单纯舒张期高血压对新发心脑血管事件影响的前瞻性研究  

Impact of Isolated Diastolic Hypertension on Cardio-cerebrovascular Events:A Prospective Study

作　　者：张清云[1] 周芸玲[1] 胡伟[2] 胡立禄 邹兰[1] 肖莲[1] 罗卉[1] 

机构地区：[1]四川省广元市第二人民医院心血管内科,628017 [2]广元市第三人民医院心血管内科 [3]成都416医院心血管内科

出　　处：《实用心脑肺血管病杂志》2015年第5期1-4,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的探讨单纯舒张期高血压（IDH）对新发心脑血管事件的影响。方法选取2009年2月—2014年2月在广元市第二人民医院、广元市第三人民医院、成都416医院体检中心体检的3 850例既往无心脑血管病史的IDH患者作为IDH组,另选取同期在三家医院体检的3 000例血压正常者作为对照组。对患者随访12~70个月,随访截止至2015-02-28。收集并记录患者的一般资料〔性别、年龄、体质指数（BIM）、吸烟、饮酒、喜盐、锻炼、收缩压（SBP）、舒张压（DBP）、心率（HR）〕、生化指标〔总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、空腹血糖（FPG）〕及心肌梗死、脑梗死、脑出血及总心脑血管事件的发生情况。采用Cox回归模型分析IDH对心脑血管事件的影响。结果两组受试者年龄、HDL、FPG比较,差异无统计学意义（P〉0.05）;IDH组患者男性比例、BMI、吸烟率、饮酒率、喜盐率、SBP、DBP、HR、TC、TG、LDL均高于对照组,锻炼率低于对照组（P〈0.05）。IDH组患者脑梗死、脑出血及总心脑血管事件发生率（1.10%、0.52%、1.93%）高于对照组（0.50%、0.10%、0.80%）（P〈0.05）;两组受试者心肌梗死发生率（对照组及IDH组分别为0.31%与0.30%）比较,差异无统计学意义（P〉0.05）。IDH组患者脑梗死、脑出血及总心脑血管事件的发生风险分别是对照组的2.52倍〔RR=2.52,95%CI（1.32,5.04）〕、1.54倍〔RR=1.54,95%CI（1.14,2.58）〕、1.51倍〔RR=1.51,95%CI（1.20,2.63）〕;〈60岁的IDH患者脑梗死、脑出血及总心脑血管事件的发生风险分别是对照组的1.49倍〔RR=1.49,95%CI（1.21,2.76）〕、1.32倍〔RR=1.32,95%CI（1.13,2.76）〕、1.18倍〔RR=1.18,95%CI（1.04,3.24）〕;≥60岁的IDH患者的脑梗死、脑出血及总心脑血管事件的发生风险分别是对照组的2.98倍〔RR=2.98,95%CI（1.64,4.95）〕、4.32倍〔RR=4.32,95%CI（2.76,7.33）�Objective To investigate the impact of isolated diastolic hypertension on cardio-cerebrovascular events.Methods From February 2009 to February 2014 in the Second People＇s Hospital of Guangyuan,the Third People＇s Hospital of Guangyuan and the 416 th Hospital of Chengdu,3 850 isolated diastolic hypertension patients without cardio-cerebrovascular disease history were selected as case group,and 3 000 healthy cases with normal blood pressure were selected as control group.All of the cases were followed up for 12 to 70 months,the deadline of follow-up was 2015-02-28.General information including gender,age,BMI,SBP,DBP,HR and smoking rate,drinking rate,high-salt diet rate,exercise frequency,biochemical index including TC,TG,LDL,HDL,FPG,incidence of myocardial infarction,cerebral infarction,cerebral hemorrhage and total cardio-cerebrovascular events were recorded.Cox regression model was used to analyze the impact of isolated diastolic hypertension on cardio-cerebrovascular events.Results No statistically significant differences of age,HDL or FPG was found between the two groups（P〉0.05）;The proportion of male,BMI,smoking rate,drinking rate,high-salt diet rate,SBP,DBP,HR,TC,TG,LDL of case group were statistically significantly higher than those of control group,while exercise frequency of case group was statistically significantly lower than that of control group（P〈0.05）.The incidence of cerebral infarction,cerebral hemorrhage and total cardio-cerebrovascular events of case group（1.10%,0.52%,1.93%,respectively） was statistically significantly higher than that of control group（0.50%,0.10%,0.80%,respectively）（P〈0.05）;while no statistically significant differences of incidence of myocardial infarction was found between the two group（0.31% versus 0.30%,P〉0.05）.The occurrence risk of cerebral infarction,cerebral hemorrhage and total cardio-cerebrovascular events of case group was 2.52 times 〔RR = 2.52,95% CI（1.32,5.04） 〕,1.54 times 〔RR = 1.54,95% CI（1.14,2.58） 〕,1.51 times �

关 键 词：舒张期高血压 心肌梗死 脑梗死 脑出血 

分 类 号：R544.1[医药卫生—心血管疾病] R542.22[医药卫生—内科学]