60岁以下隐匿性高血压患者靶器官损害与踝臂指数的关系

Relationship between target organ damage and ankle-brachial index in patients with masked hypertension under 60 years old

目的探讨60岁以下隐匿性高血压(MH)患者踝臂指数(ABI)与靶器官损害的关系。方法选取2016年3月~2017年6月于阳江市人民医院体检中心及心内科门诊就诊的60岁以下非高血压患者240例为研究对象。依据24 h动态血压分为MH组(120例)和对照组(120例)。检测入选者ABI、左心室肥厚(LVH)、颈动脉内膜中层厚度(IMT)、左心室射血分数(LVEF)、肌酐(Scr)、尿微量白蛋白、动态血压等。结果 MH组ABI值为(0.87±0.18),对照组为(1.12±0.24),差异有统计学意义(P<0.01)。MH组ABI正常比例低于对照组,血管钙化或失去弹性、中度和重度病变比例高于对照组,差异有统计学意义(P均<0.05)。120例MH患者中ABI异常93例,ABI正常27例。ABI异常组动脉壁增厚、LVH、尿微量白蛋白阳性比例均高于ABI正常组,IMT、Scr水平高于ABI正常组,LVEF低于ABI正常组,差异有统计学意义(P均<0.05)。MH组患者ABI与动脉壁增厚(OR=2.667,95%CI:1.001~11.321)及IMT(OR=1.974,95%CI:1.061~9.167)、Scr(OR=3.110,95%CI:1.647~16.647)有关。结论 60岁以下隐匿性高血压患者ABI异常比例较高,动脉壁增厚、IMT以及Scr等隐匿性高血压靶器官损害指标与ABI异常有关。

Objective To discuss the relationship between ankle-brachial index（ABI） and target organ damage in patients with masked hypertension（MH） under 60 years old. Methods Non-hypertension patients under 60 years old（n=240） were chosen as subjects from the Center for Physical Examination of People＇s Hospital of Yangjiang City from Mar. 2016 to June 2017. All patients were divided, according to ambulatory blood pressure（ABP）, into MH group and control group（each n=120）. The indexes of ABI, left ventricular hypertrophy（LVH）, carotid artery intima-media thickness（CA-IMT）, left ventricular ejection fraction（LVEF）, serum creatinine（Scr）, urinary micro albuminuria（U-m Alb） and ABP were detected in 2 groups. Results The value of ABI was（0.87±0.18） in MH group and（1.12±0.24） in control group（P〈0.01）. The percentage of patients with normal ABI was lower, and percentages of patients with angiosteosis or loss of elasticity and patients with moderate and severe lesions were higher in MH group than those in control group（all P〈0.05）. Among 120 MH patients, 93 had abnormal ABI（abnormal ABI group） and 27 had normal ABI（normal ABI group）. The percentages of patients with thickened artery wall, LVH and positive U-m Alb were higher, and levels of CA-IMT and Scr were higher, and LVEF was lower in abnormal ABI group than those in normal ABI group（all P〈0.05）. In MH patients, ABI was related to thickened artery wall（OR=2.667, 95%CI： 1.001-11.321）, CA-IMT（OR=1.974, 95%CI： 1.061-9.167） and Scr（OR=3.110, 95%CI： 1.647-16.647）. Conclusion The percentage of MH patients under 60 years old with abnormal ABI is higher, and indexes of target organ damage of MH including thickened artery wall, CA-IMT and Scr are related to abnormal ABI.