2型糖尿病合并高血压患者血压昼夜节律及变异性与颈动脉硬化的相关性分析  

Correlation of blood pressure circadian rhythm and blood pressure variability with carotid atherosclerosis in type 2 diabetes mellitus patients with hypertension

作　　者：李婷[1] 段姗姗[1] 匡剑韧[1] 魏平[1] 

机构地区：[1]第三军医大学西南医院内分泌科,重庆400038

出　　处：《第三军医大学学报》2016年第9期1015-1020,共6页Journal of Third Military Medical University

摘　　要：目的探讨2型糖尿病合并高血压患者血压昼夜节律及变异性与颈动脉硬化的关系。方法纳入2014年1-9月在我科住院的2型糖尿病患者443例,其中男性250例,女性193例,年龄（60.36±12.11）岁,根据动态血压监测（ambulatory blood Pressure monitoring,ABPM）结果分为：正常血压组（n=158）、杓型血压组（n=59）和非杓型血压组（n=226）,比较3组间血压、血压变异性（采用血压标准差表示）及颈动脉硬化检出率,以有无颈动脉硬化为因变量,进行Logistic回归分析。结果非杓型血压组颈动脉硬化检出率（60.6%）明显高于杓型血压组（42.4%）（P〈0.01）;非杓型血压组24 h平均收缩压、24 h平均脉压、夜间平均收缩压、夜间平均舒张压、夜间平均脉压均高于杓型血压组（P〈0.01或P〈0.05）;非杓型血压组24 h平均收缩压标准差高于杓型血压组（P〈0.01）;Logistic回归分析夜间舒张压下降率与颈动脉硬化独立相关[OR=0.952（95%CI：0.929~0.975）;P〈0.01]。结论非杓型血压促进2型糖尿病合并高血压患者颈动脉硬化,夜间舒张压下降率是颈动脉硬化的保护因素。Objective To determine the relationship of blood pressure circadian rhythm and blood pressure variability with carotid atherosclerosis in type 2 diabetes mellitus（ T2DM） patients with hypertension.Methods A total of 443 T2 DM inpatients admitted in our department from January to September 2014 were recruited in this study. They were 250 males and 193 females,at an average age of 60. 36 ± 12. 11. According the results of ambulatory blood pressure monitoring（ ABPM）,the subjects were divided into 3 groups,that is,the normal group（ n = 158）,the dipper group（ n = 59） and non-dipper group（ n = 226）. Their blood pressure, blood pressure variability（ expressed as standard deviation of blood pressure） and carotid atherosclerosis were compared among the 3 groups. Logistic regression analysis was carried out with the carotid atherosclerosis as the dependent variable. Results The incidence of carotid atherosclerosis was 60. 6% in the non-dipper group,significantly higher than that in dipper group（ 42. 4%,P〈0. 01）. The non-dipper group had significantly higher 24 h systolic blood pressure（ 24 h SBP）,24 h pulse pressure（ 24 h PP）,nighttime SBP（ n SBP）,nighttime diastolic blood pressure（ n DBP） and nighttime PP（ n PP） than the dipper group（ P〈0. 01 or P〈0. 05）. The standard deviation of the 24 h SBP was obviously higher in the non-dipper group than in the dipper group（ P〈0. 01）. Logistic regression analysis showed that nighttime diastolic blood pressure fall（ DBPF） was independently related to carotid atherosclerosis（ OR = 0. 952,95% CI： 0. 929 ~0. 975,P〈0. 01）. Conclusion Non-dipper pattern promotes carotid atherosclerosis in the T2 DM patients with hypertension. Nighttime DBPF is a protective factor for carotid atherosclerosis.

关 键 词：2型糖尿病 高血压 血压昼夜节律 血压变异性 颈动脉硬化 

分 类 号：R543.4[医药卫生—心血管疾病] R544.1[医药卫生—内科学]