原发性高血压患者代谢综合征与血压昼夜节律关系的相关性研究  

Relationship Between Metabolic Syndrome and Circadian Rhythm in Patients With Essential Hypertension

作　　者：付敏敏[1] 周炳凤[1] 高斐[1] 高瑛[1] 汪兵[1] 

机构地区：[1]合肥市第一人民医院心血管内科,安徽省230061

出　　处：《中国循环杂志》2014年第5期347-351,共5页Chinese Circulation Journal

摘　　要：目的:探讨原发性高血压(EH)患者代谢综合征(MS)与血压昼夜节律的相关性。方法:回顾性分析186例明确诊断为EH的患者,所有病例均进行24 h动态血压监测及空腹血糖、餐后2 h血糖、血脂、血尿素氮及肌酐检测。以夜间收缩压较日间收缩压下降率≥10%为正常杓型血压,<10%则为血压昼夜节律异常,即非杓型血压。患者分为杓型血压组96例,非杓型血压组90例。采用2004年中华医学会糖尿病分会关于MS的定义,按EH患者是否合并MS,将患者分为EH伴MS组94例,单纯EH组92例。分析EH患者中MS与血压昼夜节律之间的关系。结果:①EH伴MS组较单纯EH组,体重指数、腰围、空腹血糖、餐后2 h血糖、甘油三酯(TG),尿酸、24 h收缩压、24 h脉压、日间收缩压、日间脉压、夜间收缩压、夜间脉压及非杓型血压比例均有增高趋势(P<0.05),而高密度脂蛋白胆固醇(HDL-C)及男性比例则下降,差异有统计学意义(P<0.05)。②非杓型血压组与杓型血压组比较,年龄、体重指数、腰围、TG、餐后2 h血糖、夜间收缩压、夜间舒张压、MS比例均升高,而HDL-C水平则下降,差异有统计学意义(P<0.05)。③随MS组分数目增加,非杓型血压比例增加,差异有统计学意义(P<0.05)。④多元线性回归相关分析显示昼夜收缩压下降百分比与年龄(β=-0.095,P<0.001)、餐后2 h血糖(β=-1.025,P<0.001)、腰围(β=-0.151,P<0.001)、TG(β=-0.123,P<0.001)的相关性具有统计学意义。⑤校正高龄、腰围、TG、HDL-C、餐后2 h血糖等因素后,MS仍与非杓型血压独立相关,比值比(OR)值为1.382(95%可信区间为1.121,2.725)。结论:EH患者中,MS与血压昼夜节律异常密切相关。Objective： To investigate the relationship between the metabolic syndrome （MS） and circadian rhythm in patients with essential hypertension （EH）. Methods： A total of 186 EH patients were retrospectively studied. The 24-hour ambulatory blood pressure monitoring （ABPM） was performed and the fasting blood glucose （FPG） level, glucose at 2 hours after diet （2h-PBG）, serum lipid profile, uric acid （UA） were examined. The patients were divided into 2 groups, Dipper group, in which the average nSBP decreased 〉 10% than the average of dSPB, n=96 and Non-dipper group, in which the average nSBP decreased 〈 10%, n=90. According to MS criteria, the patients were divided into another 2 groups, EH＋MS group, n=94 and EH group, n=92. The relationship between MS and circadian rhythm was analyzed. Results： ① Compared with EH group, the EH＋MS group presented the increased BMI, waist circumference （WC）, FPG, 2h-PBG, TG, UA, increased 24h-SBP, 24h-PP, dSBP, dPP, nSBP, nPP, more patients with the non-dipper BP and decreased level of HDL-C, less male patients, all P〈0.05. ② Compared with Dipper group, the Non-dipper group showed the elder age, increased BMI, WC, TG, 2h-PBG, nSBP, nDBP, more MS patients and decreased level of HDL-C, all P〈0.05. ③ With the increased component of MS, the ratio of non-dipper hypertension elevated accordingly, P〈0.05. ④ Multi regression analysis indicated that circadian SPB decreasing ratio related to age （β=-0.095）, 2hPBG （β=-1.025）, WC （β=-0.151）, TG （β=-0.123）, all P〈0.001.⑤ After adjustment for age, WC , TG, HDL-C, 2hPBG and other factors, MS remained independently associated with non-clipper blood pressure, odds ratio （OR） value of 1.382 （95% confidence interval 1.121, 2.725）. Conclusion： MS closely related to circadian rhythm in EH patients.

关 键 词：原发性高血压 代谢综合征 动态血压 昼夜节律 

分 类 号：R541[医药卫生—心血管疾病]