原发性高血压患者昼夜血压节律变化对其颈动脉斑块和凝血因子及Hcy以及CRP水平的影响分析

Effects of circadian blood pressure rhythm on carotid plaque,clotting factor,homocysteine and C-reactive protein in hypertensive patients

目的:分析原发性高血压患者昼夜血压节律变化对其颈动脉斑块、凝血因子、同型半胱氨酸(Hcy)和C反应蛋白(CRP)水平的影响。方法:选取2021年1月—2023年12月在芜湖市眼科医院住院的原发性高血压患者160例,均采用24h无创性携带式血压监测仪对血压进行监测,依据《2020中国动态血压监测指南》将其分为杓型组和非杓型组,每组各80例。比较两组24h平均收缩压(24hSBP)、24h平均舒张压(24hDBP)、白昼平均收缩压(dSBP)、白昼平均舒张压(dDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP);采用颈动脉血管彩超测量颈动脉内膜中层厚度(IMT)、斑块类型(低回声、高回声);检测凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)、Hcy和CRP等脑血管硬化相关指标,比较两组常见脑血管病危险因素的发生情况。结果:非杓型组24hSBP、24hDBP、dSBP、dDBP、nSBP、nDBP、FIB、Hcy、CRP水平和颈动脉IMT均高于杓型组,差异有统计学意义(P<0.05)。非杓型组颈动脉斑块和不稳定性斑块发生率高于杓型血压组,糖尿病、血脂异常和冠心病患病率均高于杓型血压组,差异有统计学意义(P<0.05)。结论:原发性高血压患者昼夜血压节律变异,尤其非杓型血压是交感神经亢进的标志,可促进Hcy升高,导致心脑血管事件发生。对原发性高血压患者昼夜血压节律变异早关注、早干预,可能是预防血管硬化的有效途径之一。

Objective The effects of circadian blood pressure on carotid plaque,coagulation factor,homocysteine and C-reactive protein(CRP)in hypertensive patients were analyzed.Methods A total of 160 patients with hypertension who were hospitalized in Wuhu Ophthalmic Hospital from January 2021 to December 2023 were selected for blood pressure monitoring by 24-hour noninvasive portable blood pressure monitor.According to the"2020 China Ambulatome Blood Pressure Monitoring Guidelines",they were divided into spoon group and non-spoon group,with 80 patients in each group.The 24-hour mean systolic blood pressure(24 h SBP),24-hour mean diastolic blood pressure(24 h DBP),daytime mean systolic blood pressure(dSBP),daytime mean diastolic blood pressure(dDBP),night mean systolic blood pressure(nSBP)and night mean diastolic blood pressure(nDBP)were compared between the two groups.Carotid intima-media thickness(IMT)and plaque types(hypoechoic and hyperechoic)were measured by carotid artery color ultrasound.Prothrombin time(PT),International normalized ratio(INR),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),D-dimer(D-D),homocysteine(Hcy),C-reactive protein(CRP)and other cerebrovascular sclerosis related indexes were detected.The occurrence of common cerebrovascular disease risk factors was compared between the two groups.Results The levels of 24 h SBP,24 h DBP,dSBP,dDBP,nSBP,nDBP,FIB,Hcy,CRP and carotid IMT in non-scoop group were higher than those in scoop group,and the differences were statistically significant(P<0.05).The incidence of carotid plaque and unstable plaque in non-scoop blood pressure group was higher than that in scoop blood pressure group,and the prevalence of diabetes,dyslipidemia and coronary heart disease were higher than that in scoop blood pressure group,with statistical significance(P<0.05).Conclusions The variation of circadian blood pressure in hypertensive patients,especially nonscoop blood pressure,is a sign of sympathetic hyperthymia,which can promote the increase of Hcy and lead to cardiovascular and cerebrovascular events.Early attention and intervention to the variation of circadian blood pressure in hypertensive patients may be one of the effective ways to prevent vascular sclerosis.