夜间/白天血压比值对冠状动脉粥样硬化性心脏病预测价值分析

Analysis of the predictive value of night/day blood pressure ratio for coronary atherosclerotic heart disease

目的:探讨夜间/白天血压比值对冠状动脉粥样硬化性心脏病(CHD)预测价值.方法:选择2018年3月至2020年5月,在我院接受治疗的血压正常疑似CHD患者208例进行研究.收集一般资料及实验室检查结果并对患者进行24 h动态血压监测,计算夜间平均收缩压/白天平均收缩压比值.根据冠状动脉造影结果将患者分为两组,合并CHD者为观察组,未合并CHD者为对照组.比较两组患者上述临床资料、实验室检查结果及夜间平均收缩压/白天平均收缩压比值,以多因素Logistic回归进行多因素分析,对夜间平均收缩压/白天平均收缩压比值与总Gensini积分进行相关性分析,并以ROC法判断夜间平均收缩压/白天平均收缩压比值对CHD的预测价值.结果:本次研究的208例疑似CHD患者中共75例(36.1%)被确诊,单因素分析基础上多因素分析结果显示:年龄≥60岁、有吸烟史、LDL-C升高及夜间平均收缩压/白天平均收缩压比值升高为血压正常胸痛患者合并CHD的危险因素(P<0.05).观察组患者平均总Gensini积分为(24.09±6.11)分,相关性分析结果显示夜间平均收缩压/白天平均收缩压比值与总Gensini积分呈显著的正相关关系(r=0.55,P<0.05).ROC分析结果显示夜间平均收缩压/白天平均收缩压比值预测血压正常的CHD患者的截断值为0.925,敏感度为0.840,特异性为0.812,曲线下面积(AUC)为0.845,95%CI:0.784~0.906(P<0.05).结论:夜间平均收缩压/白天平均收缩压比值为血压正常患者CHD的危险因素,当夜间平均收缩压/白天平均收缩压比值高于0.925时患者CHD风险升高,此外年龄、吸烟史及LDL-C对CHD也有显著的影响.

Objective: To explore the predictive value of night/day blood pressure ratio for atherosclerotic heart disease(CHD). Methods: 208 patients with normal blood pressure and suspected CHD who were treated in our hospital from March 2018 to May 2020 were selected for research. Collect general data and laboratory examination result and monitor the patient’s 24 h ambulatory blood pressure to calculate the ratio of night average systolic blood pressure/day average systolic blood pressure. According to the result of coronary angiography, the patients were divided into 2 groups. Those with CHD were the observation group, and those without CHD were the control group. The clinical data, laboratory examination result and nighttime/daytime mean systolic blood pressure ratio were compared between the two groups. Multivariate logistic regression was used for multivariate analysis. The correlation between nighttime SBP/daytime SBP ratio and total Gensini score was analyzed. The predictive value of nighttime SBP/daytime SBP ratio on CHD was evaluated by ROC method. Results: A total of 75(36.1%) of 208 suspected CHD patients in this study were diagnosed. Based on univariate analysis, multivariate analysis showed that age≥ 60 years old, smoking history, elevated LDL-C and the ratio of nighttime SBP/daytime SBP were risk factors for CHD in patients with normal blood pressure and chest pain(P< 0.05).The average total Gensini score of the observation group was(24.09 ± 6.11) points, and the correlation analysis result showed that there was a significant positive correlation between the night mean systolic blood pressure and the total Gensini score(r=0.55, P < 0.05).ROC analysis showed that the cut-off value, sensitivity, specificity, area under the curve(AUC) were 0.925, 0.840, 0.812, 0.845 and 0.784-0.906, respectively(P< 0.05). Conclusions: The ratio of nocturnal SBP to daytime SBP is a risk factor for CHD in normotensive patients. When the ratio of SBP/SBP is higher than 0.925, the risk of CHD is increased. In addition, age, smoking history and LDL-C also have significant effects on CHD.