1993至2008年影响住院老年高血压患者靶器官损害危险因素的回顾性分析  

Incidence and risk factors of target organ damage in 17 682 elderly hypertensive inpatients between 1993 and 2008

作　　者：崔华[1] 范利[1] 张梦[1] 叶平[1] 戴伟[1] 刘国树[2] 

机构地区：[1]解放军总医院南楼心血管二科,北京100853 [2]解放军总医院南楼信息管理科,北京100853

出　　处：《中华心血管病杂志》2012年第4期307-312,共6页Chinese Journal of Cardiology

摘　　要：目的对我院15年住院老年高血压患者靶器官损害（TOD）的患病率进行回顾性调查及相关危险因素的分析。方法对1993年1月至2008年12月住院治疗的老年高血压病患者电子病例数据进行回顾性调查研究，分析17682例60岁以上的住院患者的诊断、合并TOD及TOD的相关因素资料（包括年龄、性别、糖尿病、身高、体质指数、收缩压、舒张压、血脂等）。结果冠状动脉疾病、卒中、慢性肾脏病和主动脉夹层的总患病率分别为32．19％、27．33％、10．12％、0．77％。23．20％合并1个TOD，47．19％合并2个或2个以上TOD。合并TOD的患者年龄更大，体质指数水平更高、高血压的病史更长、治疗率更低，同时收缩压、脉压、总胆固醇、低密度脂蛋白胆固醇、估测的肾小球滤过率和高同型半胱氨酸的水平更高。在高血压合并TOD的患者中，女性的体质指数、糖尿病患病率、空腹血糖水平、高血压治疗率、估测的肾小球滤过率、甘油三酯、高血压1和2期患病率高于男性，而高血压3期患病率、总胆固醇和低密度脂蛋白胆固醇水平低于男性，差异均有统计学意义（P〈0．05）。在高血压未合并TOD的患者中，女性甘油三酯水平高于男性，而高血压病史、收缩压、空腹血糖和低密度脂蛋白胆固醇水平低于男性，差异均有统计学意义（P〈0．05）；男性慢性肾脏病3～5期患病率高于女性（12．75％比5．40％，P〈0．01）。不同性别冠状动脉粥样硬化性疾病（31．31％比27．96％，P=0．06）、卒中（28．23％比25．81％，P=0．08）、主动脉夹层（0．89％比0．74％，P=0．73）患病比例的差异无统计学意义。冠状动脉粥样硬化性疾病最常见亚型是心肌梗死、最少见亚型是无症状性心肌缺血；缺血性卒中的患病率显著高于出血性卒中和混合卒中；慢性肾脏病最常见亚型为4期；主动脉夹层最常见亚�Objective The aim of our study was to investigate the prevalence of target organ damage （TOD） in elderly hypertensive inpatients. Methods Data of the present retrospective survey were collected and analyzed from the computerized medical records of 17 682 aged 60 years or older inpatients with the diagnosis of essential hypertension （EH） from January 1993 to December 2008 in our hospital. The evidences of hypertensive TOD and associated risk factors with TOD including age, gender, presence of diabetes （DM）, body mass index （BMI）, systolic blood pressure （SBP） and diastolic blood pressure （DBP） , serum lipids were analyzed. Results The overall prevalence of stroke, coronary artery disease （CAD）, chronic kidney disease （CKD） and aortic dissection （AD） was 32. 19%, 27. 33%, 10. 12% and 0. 77% , respectively. Incidence of TOD was 68.03% in male and 31.70% in female patients. CKD stage 3 -5 was more prevalent in males than in females （12. 75% vs. 5.40% , P 〈0. 01 ） , while the prevalence of CAD （31.31% vs. 27.96%, P=0.06）, Stroke （28.23% vs. 25.81%, P=0.08） andAD （0.89% vs. O. 74% , P = 0. 72） was similar between men and women. One TOD was presented in 23.20% patients and two or more TODs were found in 47. 19% patients. Higher age and BMI, longer history and lower control rate of hypertension, severe degree of hypertension and higher level of SBP, pulse pressure, TC, LDL-C, estimated GFR（eGFR） and Hcy were risk factors for TOD. BMI, fasting plasma glucose, incidence of DM, prevalence of stage 1 and 2 hypertension, control rate of hypertension, eGFR and TG levels were all significantly higher while the prevalence of hypertension stage 3 and level of TC and LDL-C were significantly lower in female TOD patients than in male TOD patients （ all P 〈 0. 05 ）. In patients without TOD, TG was significantly higher while SBP, fasting plasma glucose and LDL-C were significantly lower and history of hypertension was significantly shorter in female patients than in male

关 键 词：高血压 靶器官损害 老年人 

分 类 号：R544.1[医药卫生—心血管疾病]