基于有序Logistic回归模型的H型高血压疗效影响因素研究

Analysis of Influencing Factors on the Efficacy of H-type hypertension Based on Ordinal Logistic Regression Model

目的探讨H型高血压的降压疗效及其影响因素,为H型高血压的防治提供科学依据。方法选取2019年5月-2020年12月在湖南省怀化市辖区社区中重度H型高血压患者300例,采用随机数字表法将研究对象分成综合干预组、治疗组和对照组,每组100例,分别予以口服马来酸依那普利叶酸片+氨氯地平联合行为生活方式综合干预、马来酸依那普利叶酸片+氨氯地平、马来酸依那普利+氨氯地平治疗6个月,观察用药前后各组患者的血压及血浆同型半胱氨酸(Hcy)水平,并对年龄、性别、分组干预方式、生活水平、高血压家族史、吸烟、饮酒、饮食习惯、工作性质、是否患肾脏疾病、不良反应、用药依从性进行有序多分类Logistic回归分析。结果治疗6个月后,综合干预组、治疗组及对照组的降压总有效率分别为92.71%,90.22%和91.11%,差异无统计学意义(P>0.05);三组收缩压(SBP)、舒张压(DBP)较治疗前均降低,差异有统计学意义(P<0.05);综合干预组、治疗组血浆Hcy水平较治疗前降低(P<0.05);H型高血压患者疗效影响因素的单因素回归分析显示,分组干预方式、吸烟、是否患肾脏疾病、用药依从性与H型高血压疗效有关;多因素有序Logistic回归分析显示,分组干预方式、是否患肾脏疾病、用药依从性是H型高血压疗效的独立影响因素。结论三组H型高血压患者均能有效控制血压,不同治疗及干预方式、是否患肾脏疾病、用药依从性是影响H型高血压疗效的独立相关因素。

Objective To investigate the antihypertensive effect of H-type hypertension and its influencing factors,so as to provide scientific basis for the prevention and treatment of H-type hypertension.Methods A total of 300 patients with moderate to severe H-type hypertension in the community of Huaihua City,Hunan Province from May 2019 to December 2020 were selected and randomly divided into a comprehensive intervention group,a treatment group and a control group,with 100 cases in each group;and they were treated with enalapril maleate folic acid tablets combined with amlodipine,enalapril maleate folic acid tablets combined with amlodipine,enalapril maleate folic acid tablets combined with amlodipine and enalapril maleate combined with amlodipine for 6 months,respectively.The blood pressure and plasma homocysteine(Hcy)levels were observed before and after treatment.The age,gender,group intervention,living standards,family history of hypertension,smoking,drinking,eating habits,nature of work,whether suffering from kidney disease,adverse reactions and medication compliance were analyzed by ordinal logistic regression.Results After 6 months of treatment,the total effective rates of comprehensive intervention group,treatment group and control group were 92.71%,90.22% and 91.11%,respectively,and the difference was not statistically significant(P>0.05);the systolic blood pressure(SBP)and diastolic blood pressure(DBP)of the three groups were lower than those before treatment,and the difference was statistically significant(P<0.05);the plasma Hcy levels in the comprehensive intervention group and the treatment group were significantly lower than those before treatment(P<0.05).The univariate regression analysis of the influencing factors on the efficacy of H-type hypertension showed that the grouping intervention,smoking,renal disease and medication compliance were related to the efficacy of H-type hypertension.The multivariate ordered logistic regression analysis showed that the grouping intervention,renal disease and medication compliance were independent factors affecting the efficacy of H-type hypertension.Conclusion Three groups of patients with H-type hypertension can effectively control blood pressure,different treatment and intervention methods,whether suffering from kidney disease,medication compliance are independent related factors affecting the efficacy of H-type hypertension.