体重指数和血压与血管硬化的关系及护理对策  

Interaction between body mass index and blood pressure on the risk of vascular stiffness:A community-based cross-sectional study and implications for nursing

作　　者：王一焱 汪浩 周洁 王佳琪 吴恒璟 吴静 Yiyan Wang;Hao Wang;Jie Zhou;Jiaqi Wang;Hengjing Wu;Jing Wu(School of Nursing,Shanghai University of Traditional Chinese Medicine,Shanghai,China;Department of Critical Care Medicine,West China Hospital of Sichuan University,Sichuan,China;Clinical Center for Intelligent Rehabilitation Research,Shanghai Yangzhi Rehabilitation Hospital(Shanghai Sunshine Rehabilitation Center),Yangzhi Rehabilitation Hospital,Tongji University,Shanghai,China)

机构地区：[1]School of Nursing,Shanghai University of Traditional Chinese Medicine,Shanghai,China [2]Department of Critical Care Medicine,West China Hospital of Sichuan University,Sichuan,China [3]Clinical Center for Intelligent Rehabilitation Research,Shanghai Yangzhi Rehabilitation Hospital(Shanghai Sunshine Rehabilitation Center),Yangzhi Rehabilitation Hospital,Tongji University,Shanghai,China

出　　处：《International Journal of Nursing Sciences》2023年第3期325-331,I0002,共8页国际护理科学（英文）

基　　金：funded by the Nature Science Foundation of China(No.71904127).

摘　　要：目的旨在探讨体重指数(body mass index,BMI)和血管硬化指标[包括臂踝脉搏波传导速度(brachial ankle pulse wave velocity,baPWV)和踝臂血压指数(ankle brachial index,ABI)]之间的关联,以及血压是否与之关联,并提出相关的护理对策。方法采用横断面调查研究。2019年3一12月,选取上海市张江社区医疗中心接受常规健康筛查的1894名中老年人进行调查。根据BMI将其分为3组:正常体重(n=1202)、超重(n=480)和肥胖(n=212)组。采用多变量线性回归模型和平滑曲线拟合评估BMI和血管硬化指标之间的关联。采用中介分析来检验血压是否在BMI和血管硬化指标之间起中介作用。结果多元线性回归分析显示,BMI与baPWV(m/s)[β=-0.06(-0.10,-0.03)]和ABI[β=-0.004(-0.005,-0.003)]分别显示负向关联。收缩压在BMI与baPWV关系中的交互作用检验结果有统计学意义(P=0.01)。在校正年龄和性别后,中介分析显示BMI和baPWV存在关联(β=0.090,P<0.001),收缩压(β=0.533,P<0.001)和舒张压(β=0.338,P<0.001)的中介作用有统计学意义。BMI与ABI负向关联(β=-0.135,P<0.001),收缩压(β=0.124,P<0.001)和舒张压(β=0.053,P<0.001)有部分中介作用。然而,依据血压水平进一步进行亚组分析后,多数亚组内血压中介效应无统计学意义。结论研究结果显示,BMI与不同非侵人性血管硬化测量指标之间存在矛盾的关联。在BMI和baPWV的关系中,血压可能有生物学上的交互作用。应采取针对性的健康教育和行为干预,控制血压和体质量,预防中老年人的血管硬化。Objective:This study aimed to analyze associations between body mass index(BMI)and vascular measurements(brachial ankle pulse wave velocity[baPWV]and ankle-brachial index[ABI]),whether blood pressure(BP)was involved in the relationship,and implications for nursing.Methods:A cross-sectional study was conducted,including 1,894 middle-aged and older adults who underwent routine health screening at a community medical center in the Zhangjiang community in Shanghai,China.Participants were divided into three groups based on BMI:normal weight(n?1,202),overweight(n?480),and obese(n?212).Multivariate linear regression models and smooth curve fittings were used to evaluate the associations between BMI and indices of vascular stiffness.Mediation analysis examined whether blood pressure mediate the association between BMI and vascular stiffness.Results:Multiple linear regression analysis showed that BMI to be significantly and negatively associated with baPWV(b?0.06[0.10,0.03])and ABI(b?0.004[0.005,0.003]),respectively.The interaction test results of systolic blood pressure(SBP)in the relationship between BMI and baPWV were significant(P for interaction?0.01).After adjusting for age and sex,mediation analyses showed that BMI and baPWV were correlated(b?0.090,P<0.001)and mediated by SBP(b?0.533,P<0.001)and diastolic blood pressure(DBP)(b?0.338,P<0.001).A negative association was found between BMI and ABI(b?0.135,P<0.001),which appeared to be partially mediated by SBP(b?0.124,P<0.001)and DBP(b?0.053,P<0.001).Additional subgroup analysis based on blood pressure levels did not revealed statistically significant mediating effects.Conclusions:Our findings showed conflicting associations between BMI and non-invasive vascular measurements of arterial stiffness.BP may have a biological interaction in the relationship between BMI and baPWV.Managing blood pressure and weight through comprehensive clinical care is crucial for preventing stiffness or blockage of vessels in middle-aged and older adults.

关 键 词：老年人 踝肱指数 血压 人体质量指数 心血管疾病 血管硬化 

分 类 号：R473.5[医药卫生—护理学]