血清ALP、BUN及LDL⁃C水平与中老年高血压患者血压节律及MACE的关系

Relationship between the levels of serum ALP,BUN and LDL⁃C and blood pressure rhythm and MACE in middle⁃aged and elderly patients with hypertension

目的探究血清碱性磷酸酶(ALP)、尿素氮(BUN)及低密度脂蛋白胆固醇(LDL⁃C)与中老年高血压血压节律及不良心血管事件(MACE)关系。方法选取2017年1月至2020年9月青海省红十字医院收治的312例中老年高血压患者,分为非杓型组240例、杓型组72例;另以100名健康体检者为对照组。比较三组血清ALP、肾功能及脂代谢水平;采用Pearson相关性分析法探究血清指标与夜间血压下降率关系。随访截至2022年9月20日,统计不良心血管事件(MACE)发生情况;采用Cox风险比例回归分析探究MACE发生影响因素;绘制ROC曲线探究血清指标对MACE预测价值。结果非杓型组血清ALP、BUN、LDL⁃C均较杓型组、对照组升高,且杓型组高于对照组,差异有统计学意义(P<0.05)。血清ALP、BUN、LDL⁃C与夜间SBP下降率(r=-0.572,-0.395,-0.414)、夜间DBP下降率(r=-0.489,-0.403,-0.408)均呈负相关(P均<0.05)。随访期间,非杓型组MACE总发生率20.42%,高于杓型组的6.94%,差异有统计学意义(P<0.05)。非杓型高血压、血清ALP、BUN、LDL⁃C均是中老年高血压MACE发生的危险因素(P<0.05)。血清ALP、BUN、LDL⁃C及联合检测预测高血压MACE发生的ROC曲线下面积分别为0.750、0.710、0.773、0.884(P<0.05)。结论中老年高血压患者血清ALP、BUN、LDL⁃C水平升高,且与血压昼夜节律密切相关,联合检测三者水平对高血压MACE有一定预测价值。

Objective To explore the relationship between the levels of serum alkaline phosphatase(ALP),blood urea nitrogen(BUN)and low⁃density lipoprotein cholesterol(LDL⁃C)with blood pressure rhythm and major adverse cardiovascular events(MACE)in middle⁃aged and elderly hypertension.Methods 312 middle⁃aged and elderly patients with hypertension in Qinghai Red Cross Hospital were selected from January 2017 to September 2020,and they were divided into the non⁃dipper group(240 cases)and the dipper group(72 cases),and another 100 healthy people with physical examination were selected as the control group.The levels of serum ALP,renal function and lipid metabolism were compared among the three groups.The relationship between serum indicators and rate of nocturnal blood pressure drop was explored by Pearson correlation analysis.The follow⁃up was until September 20,2022,and the incidence of adverse cardiovascular events(MACE)was counted;Cox hazard ratio regression analysis was used to explore the influencing factors of MACE;ROC curves were drawn to explore the predictive value of serum indicators for MACE.Results The levels of serum ALP,BUN and LDL⁃C in the non⁃dipper group were higher than those in the dipper group and the control group,and the levels in the dipper group were higher than those in the control group(P<0.05).Serum ALP,BUN and LDL⁃C were negatively correlated with the rate of nocturnal SBP drop(r=-0.572,-0.395,-0.414)and rate of nocturnal DBP drop(r=-0.489,-0.403,-0.408)(P<0.05).During the follow⁃up,the total incidence rate of MACE in the non⁃dipper group was 20.42%,which was higher than that in the dipper group(6.94%;P<0.05).Non⁃dipper hypertension,serum ALP,BUN and LDL⁃C were risk factors for MACE occurrence in middle⁃aged and elderly hypertension(P<0.05).The areas under the ROC curves of serum ALP,BUN,LDL⁃C and combined detection in predicting the occurrence of MACE in hypertension were 0.750,0.710,0.773 and 0.884 respectively(P<0.05).Conclusion The levels of serum ALP,BUN and LDL⁃C are elevated in middle⁃aged and elderly patients with hypertension,and are closely correlated with blood pressure circadian rhythm,and the combined detection of the three indicators has a certain predictive value for hypertensive MACE.