高血压前期患者颈动脉内膜中层厚度与血压变异的相关性研究

Association of carotid artery intima-media thickness and blood pressure variation in patients with hypertension

目的：探讨高血压前期患者颈动脉内膜中层厚度（IMT）与血压变异的关系。方法392例高血压前期患者依据颈动脉 IMT 分为颈动脉增厚组204例、无颈动脉增厚组188例，超声测定颈动脉IMT，并且均行动态血压监测。结果（1）24 h 动态血压分析显示：颈动脉增厚组与无颈动脉增厚组平均收缩压[（136.85±9.67）mmHg 与（121.92±6.54）mmHg]、收缩压变异性[（4.13±0.67）%与（2.64±0.86）%]、舒张压变异性[（2.97±0.45）%与（2.06±0.36）%]比较差异均有统计学意义（ t 值分别为21.08、5.97、3.32，P 均＜0.05）。（2）24 h 动态血压与颈动脉 IMT 增厚率：随着收缩压变异性增大，颈动脉 IMT 增厚率增加（P =0.001），而舒张压变异性、平均舒张压与 IMT 增厚率无关（P 值分别为0.435、0.126）；平均收缩压越大，IMT 增厚率越高（P =0.013）。（3）回归分析提示收缩压变异性、超敏 C 反应蛋白、平均收缩压、餐后2 h 血糖与 IMT 呈正相关。结论高血压前期患者收缩压变异性对 IMT 影响最大。

Objective To investigate the relationship of carotid artery intima-media thickness(IMT) and blood pressure variation in patients with prehypertension. Methods Three hundred and ninety-two patients were selected as our subjects. Artery IMT was measured by Doppler ultrasonography. All patients were divided into carotid artery IMT group( n = 204 ),not carotid artery IMT group( n = 188 ) based on carotid IMT. Meanwhile,all patients were monitored by ambulatory blood pressure. Results (1)The indices of 24 h mean systolic blood pressure,systolic blood pressure variability and diastolic blood pressure variability in patients of carotid artery IMT group were(136. 85 ± 9. 67)mmHg,(4. 13 ± 0. 67)% ,(2. 97 ± 0. 45)% respectively, higher than those of Not carotid artery IMT group((121. 92 ± 6. 54)mmHg,(2. 64 ± 0. 86)% ,(2. 06 ± 0. 36)% ;t = 21. 08,5. 97,3. 32;P < 0. 05).(2)The rate of the carotid artery thickness increased with systolic blood pressure variability increasing( P = 0. 001). There were no significant correlations between rate of the carotid artery thickness and diastolic blood pressure variability,24 h mean diastolic blood pressure(P = 0. 435, 0. 126). The IMT thickening rate was higher when the average systolic blood pressure was greater(P = 0. 013). (3)Regression analysis indicated that carotid artery IMT was positively related with systolic blood pressure variability,high-sensitivity C-reactive protein,24 h mean systolic blood pressure,2-hour postprandial blood glouse. Conclusion Carotid artery IMT is independently associated with variation of blood pressure,especially with systolic blood pressure variability in prehypertension patients.