冠心病合并高血压患者冠状动脉病变与血压昼夜节律的关系研究  

Correlations of circadian blood pressure with coronary lesions in coronary heart disease patients with hypertension

作　　者：杨礼文[1] 夏豪[1] 刘浙波 田国卫[1] 郑雅格 

机构地区：[1]武汉大学人民医院心内科,心血管病湖北省重点实验室,湖北省武汉市430060

出　　处：《中国心血管病研究》2016年第12期1075-1079,共5页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金（项目编号：81270184）

摘　　要：目的 探讨冠心病合并高血压患者的冠状动脉病变与血压昼夜节律的关系.方法 选取2013年1月至2015年12月于我院行冠状动脉造影诊断为冠心病且合并高血压的患者154例.通过对所有患者进行24h动态血压监测,分析动态血压参数,根据夜间血压下降率分为杓形高血压组（DH组,n=71）和非杓形高血压组（NDH组,n=83）.比较两组患者基本临床资料、实验室指标.冠脉造影示管腔狭窄≥50％定义为冠脉病变,根据病变累及部位分为单支、双支（累及左主干纳入双支病变）及三支病变组.按照Gensini评分标准对每位患者的冠脉病变程度进行定量评定.结果 NDH组急性冠脉综合征发生率（79.5％）明显高于DH组（60.6％）（P＜0.05）.NDH组患者夜间平均收缩压（nMSBP）（140.40±3.01）mm Hg、夜间平均舒张压（nMDBP）（85.58±2.38）mm Hg,均明显高于DH组（132.23士3.34）mm Hg和（78.44±2.63）mm Hg,夜间血压下降率（包括收缩压和舒张压）（6.81±1.07）％、（7.58±0.75）％,明显低于DH组（12.85±1.61）％、（14.59±1.76）％（P＜0.01）.两组患者冠状动脉病变部位比较未见统计学差异（P＞0.05）,但NDH组冠脉三支病变发生率（39.8％）、病变支数（2.08±0.84）、Gensini积分（56.61±41.62）均显著高于DH组（23.9％、1.80±0.80、38.84±28.40）（P＜0.05）.结论 冠心病合并非杓形高血压患者相比于杓形高血压患者冠状动脉病变范围更广,病变程度更重,急性冠脉综合征发生率更高,具有更高的致死风险.Objective To explore the associations of circadian blood pressure with coronary lesions in coronary heart disease patients with hypertension. Methods 154 patients with hypertension were diagnosed CHD by coronary angiography from January 2013 to December 2015 in our hospital. Based on 24 h ambulatory blood pressure monitoring （ABPM）, the parameters of ABP were analyzed, and all of the patients were divided into dip- per hypertension（DH ） group（n=71 ） or non-dipper hypertension （NDH） group （n=83） according to nocturnal blood pressure fall rate. Compare the basic clinical data and laboratory results of the patients in two groups. All patients were divided into 1 vessel lesions, 2 vessels lesions or left main vessel lesions, 3 vessels lesions groups according to stenosis of major vessels ± 50% revealed by coronary angiography. The coronary lesions of every patientwere eval- uated according to Gensini score criteria. Results NDH group has higher incidence of acute coronary syndrome （ACS）（79.5%） than DH group （60.6%）（P〈0.05）. The night mean systolic blood pressure （nMSBP）, night mean diastolic blood pressure （nMDBP）in NDH group （140.40±3.01）nun Hg, （85.58±2.38）mm Hg were significantly higher and nocturnal blood pressure fall rate （include SBP and DBP）（6.81±1.07）%, （7.58±0.75）% were signifi- cantly lower than those in DH group（ 132.23±3.34）mm Hg, （78.44±2.63）mm Hg, （ 12.85±1.61 ）%, （ 14.59± 1.76 ）% （P〈0.01）. Coronary lesions location have no significant difference between two group（P〉0.05 ）, but compared withDH group （23.9%, 1.80±0.80,38.84±28.40）, NDH group was significantly higher in the incidence of 3 vessels of coronary lesions （39.8%）, the average number of coronary artery lesion （2.08±0.84） and Gensini seore （56.61± 41.62）（P〈0.05）. Conclusion Compared with the DH group, the coronary lesions of CHD combined with NDH was more extensive and serious, has higher ineidenee of ACS and risk of d

关 键 词：血压昼夜节律 高血压 杓形 非杓型 冠状动脉病变 

分 类 号：R541.4[医药卫生—心血管疾病]