动态脉压对原发性高血压患者颈动脉内膜中层厚度及左室肥厚的影响  

Effects of ambulatory pulse pressure on carotid artery intima-media thickness and left ventricular hypertrophy in patients with essential hypertension

作　　者：江凤[1] 粟宏伟[2] 王惠兰[1] 刘建英[1] 

机构地区：[1]泸州医学院附属医院心血管内科,四川省泸州市646000 [2]泸州医学院附属医院泌尿外科,四川省泸州市646000

出　　处：《中国临床康复》2005年第31期66-68,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:通过监测原发性高血压患者24h动态血压,探讨其对颈动脉内膜中层厚度及左室肥厚的影响及相互关系。方法:选择2003-10/2004-12在泸州医学院附属医院心血管内科就诊且初诊为原发性高血压患者193例。行24h动态血压监测获取相应血流动力学参数(包括脉压),利用超声技术检测颈动脉内膜中层厚度及左室舒张末期内径、室间隔厚度及左室后壁厚度,根据相关公式求取左室重量指数;根据24h脉压的不同分为三组:24h脉压<40mmHg组;40mmHg≤24h脉压<60mmHg组;24h脉压≥60mmHg组。比较3组左室重量及左室重量指数;根据左室重量指数分为左室肥厚组和非左室肥厚组,比较两组间血压参数及内膜中层厚度的差异;并就内膜中层厚度、左室重量指数和脉压的各项参数作相关性分析。结果:纳入193例患者均进入结果分析。①原发性高血压患者年龄越大,脉压越高,尤以60岁以后明显。②左室内膜中层厚度比较:24h脉压≥60mmHg组明显高于40mmHg≤24h脉压<60mmHg组犤(1.06±0.02、0.94±0.07)mm,(P<0.001)犦;左室肥厚组明显高于非左室肥厚组犤(0.97±0.08),(0.86±0.05)mm,(P=0.000)犦。③左室重量指数比较:24h脉压≥60mmHg组明显高于24h脉压<40mmHg组犤(138.54±29.46、109.75±15.8)g/m2,(P<0.001)犦。④夜间脉压下降率比较:左室肥厚组明显低于非左室肥厚组犤(3.42%,11.44%),P=0.002犦。⑤相关性分析显示:全天脉压、白昼脉压、夜间脉压与内膜中层厚度及左室重量指数间均有较好的相关性,尤其以夜间脉压与二者的相关性最好。结论:原发性高血压患者动态脉压随年龄增长而增大,其血管的损害与心脏损害在早期是同步的,在由动态血压监测所获得的所有血流动力学参数中,以脉压(尤其是夜间脉压)及其昼夜节律改变对早期动脉硬化及早期心室重构的影响最为重要。AIM Through monitoring the 24 hours ambulatory pulse pressure in patients with essential hypertension, to explore the effects of it on the carotid artery intima-media thickness （IMT） and left ventricular hypertrophy, and the relationship of the three factors. METHODS： 193 never-treated patients with essential hypertension from Department of Cardiology, Affiliated Hospital, I,uzhou Medical College between October 2003 and December 2004 were selected. The 24 hours ambulatory blood pressure monitoring （ABPM） was conducted to gain the corresponding hemodynamics parameter （including pulse pressure）. The ultrasound technique was used to detect the thickness of carotid artery intima-media and bore and interventricular septum and left ventricular posterior wall at the left ventricular diastasis, according to corresponding formula to obtain left ventricular ponderal index. They were divided into 3 groups according to the 24 hours different pulse pressure： 24 hours pulse pressure 〈 40 mmHg group; 40 mmHg ≤ 24 hours pulse pressure 〈 60 mm Hg group; 24 hours pulse pressure ≥60 mm Hg group. The ponderance of the left ventricle and the ponderal index of the left ventricle were compared among the 3 groups, respectively. According to the ponderance of the left ventricle, they were assigned into left ventricular hypertrophy group and non-left ventricular hypertrophy group, and the difference of the blood pressure parameter and intima-media thickness was compared between the two groups; The correlative analysis of every parameter of the intima-media thickness, ponderal index of left ventricle and pulse pressure was done. RESULTS： 193 patients were all involved in the result analysis. ① The older the hypertensive patients, the higher the pulse pressure, especially in the patients which exceeded 60 years old. ② Comparison of the left ventricle intima-media thickness： It was higher significantly in the 24 hours pulse pressure ≥ 60 mmHg group than that in the 40 mmHg ≤ 24 hours pulse pressure 〈 60

关 键 词：动态脉压 内膜中层厚度 肥厚性 高血压 

分 类 号：R544.1[医药卫生—心血管疾病]