儿童期至成年期长期血压变异性与早期血管老化关系  

Association between long-term blood pressure variability from childhood to adulthood with early vascular ageing

作　　者：罗文婧 高可 常鸣珂 赵芃 杜鸣飞 胡桂霖 褚超[1] 陈方尧 汪洋[1] 牟建军[1] LUO Wenjing;GAO Ke;CHANG Mingke;ZHAO Peng;DU Mingfei;HU Guilin;CHU Chao;CHEN Fangyao;WANG Yang;MU Jianjun(Department of Cardiovascular Medicine,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an,Shaanri 710061,China;不详)

机构地区：[1]西安交通大学第一附属医院心内科,陕西西安710061 [2]西安交通大学医学部公共卫生学院流行病与卫生统计学系

出　　处：《中国预防医学杂志》2024年第9期1099-1104,共6页Chinese Preventive Medicine

基　　金：陕西省自然科学基础研究计划项目(2021JM-257,2021JM-588);陕西省重点研发计划项目(2023-ZDLSF-50);西安交通大学第一附属医院中西医结合项目(2021ZXY-14);西安交通大学第一附属医院临床研究课题(XJTU1AF-CRF-2022-002,XJTU1AF2021CRF-021)。

摘　　要：目的 探讨儿童期至成年期的长期血压变异性与早期血管老化的潜在关联,为心脑血管疾病防控提供依据。方法 利用1987年建立的“汉中儿童高血压研究队列”数据,通过30年(1987—2017年)的标准差(standard devition,SD)和平均真实变异性(average real variability,ARV)评估血压变异性。早期血管老化定义为肱踝脉搏波传导速度大于整个研究人群中各年龄阶段的90%上限。结果 在1 050名受试者30年随访中,共有105名出现了早期血管老化。经过校正末次随访的人口统计学变量、临床特征及随访30年的平均血压后,SDSBP(OR=1.13,95%CI:1.08~1.18)、ARVSBP(OR=1.30,95%CI:1.20~1.40)、SDDBP(OR=1.23,95%CI:1.16~1.31)、ARVDBP(OR=1.42,95%CI:1.28~1.57)、SDMAP(OR=1.22,95%CI:1.15~1.29)、ARVMAP(OR=1.44,95%CI:1.30~1.60)、SDPP(OR=1.05,95%CI:0.99~1.12)和ARVPP(OR=1.22,95%CI:1.12~1.33)与早期血管老化的发生风险均显著相关(P<0.05)。当使用儿童期至成年期的累积血压暴露代替平均血压作为校正变量时,结果与前述结论基本一致,关联较为稳定。结论 儿童期至成年期长期血压变异性与早期血管老化密切相关,且这种关联独立于平均血压或累积血压暴露。早期识别长期血压变异性,可能有助于预测未来心脑血管疾病的发生。Objective To explore the potential associations of long-term blood pressure variability from childhood through adulthood with early vascular ageing,providing evidence for the prevention and control of cardiovascular and cerebrovascular diseases.Methods Using data from the ongoing cohort of the Hanzhong Adolescent Hypertension Study,which enrolled children and adolescents in 1987,blood pressure variability was evaluated by standard deviation (SD) and average real variability (ARV) over 30 years.Early vascular aging was defined as brachial-ankle pulse wave velocity exceeding the 90th percentile of the entire study population at each age stage.Results Among 1 050 participants followed up for 30 years,105 developed early vascular ageing.After adjusting for demographic variables,clinical characteristics,and 30-year mean blood pressure at the final follow-up,higher SD_(SBP),ARV_(SBP),SD_(DBP),ARV_(DBP),SD_(MAP),ARV_(MAP),SD_(PP) and ARV_(PP) since childhood was significantly associated with a higher risk of early vascular ageing[ORs (95%CIs) were 1.13 (1.08-1.18),1.30(1.20-1.40),1.23 (1.16-1.31),1.42 (1.28-1.57),1.22 (1.15-1.29),1.44 (1.30-1.60),1.05 (0.99-1.12)and 1.22 (1.12-1.33),respectively](P<0.05).The result was basically consistent when using cumulative exposure to blood pressure from childhood to adulthood instead of mean blood pressure as an adjustment variable,which indicated that the association was relatively stable.Conclusions Long-term blood pressure variability from childhood to adulthood was associated with a higher risk of early vascular ageing,and this association is independent of mean blood pressure or cumulative blood pressure exposure.Therefore,identifying long-term blood pressure variability from early an age may assist in predicting cardiovascular and cerebrovascular diseases in later life.

关 键 词：儿童期 血压变异性 早期血管老化 纵向队列研究 

分 类 号：R543[医药卫生—心血管疾病] R544[医药卫生—内科学]