诊室血压正常的代谢综合征患者血压波动状况及其对心脑血管事件发生的影响  

Blood pressure fluctuation in metabolic syndrome patients with normal clinic blood pressure and its effect on cardiovascular and cerebrovascular events

作　　者：吕国令 李霞[1] 刘爱玲[1] 黄建英[1] 崔爱东[1] 张京波[1] 许耀[1] LYU Guo-ling;LI Xia;LIU Ai-ling(Department of Cardiology, Laiyang Central Hospital of Yantai City, Shandong 265200, China)

机构地区：[1]烟台市莱阳中心医院心内科,山东265200

出　　处：《中国临床新医学》2020年第6期579-583,共5页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：烟台市科技计划项目(编号:2017YD028)。

摘　　要：目的观察诊室血压正常的代谢综合征(MS)患者的血压波动情况,分析MS发生的影响因素及其对心脑血管事件的影响。方法选择2015-02~2017-09在该院心内科住院的可疑冠心病患者125例,根据MS的发生情况将其分为非MS组(n=60)和MS组(n=65),比较两组一般临床指标及动态血压参数的差异,分析MS发生的影响因素及其对主要心脑血管事件(MACCE)发生的影响。结果MS组腰围、体质量指数(BMI)、三酰甘油(TG)、空腹血糖和糖化血红蛋白(HbA1c)水平高于非MS组,合并糖尿病、隐蔽性高血压(MH)人数比例大于非MS组,但HDL-C水平低于非MS组(P<0.05)。MS组24 h平均收缩压(24hSBP)、白天平均收缩压(dSBP)、夜间平均收缩压(nSBP)、白天收缩压平台、夜间收缩压平台及清晨收缩压上升速度、24 h平均动脉压(24hMAP)、白天平均动脉压(dMAP)及夜间平均动脉压平台均显著高于非MS组(P<0.05)。Logistic回归分析结果显示,较大的腰围、更高水平的BMI及清晨收缩压上升速度是促进MS发生的危险性因素,而较高水平的HDL-C是抑制MS发生的保护性因素(P<0.05)。以发生MACCE为结局进行生存分析,结果显示MS组发生MACCE的风险显著高于非MS组(P<0.05)。结论MS的发生会升高收缩压水平和加剧清晨血压波动,并可能会进一步增加MACCE发生的风险。Objective To observe the blood pressure fluctuation in metabolic syndrome(MS)patients with normal clinic blood pressure,and to analyze the influencing factors of MS and the effects of MS on cardiovascular and cerebrovascular events.Methods One hundred and twenty-five patients with suspected coronary heart disease admitted to the Department of Cardiology,Laiyang Central Hospital of Yantai City from February 2015 to September 2017 were selected and were divided into non-MS group(n=60)and MS group(n=65)according to whether or not MS occurred.The differences of general clinical indicators and ambulatory blood pressure parameters were compared between the two groups,and the influencing factors of MS and the effects of MS on the occurrence of major adverse cardio-cerebral vascular events(MACCE)were analyzed.Results The levels of waist circumference,body mass index(BMI),triglyceride(TG),fasting blood glucose and glycated hemoglobin(HbA1c)in the MS group were higher than those in the non-MS group.The proportion of the patients complicated with diabetes and masked hypertension(MH)in the MS group was higher than that in the non-MS group,but the level of HDL-C in the MS group was lower than that in the non-MS group(P<0.05).The levels of 24-hour mean systolic blood pressure(24hSBP),daytime average systolic blood pressure(dSBP),nighttime average systolic blood pressure(nSBP),daytime systolic blood pressure plateau,nighttime systolic blood pressure plateau and increasing rate of early morning SBP,24-hour mean arterial blood pressure(24hMAP),diurnal mean arterial blood pressure(dMAP)and nocturnal mean arterial blood pressure plateau in the MS group were significantly higher than those in the non-MS group(P<0.05).The results of Logistic regression analysis showed that larger waist circumference,higher levels of BMI and increasing rate of early morning systolic blood pressure were the risk factors that promoted the occurrence of MS,while higher levels of HDL-C were the protective factors that inhibited the occurrence of MS(P<0.05

关 键 词：代谢综合征 血压变异性 影响因素 主要心脑血管事件 

分 类 号：R544[医药卫生—心血管疾病]