用动态血压监测探讨计算T/P比值的方法学研究  

Study on methodology of calculating trough to peak ratio according to ambulatory blood pressure monitoring

作　　者：林伯贤[1] 郭冀珍[1] 张博恒[2] 诸骏仁[2] 

机构地区：[1]上海第二医科大学附属瑞金医院高血压科上海市高血压研究所,200025 [2]上海复旦大学附属中山医院心内科

出　　处：《中华心血管病杂志》2004年第4期313-316,共4页Chinese Journal of Cardiology

摘　　要：目的　用 30h动态血压 (ABPM)监测 ,探讨高血压病患者服长效降压药物后计算谷峰比值 (T/P)的方法学。方法　 10 8例轻中度高血压病患者 ,服用缓释吲哒帕胺 (N SR) 1 5mg 8周前、后测定 30hABPM。用个体与总体 2种方法计算T/P比值。剔除T、P为负数以及T/P >1者中的无效或短效患者后计算T/P比值并作比较。计算机随机抽样分别重复 2 0 0 0次 ,计算T/P比值的平均值和 95 %CI,估计测定T/P比值的最佳样本量。结果　 (1)高血压病患者服用N SR后 30h的血压显著平稳下降。 (2 )用个体方法计算 2 4h的T/P比值中位数 ,收缩压与舒张压分别为 0 4 1、0 36 ,离散度大 ;用总体方法计算的结果为 0 80 4、0 76 2 ,与 30hABPM结果大致符合。 (3)分析 10 8例资料 ,T/P比值为负数中有 6例 ,T/P >1中有 2例 ,其峰效应 <7/ 5mmHg(1mmHg =0 133pBa) ,定为无效病例。其余 10 0例峰效应 >7/ 5mmHg ,其中 2 6例为短效。 (4 )按T/P比值的 95 %CI为0 4 97～ 0 94 9,6 0例为本研究的最佳样本数。结论　计算T/P比值用总体方法优于个体。使用≥ 7/5mmHg作为峰效应的有效标准是可取的。N SR用ABPM计算T/P比值的最小样本量需约 6 0例。Objective To explore the methodology of calculating trough to peak (T/P) ratio by using 30 h ambulatory blood pressure monitoring (ABPM) for hypertensive patients after taking long-effective antihypertensive drugs. Methods One hundred and eight patients with mild to moderate hypertension were followed-up. Thirty hour ABPM was performed 8 weeks before and after administration of sustained-released indapamide (N-SR) once daily. T/P ratios were calculated by 2 methods: individual and group. T/P ratios were also calculated and compared after rejecting the cases with T/P<0 and T/P>1, which were considered to be ineffective or short-effective. To calculate average and 95% CI of T/P ratio by random samples repeated for 2000 times, and to estimate the optimal sample size for measuring T/P ratio. Results (1) Thirty hour blood pressure of hypertensive patients decreased significantly and steadily after taking N-SR. (2) The median of T/P ratio calculated by individual method was 0.41 for SBP and 0.36 for DBP, and it was 0.804 for SBP and 0.762 for DBP calculated by group method. (3) In 108 cases with T/P<0 and >1, the peak effect of 8 patients did not achieve 7/5 mm Hg, which were considered ineffective. The rest 100 cases were effective (peak effect>7/5 mm Hg), in which 26 cases were short-effective. (4) Based on 95% CI of T/P ratio (0.497-0.949), 60 was considered as the optimal sample size. Conclusion The group method is better than individual method in calculating T/P ratio. The utility standard of peak effect of ABPM was set to be 7/5 mm Hg. The minimum sample size for calculating T/P ratio was 60 cases for N-SR.

关 键 词：动态血压监测 计算 T/P比值 方法学 高血压 利尿药 谷峰比值 

分 类 号：R544.1[医药卫生—心血管疾病]