冠心病合并原发性高血压患者的脉压差与冠状动脉病变的关系  

Relationship between pulse pressure difference and coronary artery lesion in patients with coronary heart disease and hypertension

作　　者：田国卫[1] 夏豪[1] 刘浙波 钱才媛 杨礼文[1] 

机构地区：[1]武汉大学人民医院心内科,武汉430060

出　　处：《岭南心血管病杂志》2017年第2期129-132,共4页South China Journal of Cardiovascular Diseases

基　　金：国家自然科学基金(项目编号:81270184)

摘　　要：目的探讨冠状动脉粥样硬化性心脏病(冠心病)合并原发性高血压(高血压)患者的脉压差与其冠状动脉病变的关系。方法选取2013年11月至2016年1月就诊于武汉大学人民医院心内科经冠状动脉造影诊断为冠心病的患者212例,根据患者入院后24 h内的平均脉压差将患者分为高脉压差组(n=97)和对照组(n=115)。统计患者基本临床资料及入院24 h内多次测量血压的结果。根据冠状动脉狭窄直径≥50%累及左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)或左主干(LM)分为单支、双支(累及左主干为双支病变)及三支病变组。根据Gensini积分标准对每位患者冠状动脉病变进行评分。结果高脉压差组冠状动脉三支病变发生率高于对照组[42.3%(41/97)vs.23.5%(27/115),χ~2=8.527,P=0.003],单支病变发生率低于对照组[27.8%(27/97)vs.51.3%(59/115),χ~2=8.527,P=0.003],差异有统计学意义(P<0.05)。高脉压差组冠状动脉病变部位更多累及左前降支,两组比较差异有统计学意义(P<0.05)。两组左回旋支及右冠状动脉病变情况比较,差异无统计学意义(P>0.05)。与对照组比较,高脉压差组冠状动脉病变支数更多、Gensini积分更高,差异有统计学意义(P<0.05)。结论冠心病合并高血压患者有较高脉压差时,其冠状动脉病变程度更为严重。Objectives To explore the relationship between pulse pressure （PP） difference and coronary artery lesion in patients with coronary heart disease （CHD） and hypertension. Methods Totally 212 patients were diagnosed as CHD by coronary angiography from November 2013 to January 2016 in Renmin Hospital of Wuhan University were included in this study. Patients were divided into high PP difference group （n=97） and control group （n= 115 ） according to the average PP difference measured within 24 hours after being hospitalized. Basic clinical data, laboratory results of the patients were collected and PP was measured within 24 hours. Cardiac function tests were performed for all the patients during the period of hospitalization. All the patients were divided into 1 vessel lesions group, 2 vessels lesions or large main vessel lesions group, 3 vessels lesions group according to the stenosis of major vessels≥50%. Coronary lesions of the patients were evaluated according to Gensini score criteria. Results Compared with control group, high PP difference group was with higher percentage of patients with 3 vessels of coronary lesions [ 42.3% （ 41/97 ） vs. 23.5% （ 27/115 ）, χ2=8.527, P=0.003 ] , but was with lower percentage of patients with 1 vessel lesions [ 27.8% （ 27/97 ） vs. 51.3% （ 59/115 ） ,χ2=8.527 , P=0.003 ] . Coronary lesions were involved more in left anterior descending coronary artery in PP difference group than in control group （P〈0.05）. There were no significant differences of left circumflex coronary artery diseases and right coronary artery diseases between the two groups （ P〉0.05 ）. Numbers of coronary artery lesions and Gensini scores in high PP difference group were significantly higher than those in control group （P〈0.05）. Conclusions Patients with coronary heart disease and hypertension may have a more serious coronary artery lesion when combined with higher PP difference.

关 键 词：冠状动脉疾病 高血压 脉压差 

分 类 号：R541.4[医药卫生—心血管疾病]