某体检人群血压水平与颈动脉斑块相关性的横断面研究

Association between hypertension and carotid plaque in a physical examination population:a cross-sectional study

目的探讨血压水平与颈动脉斑块患病风险的相关性。方法选取2017年在解放军总医院第四医学中心进行颈部超声检查的某单位体检人群为研究对象,采集血压等生理、生化指标。将血压指标按连续变量(收缩压、舒张压和脉压差)和分类变量(是否高血压、血压分级和脉压差四分类)进行分析,采用Logistic回归模型分析该人群血压水平与颈动脉斑块的关联性。结果共纳入研究对象716名,其中男性321名(44.8%),女性395名(55.2%),高血压和颈动脉斑块的患病率分别为40.9%(293例)和40.4%(289例)。≥60岁、糖尿病、高血压以及腰围增加、收缩压、空腹血糖、糖化血红蛋白升高者的颈动脉斑块患病率更高(P<0.05)。随着血压分级和脉压差四分类水平的升高,颈动脉斑块患病风险呈现增高趋势(Ptrend<0.05)。Logistic回归模型分析结果显示,收缩压每升高1 mmHg使颈动脉斑块的患病风险增加了1.4%(95%CI:1.005~1.024);以非高血压人群为对照组,高血压人群的颈动脉斑块的患病风险增加了62.9%(95%CI:1.146~2.316),其中,女性高血压人群的颈动脉斑块患病风险增加106.3%(95%CI:1.242~3.427);以正常血压人群为对照组,正常高值、1级高血压、2和3级高血压的颈动脉斑块的患病风险分别增加了86.8%(95%CI:1.175~2.946)和84.8%(95%CI:1.098~3.110)和119.6%(95%CI:1.165~4.142);以脉压差<60 mmHg(1 mmHg=0.133 kPa)人群为对照组,脉压差≥60 mmHg组的颈动脉斑块的患病风险增加56.2%(95%CI:1.049~2.326),其中女性脉压差≥60 mmHg人群的颈动脉斑块风险增加了73.3%(95%CI:1.007~2.983);以脉压差四分类Q1(≤42 mmHg)人群为对照组,Q3(50~61 mmHg)和Q4(≥62 mmHg)人群颈动脉斑块的患病风险分别增加了92.2%(95%CI:1.173~3.149)和95.0%(95%CI:1.147~3.316)。结论血压和脉压差水平升高与颈动脉斑块患病风险升高相关联,防控血压和脉压差升高可能是防控颈动脉斑块的有效措施之一。

Objective This study aimed to assess the association between hypertension and carotid plaque in a research population in China.Methods The subjects of this study were selected from a population undergoing physical examination at the Fourth Medical Center of PLA General Hospital in 2017.We collected information on physical examination,physiological index test,blood pressure indicators were analyzed according as continuous variables(systolic blood pressure,diastolic blood pressure,and pulse pressure)and categorical variables(hypertension and quartile of blood pressure pulse pressure).A multivariate logistic regression model was conducted to estimate the correlation between blood pressure and carotid plaque development.Results A total of 716 individuals were surveyed,including 321 men(44.8%)and 395 women(55.2%),and the prevalence of hypertension and carotid plaque were 40.9%(293 cases)and 40.4%(289 cases),respectively.The prevalence of carotid plaque was higher in individuals aged≥60 years,diabetes mellitus,hypertension and increased waist circumference,systolic blood pressure,fasting blood glucose and glycosylated hemoglobin.The prevalence of carotid plaque increased with the increase of the quartile of blood pressure and pulse pressure(Ptrend<0.05).After adjustment for age,sex,BMI,waist circumference,and total cholesterol,triglyceride,fasting blood glucose,glycosylated hemoglobin,and hemoglobin levels,every 1 mmHg increased systolic blood pressure increases the risk of carotid plaque by 1.4%(95%CI:1.005-1.024).Compared with the control group,the risk of carotid plaque increased by 86.8%(95%CI:1.175-2.946)and 84.8%(95%CI:1.098-3.110)and 119.6%(95%CI:1.165-4.142)in the group of normal high blood pressure,grade 1 hypertension and grade 2 and grade 3 hypertension,respectively;compared with the control group,the risk of carotid plaque increased by 56.2%in the group of pulse pressure difference≥60 mmHg(95%CI:1.049-2.326),in which the risk of carotid plaque increased by 73.3%(95%CI:1.007-2.983)in women with pulse pressure difference≥60 mmHg(1 mmHg=0.133 kPa);in the control group with pulse pressure difference of four categories Q1(<42 mmHg),the risk of carotid plaque increased by 92.2%(95%CI:1.173-3.149)and 95.0%(95%CI:1.147-3.316)in Q3(50-61 mmHg)and Q4(≥62 mmHg),respectively.Conclusion Increased blood pressure or pulse pressure are associated with increased prevalence of carotid plaque.Prevention of elevated blood pressure and pulse pressure might be one of the effective precautions for the prevention of carotid plaque development.