老年人直立性低血压患病情况及其与靶器官损伤的相关性研究  

Prevalence of Orthostatic Hypotension and Its Correlation with Target Organ Injury in the Aged

作　　者：董月 孟超[2] 汪海娅[2] 方宁远[2] DONG Yue;MENG Chao;WANG Haiya;FANG Ningyuan(Jiangchuan Community Health Service Center,Minhang District,Shanghai,Shanghai 200240,China;Department of Gerontology,Renji Hospital Affiliated to School of Medicine,Shanghai Jiaotong University,Shanghai 200001,China)

机构地区：[1]闵行区江川社区卫生服务中心,上海市200240 [2]上海交通大学医学院附属仁济医院老年科,上海市200001

出　　处：《实用心脑肺血管病杂志》2019年第8期46-50,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：上海申康第三批慢病防治项目（SHDC12015317）

摘　　要：背景直立性低血压(OH)可能引起重要器官灌注障碍及功能改变,但其与靶器官损伤的具体关系尚未明确。目的分析老年人OH患病情况及其与靶器官损伤的相关性。方法选取2016年8月—2017年10月在上海交通大学医学院附属仁济医院老年科病房住院及体检中心体检的老年人245例,其中OH患者65例(OH组)、非OH患者180例(非OH组)。比较两组患者体位改变前后血压和心率、实验室检查指标、缺血性脑卒中发生率、颈动脉硬化指标及左心结构指标,不同高血压分级患者OH发生率。结果(1)本组老年人OH发生率为26.5%(65/245)。两组患者卧位脉压、卧位心率及立位心率比较,差异无统计学意义(P>0.05);OH组患者卧位收缩压、卧位舒张压高于非OH组,立位收缩压、立位舒张压及立位脉压低于非OH组(P<0.05)。(2)两组患者总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、尿素氮(BUN)、肌酐(Cr)、肾小球滤过率(GFR)及尿微量白蛋白(UALB)比较,差异无统计学意义(P>0.05);OH组患者胱抑素C(Cys C)高于非OH组(P<0.05)。(3)两组患者缺血性脑卒中发生率、颈总动脉内膜中膜厚度(IMT)、颈内动脉IMT、左心房内径(LAD)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心房舒张末期内径(LVEDD)及左心室质量指数(LVMI)比较,差异无统计学意义(P>0.05)。(4)1、2级高血压患者OH发生率比较,差异无统计学意义(P>0.05);但3级高血压患者OH发生率高于1、2级高血压患者(P<0.05)。结论老年人OH发生率为26.5%,而OH与卧位血压升高、高血压分级及早期肾功能损伤有关。Background Orthostatic hypotension(OH)may cause perfusion disorders and functional changes of important organs,but the relation between OH and target organ injury is not yet clear. Objective To analyze the prevalence of OH and its correlation with target organ injury in the aged. Methods From August 2016 to October 2017,a total of 245 old people(including elderly patients in the Department of Gerontology and old people for physical examination in the Physical Examination Center)were selected in Renji Hospital Affiliated to School of Medicine,Shanghai Jiaotong University,including 65 patients with OH(served as OH group)and 180 old people without non-OH(served as non-OH group). Blood pressure and heart rate before and after postural changes,laboratory examination results,incidence of ischemic stroke,indicators of carotid atherosclerosis and left ventricular structure were compared between the two groups,and incidence of OH was compared in patients with different grades of hypertension. Results (1)The incidence of OH was 26.5%(65/245)in this study. There was no statistically significant difference in clinostatic pulse pressure,clinostatic heart rate or upright heart rate between the two groups(P>0.05);clinostatic SBP and DBP in OH group were statistically significantly higher than those in non-OH group(P<0.05),while upright SBP,DBP and pulse pressure in OH group were statistically significantly lower than those in non-OH group(P<0.05).(2)There was no statistically significant difference in TC,TG,HDL-C,LDL-C,FBG,HbA1c,BUN,Cr,GFR or urinary albumin(UALB)between the two groups(P>0.05);Cys C in OH group was statistically significantly higher than that in non-OH group(P<0.05).(3)There was no statistically significant difference in incidence of ischemic stroke,IMT of common carotid artery or internal carotid artery,LAD,IVST,LVPWT,LVEDD or LVMI between the two groups(P>0.05).(4)There was no statistically significant difference in incidence of OH between patients with grade-1 and grade-2 hypertension(P>0.05),while incidence

关 键 词：低血压 直立性 老年人 靶器官损伤 肾功能 胱抑素C 

分 类 号：R544.2[医药卫生—心血管疾病]