高血压前期合并糖耐量异常患者颈动脉内中膜厚度与血压变异的相关性  

Association of carotid artery intima-media thickness and blood pressure variability in prehypertension patients with impaired glucose tolerance

作　　者：闫文珍[1] 王瑞英[2] 黄淑田[2] 

机构地区：[1]山西省大同市第五人民医院,037000 [2]山西医科大学第二人民医院,太原030001

出　　处：《中国实用医刊》2017年第4期6-9,共4页Chinese Journal of Practical Medicine

基　　金：山西省科技攻关项目（20140313015-9）

摘　　要：目的：探讨高血压前期合并糖耐量异常患者颈动脉内中膜厚度（IMT）与血压变异（BPV）的关系。方法将301例患者分为正常对照组（NC 组）60例、单纯高血压前期组（PH 组）82例、单纯糖耐量异常组（IGT 组）84例和高血压前期合并糖耐量异常组（ PH ﹢ IGT 组）75例，超声测定颈动脉 IMT，且均做动态血压监测。结果①IMT在 PH 组[（0.89±0.14）mm]、PH ﹢ IGT 组[（1.02±0.15）mm]、IGT 组[（0.87±0.15）mm]均高于 NC组[（0.76±0.12）mm，P 均﹤0.05]，且 PH ﹢ IGT 组高于 PH 组、IGT 组（P ﹤0.05），但 PH 组与 IGT 组间比较差异未见统计学意义（P ﹥0.05）；血压血糖对其存在交互作用。②24 h 动态血压与 IMT 增厚率：随着收缩压变异性（SBPV）增大，IMT 增厚率增加（P =0.001），而舒张压变异性（DBPV）、平均舒张压（DBP）、平均动脉压与 IMT 增厚率无显著相关性（P =0.435，0.126，0.065）；24 h 平均收缩压（SBP）越大，IMT 增厚率越高（P =0.013）。③回归分析提示 SBPV、超敏 C-反应蛋白（hs-CRP）、平均 SBP、餐后2 h 血糖（2 h PBG）与 IMT 呈正相关。结论高血压前期患者中，IMT 与血压变异性，尤其是 SBPV 相关，高血压前期即存在血管损害，合并糖耐量异常会加重动脉粥样硬化。Objective To investigate the correlation of carotid artery intima-media thickness （IMT）with blood pressure variability（BPV）in prehypertension patients with impaired glucose tolerance. Methods Three hundred and one patients were divided into four groups：normal control group（ NC group,n = 60）,prehypertension group（ PH group,n = 82）,impaired glucose tolerance group（ IGT group,n = 84）,prehypertension and impaired glucose tolerance group（ PH ﹢ IGT group,n = 75）. Carotid artery IMT was measured by Doppler ultrasonography,all patients were monitored by ambulatory blood pressure. Results ①IMT significantly increased in PH,IGT and PH ﹢ IGT groups than that in NC group[（0. 89 ±0. 14）mm,（1. 02 ±0. 15）mm,（0. 87 ±0. 15）mm vs.（0. 76 ±0. 12）mm,P all ﹤0. 05], and it was significantly higher in PH ﹢ IGT group than that in PH or IGT group. ②24 h ambulatory blood pressure and the thickness of the carotid artery IMT：the thickness of the carotid artery IMT increased with increasing systolic blood pressure variability（P = 0. 001）. There was no correlation of the diastolic blood pressure variability,24 h mean diastolic blood pressure,24 h mean artery blood pressure with IMT thickness. ③Regression analysis indicated that IMT was positively correlated with systolic blood pressure variability,high-sensitivity C-reactive protein,24 h mean systolic blood pressure,2-hour postprandial blood glucose. Conclusions IMT is independently correlated with blood pressure variability,especially with systolic blood pressure variability,vascular remodeling could be detected in prehypertension pa-tients. Impaired glucose tolerance could enhance vascular remodeling in prehypertension patients.

关 键 词：高血压前期 糖耐量异常 颈动脉内中膜厚度 血压变异 

分 类 号：R544.1[医药卫生—心血管疾病]