左心室射血分数正常的原发性高血压患者晨峰血压对颈动脉硬化的影响及与Hcy、UmAlb的相关性分析  

Effect of Morning Peak Blood Pressure on Carotid Atherosclerosis in Essential Hypertension Patients with Normal EF% and Its Correlation with Hcy and UmAlb

作　　者：雷明明[1] 张学颖[1] 李小蕾[1] 姚凤臣[1] 

机构地区：[1]中国医科大学附属第四医院心内科,辽宁沈阳110032

出　　处：《医学临床研究》2014年第11期2121-2124,共4页Journal of Clinical Research

摘　　要：目的 观察左心室射血分数（LVEF）正常的原发性高血压患者晨峰血压对颈动脉硬化、同型半胱氨酸（Hcy）和尿微量白蛋白（UmAlb）的影响，探讨Hcy和UmAlb在晨峰血压所致颈动脉硬化中的作用。方法 ①应用24 h动态血压监测仪器对197例原发性高血压且LVEF正常的患者行24 h血压监测，按晨峰血压的高低分为两组：A组：晨峰血压正常组，共90例；B组：晨峰血压增高组，共107例。②应用多普勒超声仪对每例患者均行左、右两侧颈总动脉内径（LCCAd、RCCAd）、颈内动脉内径（LICAd、RICAd）、颈总动脉内膜‐中层厚度（LCA‐IM T、RCA‐IM T ）及确定左侧、右侧颈动脉有无斑块，计算双侧颈总动脉内径均值（CCAdM）、双侧颈内动脉内径均值（ICAdM）、双侧颈总动脉内膜‐中层厚度均值（CCA‐IMTM）以及两组患者存在颈动脉硬化斑块的患者例数。③入院24 h内对以上患者均留取空腹静脉血，利用OLYMPUS AU640全自动生化仪检测Hcy、UmAlb及血脂等观察指标。结果 ①A组与B组患者在24 h、日间、夜间收缩压（SBP）和舒张压（DBP）的血压平均值，24 h平均动脉压（MAP）等方面均无显著性意义（ P＞0．01）。②B组在颈动脉硬化各参数、颈动脉硬化斑块患者例数方面均明显高于A组，差异有显著性意义（ P＜0．05）。③B组在Hcy和UmAlb水平方面均明显高于A组，差异有显著性意义（ P＜0．01）。④晨峰血压与颈动脉硬化各参数、Hcy和UmAlb均显著相关（ P＜0．01），其中晨峰血压与CCA‐IMTM相关性最强（ r ＝0．623，P ＝0．000）。结论 晨峰血压在LVEF正常的原发性高血压患者所致早期颈动脉硬化方面有重要的意义，且与Hcy、UmAlb密切相关，提示晨峰血压的控制是高血压诊治过程中的重要环节。Objective]To observe the effect of morning peak blood pressure on carotid atherosclerosis ,homocysteine（Hcy） and u‐rinary microalbumin（UmAlb） in essential hypertension patients with normal left ventricular ejection fraction（EF% ） ,and to explore the role of Hcy and UmAlb in carotid atherosclerosis caused by morning blood pressure .[Methods]The 24h ambulary blood pressure moni‐toring（ABPM） was used to monitor blood pressure in 190 cases of essential hypertension with normal EF% .According to morning peak blood pressure ,all patients were divided into group A（normal morning peak blood pressure ,n=90） and group B（increased morn‐ing peak blood pressure ,n=107） .Doppler ultrasound was performed in each patient to measure left and right sides of common carotid artery diameter（LCCAd and RCCAd） ,internal carotid artery diameter（LICAd and RICAd） ,common carotid artery intima‐media thick‐ness（LCA‐IMT and RCA‐IMT） and determine whether left and right carotid artery plaque was formed .The mean carotid artery diame‐ter（CCAdM） ,mean internal carotid artery diameter（ICAdM） ,mean common carotid artery intima‐media thickness（CCA‐IMTM） of two sides and the number of patients with carotid atherosclerosis plaque were calculated .The fasting venous blood of patients within 24h on admission was collected .OLYMPUS AU640 automatic biochemical analyzer was used to detect Hcy ,UmAlb ,blood lipids and other indicators .[Results]There was no significant difference in 24h‐,daytime and nighttime mean systolic blood pressure（SBP） and diastolic blood pressure（DBP） and 24h mean arterial pressure（MAP） between group A and group B（ P〉0 .05） .The carotid athero‐sclerosis parameters and number of patients with carotid atherosclerosis plaque in group B were obviously higher than those in group B , and there was significant differenc（ P〈0 .05） .The levels of Hcy and UmAlb in group B were obviously higher than those in group A , and there was significant diff

关 键 词：心排血量 心室功能 左 高血压/超声检查 颈动脉疾病 半胱氨酸 

分 类 号：R544.1[医药卫生—心血管疾病]