老年高血压病人血压晨峰现象与褪黑素昼夜分泌水平的相关性研究

Correlation between morning peak phenomenon and the level of melatonin secretion at day or night in elderly patients with hypertension

目的通过观察老年高血压病人褪黑素分泌水平的变化,探讨褪黑素与老年病人血压晨峰的相关性。方法根据24 h动态血压监测结果,将225例老年高血压病人分为晨峰组(119例)和非晨峰组(106例),另选择同期78例老年健康体检者作为对照组。对比分析3组昼夜尿6-羟基硫酸褪黑素(6-SMT)水平,采用多元线性回归分析昼夜尿6-SMT水平、夜间/白昼尿6-SMT比值与血压晨峰的相关性。结果晨峰组夜间6-SMT水平和夜间/白昼尿6-SMT比值显著低于非晨峰组和对照组(P<0.01);Pearson相关分析显示,晨峰血压与病程、空腹血糖、低密度脂蛋白胆固醇(LDL-C)、24 h平均收缩压呈正相关(P<0.05),与夜间6-SMT水平、夜间/白昼尿6-SMT比值呈负相关(P<0.05);多元线性回归分析结果显示,夜间6-SMT水平、夜间/白昼尿6-SMT比值是血压晨峰的危险因素(P<0.05)。结论夜间6-SMT水平和夜间/白昼尿6-SMT比值是老年高血压病人出现血压晨峰的危险因素。

Objective To observe the change of serum level of melatonin at day or night and explore the correlation between melatonin secretion and blood pressure morning peak in elderly patients with hypertension. Methods A total of 225 elderly patients with hypertention were divided into morning peak group（ 119 cases） and non-morning peak group（ 106 cases） according to the 24 hours ambulatory blood pressure monitoring,and another 78 cases of elderly healthy subjects were selected as the control group. 6-SMT level and 6-SMT ratio of night/day were compared between three groups.Pearson linear correlation analysis and multiple linear regression analysis were conducted to analyze the correlation of morning peak with 6-SMT,6-SMT ratio of night/day. Results The levels of 6-SMT at night and 6-SMT ratio of night/day were significantly lower in morning peak group than those in nonmorning peak group and the control group（ P〈0. 01）. Pearson correlation analysis showed that the morning peak blood pressure was positively correlated with the the length of the course,the fasting blood glucose,low density lipoprotein-cholesterol,24 h mean systolic pressure（ P〈0. 05）,and negatively correlated with the level of 6-SMT at night and 6-SMT ratio of night/day（ P〈0. 05）. Multivariate linear regression analysis showed that the level of 6-SMT at night and 6-SMT ratio of night/day were risk factors of blood pressure morning peak（ P〈0. 05）. Conclusions The level of 6-SMT at night and 6-SMT ratio of night/day are risk factors of elderly hypertensive patients with blood pressure morning peak.