高血压患者糖化血红蛋白与动态血压及心率的相关性  

Association between glycated hemoglobin and ambulatory blood pressure or heart rate in hypertensive patients

作　　者：李媛[1] 邓彬[1] 郭宇轩 彭庆翎 胡涛 夏珂[1] LI Yuan;DENG Bin;GUO Yuxuan;PENG Qingling;HU Tao;XIA Ke(Department ofCardiovascularMedicine,Xiangya Hospital,Central SouthUniversity,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院心血管内科,长沙410008

出　　处：《中南大学学报（医学版）》2021年第5期488-496,共9页Journal of Central South University ：Medical Science

基　　金：湖南省自然科学基金(2016JJ6166);中国心血管健康联盟――进阶基金(2020-CCA-ACCESS-117);中华国际医学交流基金会心血管多学科整合思维研究基金(z-2016-23-2101-20)。

摘　　要：目的:探讨高血压患者糖化血红蛋白(glycosylated hemoglobin,HbA1c)与动态血压及心率的关系。方法:纳入2018年9月至2019年4月在中南大学湘雅医院行24 h动态血压监测的患者585例,其中高血压患者470例(高血压组),健康体检者115名(对照组)。比较两组的HbA1c水平。根据HbA1c水平再将高血压组分为两个亚组:高HbA1c组(HbA1c≥6.1%,n=142)和正常HbA1c组(<6.1%,n=328)。比较各组间基本资料和动态血压及心率参数。HbA1c与动态血压及心率的相关性采用Pearson/Spearman相关分析;HbA1c≥6.1%的危险因素采用多因素logistic回归分析,不同高血压人群HbA1c升高的影响因素采用多元线性逐步回归分析。结果:高血压组的HbA1c水平较对照组高[(6.1±1.3)%vs (5.1±1.7)%,P<0.05]。在高血压患者中,与正常HbA1c组相比,高HbA1c组的夜间收缩压[(131.1±19.2) mmHg vs (122.5±19.2) mmHg]、夜间收缩压负荷[62.5%(15.5%~100%) vs 28.6%(0~75%)]及白昼平均心率[(74.3±11.6) min^(-1)vs (71.2±11.4) min^(-1)]更高(均P<0.05)。Pearson/Spearman相关分析示HbA1c与收缩压和收缩压负荷呈正相关(均P<0.05)。Logistic回归分析示夜间收缩压负荷是HbA1c≥6.1%的危险因素(OR=1.025,95%CI:1.003~1.048,P<0.05);多元线性回归分析示在高血压患者、3级高血压患者、未降压治疗的高血压患者中,夜间收缩压负荷仍与HbA1c呈正相关(分别β=0.155、β=0.171、β=0.384,均P<0.05)。结论:在高血压患者中,HbA1c与血压水平、血压负荷及心率呈正相关,与血压变异性、心率变异性及清晨血压无关。Objective:To determine the association between glycosylated hemoglobin(HbA1c)and ambulatory blood pressure or heart rate in hypertensive patients.Methods:A total of 585 patients,who performed ambulatory blood pressure monitoring(ABPM)from September 2018 to April 2019 in Xiangya Hospital,Central South University,were enrolled and assigned into 2 groups(470 in a hypertensive group and 115 in a normal group).HbA1c levels were compared.According to the HbA1c level,the hypertensive group was divided into 2 subgroups:A high HbA1c group(HbA1c≥6.1%,n=142)and a normal HbA1c group(HbA1c<6.1%,n=328).Whole basic data and ABPM parameter were compared among the groups.Pearson/Spearman correlation analysis was applied to study the association between HbA1c and BPV.Multivariate logistic regression was used to explore the influential factors for HbA1c(≥6.1%)and continuous increase of HbA1c in different hypertensive populations,respectively.Results:The hypertensive group had higher HbA1c level than the normal group[(6.1±1.3)%vs(5.1±1.7)%,P<0.05].In hypertensive patients,nocturnal systolic blood pressure[(131.1±19.2)mmHg vs(122.5±19.2)mmHg],nocturnal systolic blood pressure load[62.5%(15.5%-100%)vs 28.6%(0-75%)],and daytime heart rate[(74.3±11.6)min-1 vs(71.2±11.4)min-1]of the high HbA1c group were higher than those in the normal HbA1c group(all P<0.05).Pearson/Spearman correlation analysis showed that HbA1c was positively correlated with systolic blood pressure and blood pressure load(both P<0.05).Logistic regression analysis showed that nocturnal systolic pressure load was the risk factor for the increase of HbA1c level(OR=1.025,95%CI 1.003 to 1.048,P<0.05).Multiple linear regression showed that nocturnal systolic pressure load was still positively correlated with HbA1c in total,tertiary,and hypertensive patients without treatment(β=0.155,β=0.171,β=0.384,respectively,all P<0.05).Conclusion:In hypertensive patients,HbA1c is positively correlated with ambulate blood pressure,blood pressure load,and heart rate,and it ha

关 键 词：糖化血红蛋白 血压负荷 血压变异性 心率变异性 清晨血压 

分 类 号：R544.1[医药卫生—心血管疾病]