出现相关症状人群体位性低血压的患病率及其直立性血压变化  

Prevalence of symptomatic orthostatic hypotension and orthostatic blood pressure changes

作　　者：沈丹彤[1] 李志棵[1] 谢志泉[2] 潘春梅[2] 林仲秋[2] 钟一新 

机构地区：[1]南方医科大学附属珠江医院心血管内科,广州510010 [2]广州军区广州总医院干部病房四科 [3]广东省珠海市七五六四五部队卫生所

出　　处：《中华心血管病杂志》2014年第4期314-320,共7页Chinese Journal of Cardiology

基　　金：广东省科技计划项目（20108031500015）

摘　　要：目的明确出现相关症状的人群体位性低血压的患病率及其直立性血压的变化规律，分析症状与直立性血压的联系。方法因出现体位性低血压相关症状就诊的患者193例入选本研究，将其分为青年组（37例）、中年组（66例）和老年组（90例）共3组。测量患者的身高、体质量、腰围、臀围、卧位心率。对患者进行症状评分。分别在间隔1周以上的2个检查日，2次测量患者的心踝指数（CAVI）和踝臂指数（ABI），分上、下午测量血压共4次，分别测量卧位、不同立位时相的收缩压和舒张压，计算直立性收缩期血压变化（OCs）和直立性舒张期血压变化（OCd）。分析体位性低血压患病率、直立性血压变化规律、动脉硬化指数特征，评判目前体位性低血压诊断标准的可重复性，分析症状评分与不同时间的体位性血压变化值的关系。结果本研究人选病例体位性低血压的患病率为32．6％（63／193），青年组、中年组和老年组的患病率分别为32．4％（12／37）、25．8％（17／66）和37．8％（34／90），组间差异无统计学意义（P〉0．05）。仅有9例（占确诊人数14．29％）分别在2次或2次以上的直立性血压检查中都符合体位性低血压的诊断标准。4次直立性血压检查共筛查出体位性低血压患者63例，单次直立性血压检查占19．5％一57．14％。体位性低血压组与非体位性低血压组比较，年龄、体质量、体质指数、腰臀比、吸烟、饮酒、性别、冠心病、高血压病、帕金森病、脑卒中病史、服用降压药物等因素差异均无统计学意义（P〉0．05），身高、腰围、臀围、心率差异则有统计学意义（P〈0．05或0．01），体位性低血压组明显偏低。OCs和OCd波动较大，未发现显著规律。体位性低血压组CAVI值（8．37±0．27）与非体位性低血压组（8．45±0．19）比较差异无统计学意义（P〉0Objective To analyze the prevalence and orthostatic blood pressure changes in subjects with symptomatic orthostatic hypotension （OH）, and to observe the relation between symptoms and orthostatic blood pressure change in this population. Methods A total of 193 subjects who consulted physicians due to OH related symptoms were selected, and divided into three groups ： young （ n = 37 ） , middle-aged （ n = 66） and elder （ n = 90 ）. Height, body weight, waist circumference, hip circumference and resting heart rate were measured. Symptom scores of every subject were obtained. CAVI and ABI were measured. Blood pressure including recumbent position, orthostatic systolic and diastolic blood pressure was measured at the morning and at the afternoon on two separate examination days with at least one weekinterval. After that, orthostatic changes in systolic blood pressure （OCs） and orthostatic changes in diastolic blood pressure （OCd） were calculated. Results OH prevalence was 32. 6% in this cohort. The prevalence of three groups was similar [ young： 32. 4%, middle-aged： 25.8%, and elderly： 37.8%, respectively （P 〉 0. 05） ]. Only 9 cases （ 14. 29% of confirmed OH cases） reached the OH diagnostic criteria with equal or more than 2 times orthostatic blood pressure measurements. OH was diagnosed in 63 patients during the 4 times orthostatic blood pressure check, of which 19. 5% to 57.14% cases were diagnosed with single orthostatic blood pressure check. Age, weight, body mass index, waist-to-hip ratio, smoking, drinking habit, sex, coronary heart disease, hypertension, Parkinson＇s disease, stroke history, antihypertensive drug use were similar between OH group and non-OH group. Height, waist circumference, hip circumference, and resting heart rate were significantly lower in OH group than in non-OH group （P 〈 0. 05 ）. The values of the factors in OH group were lower. CAVI was 8.45 ±0. 19 in non-OH group and 8.37 ±0. 27 in OH group （P 〉 0. 05 ） , ABI was significantly lowe

关 键 词：低血压 直立性 患病率 症状和体征 诊断 

分 类 号：R544.2[医药卫生—心血管疾病]