,采用全自动动脉硬化检测仪测量baPWV,并根据其值分为C组(baPWV<1 400 cm/s,n=168例)和H组(baPWV≥1 400 cm/s,n=112例)。所有患者均进行同步动态血压及动态心电图监测,记录并比较两组患者一般资料、血生化相关指标、心率及血压等相关指标的差异。分别采用Pearson相关性分析和多元线性回归法分析各指标与ba PWV的相关性。结果 H组的血同型半胱氨酸(HCY)、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、24 h平均收缩压、24 h平均脉压(24 h PP)、白昼平均收缩压、夜间平均收缩压、夜间平均脉压、24 h收缩压负荷、24 h收缩压标准差(24 h SSD)、夜间收缩压下降率、24 h收缩压变异系数、每5 min心搏R-R间期均值的标准差和夜间/白天心率比值(n HR/d HR)与C组相比差异有统计学意义(P<0.05);HCY、24 h PP、24 h收缩压负荷、24 h SSD、n HR/d HR与baPWV独立相关(P<0.05),其中HCY、24 h SSD的相关性最强。结论原发性高血压病患者血HCY水平和动态血压、心率部分检测指标与baPWV密切相关,可间接反映动脉弹性功能并作为高血压病血管损害的指标。

Objective To investigate the relationship between relative parameters of heart rate and blood pressure and bra-chial-ankle pulse wave velocity（baPWV）in patients with essential hypertension. Methods 280 out patients and inpatients diagnosed with essential hypertension in our hospital from March 2013 to March 2015 were divided into group C （PWV〈1400 cm/s,n=168）and group H（PWV≥1400 cm/s,n=112）based on the results of baPWV. Ambulatory blood pressure monitoring and dynamic electrocardiogram were performed for all patients to simuhaneously monitor relative parameters of heart rate and blood pressure. Clinical data ,blood biochemical parameters and relative parameters of heart rate and blood pressure were recorded and compared. Pearson single factor analysis and multivariate logistic regression analysis were per-formed to define the relationship between baPWV and all relative parameters. Results The level of homocysteine（HCY）, low density lipoprotein cholesterol ,high density lipoprotein cholesterol ,24 hours′ mean systolic blood pressure ,24 hours′mean pulse pressure（24 h PP）,day mean systolic blood pressure,night mean systolic blood pressure,night mean pulse pressure,24 hours′ systolic pressure load,standard deviation of 24 hours′ systolic blood pressure（24 h SSD）,systolic blood pressure fall ,coefficient of variation of 24 hours′systolic blood pressure ,standard deviation of the average of all nor-mal to normal intervals in all 5-minute intervals and night/day heart rate ratio（n HR/d HR）had significant differences be-tween group H and C（P〈0.05）. baPWV was correlated with HCY,24 h PP,24 hours′systolic pressure load,24 h SSD and n HR/d HR respectively（P〈0.05）. Conclusion HCY and several relative parameters of heart rate and blood pressure were correlated with baPWV in patients with essential hypertension. Our results show that the above relative parameters could indirectly reflect arterial elasticity function and could become the index of vascular damage in hypertensive patients.