原发性高血压合并2型糖尿病患者日间及夜间血压变异性与颈动脉硬化的关系  

The relationship of daytime and nighttime blood pressure variability with carotid atherosclerosis in patients with primary hypertension and type 2 diabetes

作　　者：王显利[1] 廉秋芳[1] 牟建军[2] 王雅宁[1] 李雪杰[1] 刘丽蓉[3] 

机构地区：[1]延安大学咸阳医院心内科,陕西咸阳712000 [2]西安交通大学医学院第一附属医院心内科 [3]延安大学咸阳医院心电中心

出　　处：《中华高血压杂志》2015年第10期940-945,共6页Chinese Journal of Hypertension

摘　　要：目的探讨糖尿病对高血压患者日间及夜间血压变异性(BPV)的影响及其与颈动脉硬化的关系,为高血压合并糖尿病的优化治疗提供依据。方法选取原发性高血压患者163例,根据是否合并糖尿病分为单纯高血压组(EH组)98例,高血压合并糖尿病组(EH+DM组)65例;另收集血压正常的糖尿病患者(DM组)35例,健康体检者50名作为正常对照组(N组)。所有受试者行24h动态血压监测和颈部血管超声检查。BPV指标包括血压标准差和血压变异系数。结果以血压标准差作为BPV指标时,与N组比较,EH+DM组、EH组、DM组的日间收缩压标准差(dSSD)及舒张压标准差(dDSD)、夜间收缩压标准差(nSSD)升高(均P<0.05);与EH组比较,EH+DM组nSSD[(13.3±2.9)比(10.5±2.3)mm Hg]、夜间舒张压标准差(nDSD)[(10.7±2.2)比(8.4±2.0)mm Hg]水平升高(均P<0.05)。血压变异系数作为BPV指标时,与N组比较,EH+DM组日间收缩压变异系数(dSCV)、日间舒张压变异系数(dDCV)、夜间收缩压变异系数(nSCV)、夜间舒张压变异系数(nDCV)升高(均P<0.05);DM组dDCV大于N组[(12.1±1.9)%比(10.8±2.0)%,P<0.05];与EH组比较,EH+DM组dSCV[(10.7±2.5)%比(8.5±1.8)%]、nSCV[(9.8±1.6)%比(8.0±1.7)%]升高(均P<0.05)。DM组及EH+DM组非杓型血压检出率(68.6%和69.2%)高于EH组和N组(43.9%和42.0%),均P<0.01。颈部血管超声结果显示,EH组、DM组、EH+DM组颈动脉内膜中层厚度(IMT)异常检出率较N组升高(60.2%、77.1%、84.6%比24.0%,均P<0.01);男性高于女性(73.6%比45.2%,P<0.05);非杓型组颈动脉IMT异常检出率明显高于杓型组(74.4%比47.0%,P<0.01)。多因素分析结果显示,男性、nSSD和nSCV与IMT相关(分别B=0.491、0.582、0.637,均P<0.05)。结论高血压合并糖尿病患者日间及夜间BPV增大,血压昼夜节律紊乱更为突出,非杓型血压检出率明显增加;颈动脉IMT异常检出率升高,且男性多于女性。Objective To examine the relationship of daytime and nighttime blood pressure variability（BPV）with ca- rotid atherosclerosis in patients with hypertension and type 2 diabetes, and to provide a foundation for optimizing the treatment. Methods A total of 163 patients with essential hypertension （EH） were divided into hypertension with diabetes mellitus group （EH-DM, n=65） and hypertension group （EH, n=98）. A total of 35 diabetes mellitus patients with normal blood pressure were enrolled as DM group and 50 healthy individuals as normal control group （N group）. All subjects received 24 hour ambulatory blood pressure monitoring and neck vascular ultrasound ex- amination. BPV indexes included both standard deviation and variation coefficient of blood pressure. Results Using standard deviation as BPV index： daytime systolic blood pressure standard deviation （dSSD） and diastolic blood pressure standard deviation （dDSD）, nighttime systolic blood pressure standard deviation （nSSD） in EH-4- DM, EH and DM group were significantly higher than N group（all P（0.05）. Compared with EH group, EH＋ DM group＇s nSSD [ （ 13.3± 2.9 ） vs （ 10.5 ± 2.3 ） ram Hg], nighttime diastolic blood pressure standard deviation （nDSD） [（10.7±2.2） vs （8.4±2.0）mm Hg] were higher. Using blood pressure variation coefficient as BPV index：compared with the N group, EH＋DM group＇s daytime systolic blood pressure variation coefficient （dSCV） and dias- tolic blood pressure variation coefficient （dDCV）, nighttime systolic blood pressure variation coefficient （nSCV） and diastolic blood pressure variation coefficient （nDCV） were significantly increased（all P〈0. 05）. Compared with N group, DM group＇s dDCV [（12.1±1.9）%vs （10.8±2.0）%, P〈0.05] was higher. EH＋DM group＇s dSCV [（10. 7±2. 5）% vs （8.5±1.8）%] and nSCV [（9.8±1.6）% vs （8.0±1.7）%] were increased（both P〈0.05） when compared with EH group. In addition, DM and EH＋DM group＇s

关 键 词：高血压 糖尿病 血压变异性 颈动脉硬化 

分 类 号：R544.1[医药卫生—心血管疾病]