缺血诱导的臂间舒张压差异对假性高血压诊断价值的研究

Diagnostic value of ischemia-induced inter-arm diastolic pressure difference in pseudohypertension

目的:探讨缺血诱导的臂间舒张压差异(dIAD)在假性高血压(PHT)诊断中的应用价值。方法:纳入行冠状动脉(冠脉)造影患者51例,根据直接、间接测得的收缩压及舒张压差值(收缩压差值或舒张压差值>10 mmHg,1 mmHg=0.133 kPa),将患者分为PHT组(26例)和非PHT组(25例)。收集并比较两组患者一般资料、血生化指标及影像学指标。采用Logistic回归模型分析PHT的影响因素,采用ROC曲线分析dIAD对PHT的诊断价值。结果:PHT组束臂前后内皮素(ET)浓度、左室舒张功能减退比例、脉压(PP)、袖带收缩压与腔内收缩压差值(S-S)均显著高于非PHT组(均P<0.05);PHT组估测肾小球滤过率(eGFR)、束臂前后一氧化氮(NO)浓度、束臂后dIAD均显著低于非PHT组(均P<0.05)。二元Logistic回归分析显示,PP、束臂后dIAD、束臂前后ET浓度是PHT的危险因素。ROC分析显示,dIAD诊断PHT的曲线下面积为0.786,dIAD<3.5 mmHg时,灵敏度为77%,特异度为68%时,为PHT的最佳诊断截点值。结论:缺血诱导的dIAD诊断PHT有较高的灵敏度和特异度。

Objective:To evaluate the diagnostic value of ischemia-induced inter-arm diastolic pressure difference(dIAD) in patients with pseudohypenension(PHT).Method:A total of 51 patients underwent coronary angiography were enrolled,and were divided into PHT group(n=26) and non-PHT group(n=25) according to the difference of systolic and diastolic blood pressure(systolic or diastolic blood pressure difference > 10 mmHg).The general data,blood biochemical indexes,and imaging indexes of the two groups were collected and compared.Logistic regression analysis was used to analyze the influencing factors of PHT,and ROC curve was used to analyze the diagnostic value of IAD for PHT.Result:The level of endothelin(ET),proportion of left ventricular diastolic dysfunction,pulse pressure(PP),difference of cuff systolic pressure,and intraluminal systolic pressure(S-S) in PHT group were significantly higher than those in non-PHT group(all P<0.05);while estimated glomerular filtration rate(eGFR),nitric oxide(NO) concentration before and after inter-arm,and dIAD after inter-arm in PHT group were significantly lower than those in non-PHT group(all P<0.05).Binary Logistic regression analysis showed that PP,dIAD after inter-arm,ET concentration before and after inter-arm were risk factors of PHT.ROC analysis showed that the area under the curve was 0.786,the sensitivity was 77% and the specificity was 68% when dIAD<3.5 mmHg,which was the best diagnostic cutoff value for PHT.Conclusion:There is high sensitivity and specificity in the diagnosis of PHT by ischemia-dIAD.