冠状动脉分叉病变与血压昼夜节律的关系  

Relation between coronary bifurcation lesions and blood pressure circadian rhythm

作　　者：李菁[1] 赵全明[1] 米树华[1] 苏工[1] 周芸[1] 贾淑杰[1] 

机构地区：[1]首都医科大学附属北京安贞医院特需医疗科北京市心肺血管疾病研究所,100029

出　　处：《中国医药》2016年第7期949-953,共5页China Medicine

基　　金：国家自然科学基金（30972810）;北京市自然科学基金（7132078）

摘　　要：目的探讨冠状动脉分叉病变与血压昼夜节律的关系。方法选取2012年1月至2014年12月于首都医科大学附属北京安贞医院经冠状动脉造影证实为冠状动脉粥样硬化性心脏病且接受无创便携式动态血压监测仪检查的高血压患者153例，根据血压昼夜节律模式分为杓型组（32例）、非杓型组（78例）及反杓型组（43例），经冠状动脉造影后应用SYNTAX积分对冠状动脉分叉病变进行量化，得出分叉病变积分及分叉病变积分百分比，分析其与血压昼夜节律之间的相关性。结果杓型组、非杓型组、反杓型组患者的SYNTAX积分、分叉病变积分、分叉病变积分百分比均依组别而递增[SYNTAX积分：（17±3）、（26±4）、（34±5）分；分叉病变积分：（6．2±2．6）、（15．1±3．8）、（21．4±4．1）分；分叉病变积分百分比：（36±11）％、（57±9）％、（63±6）％]，任意组问差异均有统计学意义（均P〈0．01）。分叉病变积分与24h平均收缩压、夜间收缩压、夜间舒张压、年龄、糖尿病及高血压病程呈正相关（r=0．259、0．433、0．323、0．376、0．311、0．282，均P〈0．01），与夜间收缩压下降率、夜间舒张压下降率呈显著负相关（r=-0．561、-0．531，均P〈0．01）；与夜间收缩压下降率、夜间舒张压下降率、年龄、糖尿病独立相关（均P〈0．05）。分叉病变积分百分比与24h平均收缩压、夜间收缩压、夜间舒张压及年龄呈正相关（r=0．267、0．432、0．486、0．284，均P〈0．01），与夜间收缩压下降率及夜间舒张压下降率呈显著负相关（r=-0．632、-0．579，均P〈0．01）；与夜间收缩压下降率、夜间舒张压下降率、年龄独立相关（均P〈0．01）。结论血压节律异常与冠状动脉分叉病变的严重程度及好发性高度相关。Objective To investigate the relation between coronary bifurcation lesions and blood pressure circadian rhythm. Methods Totally 153 patients with coronary atherosclerotic heart disease and hypertension from January 2012 to December 2014 in Beijing Anzhen Hospital, Capital Medical University were enrolled; all patients received portable noninvasive blood pressure monitoring. According to blood pressure circadian rhythm, all patients were divided into 3 groups ： dipper group （ 32 cases ） , non-dipper group （ 78 cases ） and reverse-dipper group （43 cases）. SYNTAX score was used to quantify coronary bifurcation lesions after coronary angiography; correla- tion among bifurcation lesion score, bifurcation lesion ratio and blood pressure circadian rhythm were analyzed. Results SYNTAX score, bifurcation lesion score and bifurcation lesion ratio in dipper group, non-dipper group, reverse-dipper group were （ 17 ± 3 ） , （26 ± 4 ） , （34 ± 5 ） scores, （6.2 ± 2.6 ） , （ 15.1 ± 3.8 ） , （ 21.4 ± 4.1 ） scores and （ 36 ± 11 ） % , （ 57 ± 9 ） % , （ 63 ± 6 ） % respectively ; differences between groups were all statistically significant （P 〈0.01 ）. Bifurcation lesion score was positively correlated with 24 h mean systolic blood pressure, nocturnal systolic blood pressure, nocturnal diastolic blood pressure, age, diabetes and hypertension （ r = 0. 259, 0. 433, 0. 323, 0.376, 0.311,0. 282 ; P 〈 0.01 ） ; it was negatively correlated with ratios of nocturnal systolic blood pres- sure decreasing and nocturnal diastolic blood pressure decreasing （ r = - 0.561, - 0.531 ; P 〈 0.0 t ） ; it was inde- pendently correlated with ratios of nocturnal systolic blood pressure decreasing, nocturnal diastolic blood pressure decreasing, age and diabetes （P 〈 0.05 ）. Bifurcation lesion ratio was positively correlated with 24 h mean systolic blood pressure, nocturnal systolic blood pressure, nocturnal diastolic blood pressure and age（r = 0. 267, 0.432, 0. 486, 0. 284; P 〈

关 键 词：冠状动脉分叉病变 血压昼夜节律 SYNTAX积分 

分 类 号：R543[医药卫生—心血管疾病]