不同血压水平血管病变情况评估及相关危险因素分析  

Assess of blood vessel condition on different levels of blood pressure and analysis of the relevant risk factors

作　　者：胡明昕[1] 于力[2] 吴媛媛[1] 高金颖[1] 刘岚[1] 

机构地区：[1]航天中心医院健康管理部,北京100049 [2]航天中心医院公共健康保进部,北京100049

出　　处：《中国实验诊断学》2017年第7期1221-1225,共5页Chinese Journal of Laboratory Diagnosis

基　　金：中国航天科工集团公司医疗卫生科研基金(基金编号:2015-LCYL-003)

摘　　要：目的评估不同血压水平血管病变情况,并对其相关危险因素进行分析。方法将2016年4月在航天中心医院体检中心体检人群744例按照血压水平分为4组,其中理想血压组224例、正常高值血压组344例、高血压1级组135例、高血压2级及3级组41例。首先评估各组血管病变的情况,包括颈股脉搏波传导速度(cfPWV)、臂踝脉搏波传导速度(baPWV)、踝臂指数(ABI)及颈动脉内膜中层厚度(CIMT)等;然后对各组血管病变的相关危险因素进行对比及统计学分析。结果随着血压水平的逐级升高,理想血压组、正常高值血压组、高血压1级组、高血压2级及3级组各组间血管病变的程度也逐渐加重,以上4组cfPWV、baPWV、CIMT值逐渐增高(P<0.05),并且从正常高值血压水平开始cfPWV、baPWV、CIMT等检查的异常检出率就已经明显增加;而上述4组血压人群的ABI异常检出率均较低,组间无统计学差异(P>0.05)。上述4组随着血压水平的升高,年龄、体质量指数、骨密度、幽门螺杆菌感染情况、C反应蛋白、尿酸、空腹血糖、糖化血红蛋白、甘油三酯、低密度脂蛋白胆固醇、总胆固醇水平逐渐升高(P<0.05),而高密度脂蛋白胆固醇逐渐降低(P<0.05)。年龄、空腹血糖(FPG)、骨密度为颈股脉搏波传导速度(cfPWV)的独立危险因素,其OR值、95%CI分别为1.158(1.123-1.195)、1.568(1.118-2.200)、0.055(0.012-0.259);年龄、甘油三酯(TG)、骨密度为颈动脉内膜中层厚度(CIMT)的独立危险因素,其OR值、95%CI分别为1.102(1.077-1.127)、0.572(0.358-0.913)、0.008(0.002-0.033)。结论极易被人们忽视的正常高值血压水平人群已经开始存在代谢异常,并且已经存在较为明显的动脉早期亚临床损害。因此从心脑血管病预防的角度来看,从正常高值血压阶段开始就要重视对血压及亚临床血管病变的及时监控及治疗。Objective To explore the blood vessel condition on different levels of blood pressure,and analyse the relevant risk factors.Methods The data of 744 cases in Health Management Department were analyzed,including 224 subjects with normotension,344 with prehypertension,135 with hypertension grade 1,and 41 with hypertension grade 2or 3.First the blood vessel condition examinations included carotid-femoral pulse wave velocity（cfPWV）,brachial-ankle pulse wave velocity（baPWV）,ankle-brachial index（ABI）,and the carotid artery intima-media thickness（CIMT）were measured,then the relevant risk factors were statistically analyzed.Results Among the four blood pressure groups,with the level of blood pressure higher,the blood vessel condition examinations worsened correspondingly（P〈0.05）.In addition,abnormal blood vessel conditions were distinctly detected in prehypertension group.While,the abnormal ratio of ABI were all lower in the four groups,and there were no statistic differences（P〉0.05）.Also we found that age,body mass index,bone mineral density,helicobacter pylori infection,C-reactive protein,uric acid,fasting blood glucose,glycosylated hemoglobin,triglyceride,low density lipoprotein cholesterol,and total cholesterol were gradually increased among the four groups（P〈0.05）,and high density lipoprotein cholesterol was gradually decreased（P〈0.05）.Age,fasting blood glucose,bone mineral density were the independent risk factors of cfPWV with the OR value,95%CI1.158（1.123-1.195）、1.568（1.118-2.200）、0.055（0.012-0.259）respectively.Age,triglyceride,bone mineral density were the independent risk factors of CIMT with the OR value,95%CI 1.102（1.077-1.127）、0.572（0.358-0.913）、0.008（0.002-0.033）respectively.Conclusion Metabolic disturbance and obvious blood vessel subclinical damage were found in prehypertension cases who were easily neglected.We should pay more attention to the monitoring and cure of blood pressure and early subclinical blood vessel damage.

关 键 词：血压 血管病变 脉搏波传导速度 踝臂指数 颈动脉内膜中层厚度 代谢指标 危险因素 

分 类 号：R543[医药卫生—心血管疾病]