本文選題：血壓 + 血壓負荷�。� 參考：《重慶醫(yī)科大學》2014年碩士論文

【摘要】：研究背景與目的：血壓與頸動脈硬化的存在相關(guān)性已有較多文獻證實，但多為研究偶測血壓與頸動脈硬化的關(guān)系[1]。偶測血壓對患者真實血壓的反應(yīng)受到較多因素影響，例如測量者水平、白大褂高血壓、服藥的規(guī)律性、血壓控制情況等，對真實血壓的反應(yīng)存在局限。動態(tài)血壓在臨床越來越受到醫(yī)生的重視，可以通過動態(tài)血壓監(jiān)測觀察到血壓波動情況、晝夜節(jié)律、晨峰血壓等，對指導臨床工作很有意義[2]。本臨床研究通過收集病人的動態(tài)血壓指標，探討病人血壓負荷與頸部粥樣硬化（CIMT增厚或頸部斑塊性質(zhì)）之間的關(guān)系。 方法：所有入選患者均為2012年1月至2013年12月在重醫(yī)附二院神經(jīng)內(nèi)科住院治療患者，符合納入排除標準，收集24小時動態(tài)血壓指標（包括血壓負荷及平均血壓）、吸煙飲酒史、代謝指標、HBP病程、血壓控制情況，彩超測定CIMT、頸動脈斑塊性質(zhì)等。血壓負荷分為3個等級（0~10%，10~40%，40%以上），CIMT大于1mm記為增厚，斑塊性質(zhì)分為無斑塊、硬斑、混合斑、軟斑。使用Logistic回歸分析研究血壓負荷與CIMT增厚、血壓負荷與頸動脈斑塊性質(zhì)的關(guān)系。 結(jié)果：（1）白晝SBPL（10-40%）是白晝SBPL（0-10%)造成CIMT增厚的6.68倍（OR：6.68,95%CI：1.22~36.46），，白晝SBPL（40%）較白晝SBPL（0-10%）造成CIMT明顯增厚(OR：133,95%CI：13~1335)，CIMT增厚與白晝SBPL存在相關(guān)性，將一般情況、代謝因素、既往病史、服藥史等相關(guān)變量帶入模型一起分析仍能得出同樣結(jié)論。即白晝SBPL越重CIMT增厚越明顯。（2）CIMT增厚除與白晝SBPL明顯相關(guān)，還與腦卒中病史、總膽固醇水平、降壓藥服用史、降脂藥服用史存在相關(guān)性(P0.05)。CIMT增厚與性別、吸煙史、飲酒史、心臟病史、糖尿病史、服用降糖藥、空腹血糖、血CRP、TG、LDL、HDL等無明顯相關(guān)性（P0.05）。（3）同時考慮代謝、吸煙等相關(guān)影響因素后，斑塊性質(zhì)與血壓負荷之間的相關(guān)性無統(tǒng)計學差異。 結(jié)論：（1）中老年人的CIMT增厚與白晝SBPL存在正相關(guān)，白晝SBPL越重頸動脈硬化越重，白晝SBPL是CIMT增厚的獨立影響因素。（2）CIMT增厚與腦卒中病史、總膽固醇水平、降壓藥、降脂藥服用史也存在關(guān)聯(lián)性，腦卒中病史、高膽固醇血癥是頸動脈硬化的危險因素，規(guī)律服用降壓藥、降脂藥是預(yù)防頸動脈硬化的保護因素。（3）中老年高血壓病人頸動脈斑塊性質(zhì)與血壓負荷未見明顯相關(guān)性。
[Abstract]:Background and objective: the correlation between blood pressure and carotid atherosclerosis has been confirmed in many literatures, but the relationship between occasional blood pressure and carotid arteriosclerosis has been studied [1]. The response of occasional blood pressure to patients' real blood pressure is affected by many factors, such as the level of the measured person, white coat hypertension, the regularity of taking medicine, the blood pressure control and so on, and the reaction to the real blood pressure is limited. Ambulatory blood pressure (ABBP) has been paid more and more attention by doctors in clinic. The fluctuation of blood pressure, circadian rhythm, morning peak blood pressure and so on can be observed through ambulatory blood pressure monitoring, which is of great significance in guiding clinical work. This clinical study was conducted to investigate the relationship between blood pressure load and CIMT thickening or cervical plaques in patients with cervical atherosclerosis by collecting ambulatory blood pressure indexes. Methods: all the patients were admitted to the Department of Neurology, second affiliated Hospital from January 2012 to December 2013. They met the exclusion criteria and collected 24 hour ambulatory blood pressure indexes (including blood pressure load and mean blood pressure), smoking and drinking history. The course of HBP, blood pressure control, CIMT and carotid plaque were measured by color Doppler ultrasound. The blood pressure load was divided into 3 grades. More than 40% CIMT was more than 1mm recorded as thickening. The plaque nature was divided into no plaque, hard spot, mixed spot and soft spot. Logistic regression analysis was used to study the relationship between blood pressure load and CIMT thickening, blood pressure load and carotid plaque. Results: (1) it was the daytime SBPLT 10-40) that caused the thickening of CIMT by 6.68 times (OR 6.68 / 95 CI: 1.22N 36.46) and the daytime SBPLL (40) than the daytime SBPLL (0-10).) the thickening of CIMT was significantly increased by ORW 13395CIW 131335CIMT, which was related to the daytime SBPL, and the general situation, metabolic factors, past medical history, and the following factors were also found to be related to the thickening of the CIMT in the day, and the results showed that there was a significant correlation between the thickening of the CIMT and the SBPL during the day, so that there was a significant correlation between the thickening of the CIMT and the diurnal SBPL. The same conclusion can still be drawn from the analysis of related variables such as the history of medication into the model. That is to say, the thicker the day SBPL, the more obvious the thickening of CIMT. The thickening of CIMT is related not only to the daytime SBPL, but also to the history of stroke, the level of total cholesterol, the history of taking antihypertensive drugs, the history of taking lipid-lowering drugs, the thickening of CIMT with sex, the history of smoking, and the history of drinking. History of heart disease, diabetes mellitus, taking hypoglycemic drugs, fasting blood glucose, serum CRP TGG LDLU HDL, etc.) there was no statistical difference between plaque nature and blood pressure load after taking into account the related factors of metabolism, smoking and so on. Conclusion there is a positive correlation between CIMT thickening and daytime SBPL in middle and old people. The more severe carotid arteriosclerosis in daytime SBPL, the more severe carotid arteriosclerosis. Day SBPL is an independent influencing factor of CIMT thickening. The thickening of SBPL is associated with stroke history, total cholesterol level and antihypertensive drugs. The history of taking lipid-lowering drugs is also related to the history of stroke, hypercholesterolemia is a risk factor of carotid atherosclerosis, regular use of antihypertensive drugs, Lipid lowering drug is the protective factor of preventing carotid arteriosclerosis. There is no significant correlation between carotid plaque character and blood pressure load in middle-aged and elderly patients with hypertension.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R544.1

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