初诊高血压患者颈动脉硬化相关危险因素分析  

Risk factors for carotid atherosclerosis in patients with newly diagnosed hypertension

作　　者：黄素兰[1] 郭宁[1] 张志翔[1] 鲁祖建[1] 葛良清 匡泽民[2] 余振球[2] Huang Sulan;Guo Ning;Zhang Zhixiang;Lu Zujian;Ge Liangqing;Kuang Zemin;Yu Zhenqiu(1Department of Cardiology,the First People′s Hospital of Changde,Changde 415000,China;Department of Hypertension,Beijing Anzhen Hospital Affiliated to Capital Medical University,Beijing 10029,China)

机构地区：[1]常德市第一人民医院心内科,415000 [2]北京安贞医院高血压科,100029

出　　处：《中华临床医师杂志（电子版）》2018年第1期39-43,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：首都医科大学基础临床科研合作基金课题(16JL42)

摘　　要：目的探讨初诊高血压患者颈动脉硬化(CAS)与相关危险因素的关系,为临床干预和预防高血压患者颈动脉硬化提供依据。方法选择2014年7月至2016年5月在常德市第一人民医院心内科门诊年龄>18岁的初诊高血压患者513例,根据颈动脉超声结果将患者分为颈动脉硬化组和正常组,其分别为233例和280例。应用t检验观察并比较2组患者血糖血脂、肾功能、诊室血压、24 h动态血压、尿蛋白定量、心脏彩超等指标,然后采用Logistic回归分析分析颈动脉硬化与相关危险因素的相关性;分析2组患者靶器官损害情况,应用χ2检验比较2组左心室肥厚和尿微量白蛋白检出率。结果 (1)颈动脉硬化组患者的年龄、空腹血糖、24 h脉压、夜间脉压和白昼舒张压均高于正常组,差异有统计学意义(t=6.47,P<0.001;t=2.60,P=0.035;t=1.13,P=0.034;t=0.79,P=0.008;t=0.34,P<0.001)。(2)年龄是初诊高血压患者发生颈动脉硬化的危险因素(β>0,OR>1,P<0.001),高密度脂蛋白(HDL)则是颈动脉硬化的保护因素(β<0,OR<1,P=0.019)。(3)颈动脉硬化组左心室肥厚和尿微量白蛋白检出率均明显高于颈动脉正常组(χ2=13.17,P<0.001;χ2=9.80,P=0.002)。结论年龄为颈动脉粥样硬化独立的危险因素,而HDL水平越高对颈动脉的保护作用越好。Objective To identify the risk factors for carotid arteriosclerosis in patients with newly diagnosed hypertension to provide a basis for the prevention of carotid arteriosclerosis in these patients.Methods A total of 513 patients(aged over 18 years)with newly diagnosed hypertension at our hospital were included in this study.According to color Doppler ultrasound results,the patients were divided into either a carotid arteriosclerosis group(n=233)or a non-carotid arteriosclerosis group(n=280).Fasting blood glucose,blood lipids,renal function,blood pressure,24-hour ambulatory blood pressure,cardiac ultrasound,and microalbuminuria were compared between the two groups by t-test.Then,logistic regression analysis was performed to identify the risk factors for carotid arteriosclerosis.The detection rates of left ventricular hypertrophy and microalbuminuria were compared between the two groups byχ2 test.Results Age,blood glucose,24-h pulse pressure,nighttime pulse pressure,and daytime diastolic blood pressure were significantly higher in the carotid arteriosclerosis group than in the non-carotid arteriosclerosis group(t=6.47,P<0.001;t=2.60,P=0.035;t=1.13,P=0.034;t=0.79,P=0.008;t=0.34,P<0.001,respectively).Age was identified to be a risk factor(β>0,OR>1,P<0.001)and HDL was identified to be a protective factor(β<0,OR<1,P=0.019)for carotid arteriosclerosis.The detection rates of left ventricular hypertrophy and microalbuminuria were significantly higher in the carotid arteriosclerosis group than in the non-carotid arteriosclerosis group(χ2=13.17,P=0.000;χ2=9.80,P=0.002).Conclusion Age can increase the risk of carotid arteriosclerosis in patients with newly diagnosed hypertension.HDL has a protective effect against carotid arteriosclerosis.

关 键 词：初诊 高血压 颈动脉硬化 危险因素 

分 类 号：R544.1[医药卫生—心血管疾病]