隐匿性高血压与冠心病的相关性研究

Correlation between masked hypertension and coronary heart disease

目的探讨隐匿性高血压与冠状动脉粥样硬化性心脏病(冠心病)的关系及其机制。方法纳入2016年1月～2018年1月收治于郑州大学第一附属医院心内科行诊室血压、24 h动态血压监测及冠状动脉造影检查的388例住院患者为研究对象,根据血压监测结果将其分为正常对照组(NC组,154例)、隐匿性高血压组(MH组,112例)及高血压组(HT组,122例),同时对研究对象的冠状动脉造影结果行Gensini评分,对三组患者的临床资料与临床指标进行统计学分析,对冠心病的多项危险因素进行多元Logistic回归模型分析。结果 MH组与HT组比较,在年龄、糖尿病、吸烟史、总胆固醇(TC)、低密度脂蛋白(LDL)、三酰甘油(TG)、高密度脂蛋白(HDL)等基线指标差异均无统计学意义(P>0.05);MH组与NC组比较,MH组在糖尿病、空腹血糖水平均较NC组高,差异具有统计学意义(P<0.05),HT组与NC组比较,HT组在年龄、TG、糖尿病、空腹血糖水平均较NC组高,差异具有统计学意义(P<0.05);HT组、MH组的Gensini积分高于NC组[(65.70±52.92)、(51.20±52.38)vs.(37.97±43.10),均P<0.05],以正常对照组为参照行多元Logistic回归分析显示:MH(OR=2.52,95%CI:2.285～3.305,P=0.00)与冠心病正相关。结论 MH患者发生冠心病的风险增加,临床上应重视对隐匿性高血压患者的检出.并进行早期干预,减少心血管并发症的发生。

Objective To discuss the correlation between masked hypertension(MH)and coronary heart disease(CHD).Methods 388 cases from 2016 January to 2018 January in the Department of Cardiology,the First Affiliated Hospital of Zhengzhou University were selected as the research objects who undergoing coronary angiography,office blood pressure measurement and ambulatory BP monitoring(ABPM).According to coronary angiography examination and BP examination,patients were divided into the MH group(MH group,n=112),Hypertension group(HT group n=122)and Normal Control group(NC group,n=154).All patients were given Gensini scoring according to their CAG outcomes,statistical analysis was made on the clinical data of three groups patients with clinical parameters.Multiple risk factors of CHD were given multivariate logistic regression analysis.Results There were no differences in baseline parameters such as age,diabetes,smoking history,total cholesterol(TC),low-density lipoprotein(LDL),triglyceride(TG),and high-density lipoprotein(HDL)between the MH group and the HT group.Academic significance(P>0.05).Compared with the NC group,the MH group had higher levels of diabetes and fasting blood glucose than the NC group,and the difference was statistically significant(P<0.05).Compared with the NC group,the HT group had higher age,triglyceride(TG),diabetes,and fasting blood glucose than the NC group,and the difference was statistically significant(P<0.05).The Gensini scores of HT group and MH group were higher than those of NC group[(65.70±52.92),(51.20±52.38)vs.(37.97±43.10),both P<0.05].Multivariate logistic regression analysis with reference to the normal control group showed that MH(OR=2.52,95%CI:2.285~3.305,P=0.00)was positively correlated with coronary heart disease.Conclusion MH can increase the risk of CHD,we should pay attention to the detection of MH in clinical to decrease occurrence of cardiovascular complication.