老年非瓣膜性心房颤动患者血压变异性特点分析  

Characteristics of Ambulatory Blood Pressure Variability in Elderly Patients with Nonvalvular Atrial Fibrillation

作　　者：张炜[1] 刘晋星 顾莹珍 李伊凡 韩笑蓉 李佐治 王娟[1] 闫森 吕纳强[1] 党爱民[1] ZHANG Wei;LIU Jinxing;GU Yingzhen;LI Yifan;HAN Xiaorong;LI Zuozhi;WANG Juan;YAN Sen;LYR Naqiang;DANG Aimin(Center for Special Medical Care,National Center for Cardiovascular Diseases and Fuwai Hospital,Peking Union Medical College&Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]北京协和医学院,中国医学科学院,国家心血管病中心,阜外医院特需中心,北京市100037

出　　处：《中国分子心脏病学杂志》2023年第5期5599-5605,共7页Molecular Cardiology of China

基　　金：国家卫生健康委科研项目(2020-YB38);国家重点研发计划(2022YFC3602400,2022YFC3602405)。

摘　　要：目的探讨65岁及以上非瓣膜性心房颤动(房颤)患者的血压变异性特点。方法回顾性连续纳入65岁及以上的非瓣膜性房颤患者150例及同期非房颤患者146例,并进行1∶1倾向性评分,最终纳入房颤患者129例[根据房颤类型分为持续性房颤组(n=46)和阵发性房颤组(n=83)]及非房颤患者129例(非房颤组),应用电子血压计测量诊室血压,采用24 h动态血压监测血压的数据,比较各组间血压变化特征,采用多因素线性回归分析影响动态血压变异性的相关因素。结果房颤患者全天及白天平均舒张压均高于非房颤患者(P<0.05),持续性房颤组诊室舒张压,全天、白天、夜间平均舒张压和白天舒张压变异性均高于阵发性房颤组及非房颤组(P<0.05),持续性房颤组全天舒张压变异性高于非房颤组(P<0.05)。多因素线性回归分析结果显示,房颤类型与全天、白天、夜间舒张压变异性有关,且随着房颤赋值的增高(非房颤→阵发性房颤→持续性房颤),全天、白天、夜间舒张压变异性升高(P<0.05)。结论老年持续性房颤患者全天、白天、夜间的平均舒张压及舒张压变异性均高于老年阵发性房颤和非房颤患者。Objective To analyze the characteristics of blood pressure variability in elderly patients aged 65 years and older with nonvalvular atrial fibrillation(AF).Methods The study retrospectively included 150 consecutive nonvalvular AF patients aged 65 years and older,and 146 nonatrial fibrillation patients during the same period,a 1:1 propensity score matching was performed.A total of 129 AF patients[classified into the persistent AF group(n=46)and the paroxysmal AF group(n=83)according to the type of AF],and 129 patients without AF(the non-AF group)were included.In this study,we applied electronic blood pressure monitors to measure blood pressure in the clinic,compared the blood pressure characteristics between groups through 24-hour ambulatory blood pressure monitoring and used multifactorial linear regression to analyze the relevant factors affecting blood pressure variability.Results All-day and daytime mean diastolic blood pressure(DBP)were higher in patients with AF than in patients without AF(P<0.05),clinic DBP,as well as all-day,daytime,and nighttime mean DBP,and DBP variability were all higher in the persistent AF group than that in the paroxysmal AF group and the non-AF group(P<0.05).In addition,all-day DBP variability in the persistent AF group was higher than that in the non-AF group(P<0.05).Multifactorial linear regression analysis showed that the type of AF was associated with all-day,daytime,and nighttime DBP variability.As the severity in AF increased(from non-AF to paroxysmal AF,and to persistent AF),the all-day,daytime,and nighttime DBP variability increased(P<0.05).Conclusion Mean DBP and DBP variability throughout the day,daytime,and nighttime were higher in elderly patients with persistent AF than that in elderly patients with paroxysmal AF and non-AF.

关 键 词：老年 心房颤动 血压变异性 动态血压监测 

分 类 号：R541.75[医药卫生—心血管疾病]