24 h动态血压变异与心脏结构和功能的关系  

Association between 24-h ambulatory blood pressure variability and cardiac structure and function

作　　者：徐婷嬿[1] 杨龑 李晶晶[1] 张冬燕[1] 王颖[1] 王继光[1] 李燕[1] XU Tingyan;YANG Yan;LI Jingjing;ZHANG Dongyan;WANG Ying;WANG Jiguang;LI Yan(Center for Vascular Evaluations,Shanghai Institute of Hypertension,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院上海市高血压研究所血管检测中心,上海200025

出　　处：《诊断学理论与实践》2019年第2期193-198,共6页Journal of Diagnostics Concepts & Practice

基　　金：上海市卫生和计划生育委员会面上项目课题(201840064)

摘　　要：目的:探讨24 h动态血压变异与心脏结构及功能间的关系。方法:纳入未经降压药物治疗的初发或疑似高血压的门诊患者80例,行24 h动态血压监测及超声心动图检查,计算24 h血压标准差(standard deviation,SD)、变异系数(coefficient of variation,CV)、平均实际血压变异(average real variability, ARV)、血压最大与最小差值(maximum-minimum difference, MMD)及独立于血压水平的血压变异(variability independent of the mean, VIM)。应用多元线性回归,将血压变异参数与血压水平同时放入模型,计算血压变异参数、血压水平与心超指标关联的标准偏回归系数(standardizedβ)及偏决定系数。结果:24 h血压水平与左心室质量指数(收缩压,β为6.8～8.0,P<0.01;舒张压,β为6.7～7.8,P<0.01)、左心室纵向应变(收缩压,β为-0.76～-0.71,P<0.05;舒张压,β为-0.81～-0.71,P<0.05)及室间隔E/e’比值(收缩压,β为0.44～0.57,P<0.05)独立相关,解释了8.3%～35.1%的心脏结构和功能变异,而24 h血压变异参数在校正了血压水平后,除了24 h收缩压CV、VIM与左室质量指数(β=3.3,P=0.048,β=3.4,P=0.049)微弱相关,24 h舒张压MMD与室间隔E/e’比值相关(β=0.46,P=0.034),解释了1.2%～6.0%的心脏结构和功能变异外,其余参数均不相关。结论:24 h短时血压变异与心脏结构功能有关,但血压水平仍可能是影响心脏结构和功能的主要因素。Objective: To investigate the association between 24-h ambulatory blood pressure variability and cardiac structure and function in untreated patients. Methods: The association between 24-hour ambulatory blood pressure(BP)recordings and echocardiography in 80 untreated patients referred to a hypertension clinic was assessed. BP variability indices were standard deviation(SD), coefficient of variation(CV), variability independent of the mean(VIM), maximumminimum difference(MMD), and average real variability(ARV). Effect sizes(standardized β)and partial coefficient of determination were computed using multivariable regression models. Results: Left ventricular mass index(LVMI)(systolic BP:β=6.8-8.0, P<0.01;diastolic BP:β=6.7-7.8, P<0.01), longitudinal strain(LS)(systolic BP:β=-0.76--0.71, P<0.05;diastolic BP:β=-0.81--0.71, P<0.05) and septal E/e’(systolic BP:β=0.44-0.57, P<0.05) were associated independently with BP, whereas the association with BP variability was not significant except for those of LVMI with systolic BP CV and VIM(β=3.3, P=0.048,β=3.4, P=0.049), and of septal E/e’ with diastolic BP MMD(β=0.46, P=0.034). Conclusion: Shortterm 24-h blood pressure variability is associated with cardiac structure and function, but blood pressure might be a major factor affecting these cardiac indices.

关 键 词：血压监测 血压变异 心脏超声 

分 类 号：R446.5[医药卫生—诊断学]