本文選題：高血壓　切入點(diǎn)：血壓晨峰　出處：《第三軍醫(yī)大學(xué)學(xué)報(bào)》2017年01期 　論文類型：期刊論文

【摘要】：目的探討高血壓伴或不伴2型糖尿病患者血壓晨峰的患病特點(diǎn)及其與冠脈病變嚴(yán)重程度的相關(guān)性。方法選擇2014年1月至2015年8月我科住院的高血壓患者244例,其中男性118例,女性126例,年齡(64.7±11.5)歲,根據(jù)是否合并糖尿病及其動(dòng)態(tài)血壓監(jiān)測(cè)結(jié)果將其分為4組:糖尿病晨峰組(D-S,36例)、糖尿病非晨峰組(D-n S,56例)、非糖尿病晨峰組(n D-S,72例)、非糖尿病非晨峰組(n D-n S,80例),入選的244例患者全部進(jìn)行冠狀動(dòng)脈造影檢查,分別比較4組患者冠狀動(dòng)脈病變程度。結(jié)果糖尿病晨峰組、糖尿病非晨峰組和非糖尿病晨峰組24 h平均收縮壓、白天平均收縮壓均高于非糖尿病非晨峰組(P0.05);糖尿病晨峰組24 h平均舒張壓、白天平均舒張壓高于糖尿病非晨峰組、非糖尿病晨峰組和非糖尿病非晨峰組(P0.05);晨峰組三支病變率、C型病變率及晨峰組Gensini總積分顯著高于非晨峰組(P0.01);Pearson相關(guān)分析顯示,冠狀動(dòng)脈病變嚴(yán)重程度與年齡(r=0.786,P0.01)、BMI(r=0.284,P0.05)、空腹血糖(r=0.712,P0.05)、LDL-C(r=0.765,P0.05)、晨峰程度(r=0.852,P0.01)及24 h MSBP(r=0.804,P0.01)呈正相關(guān);多元線性回歸分析顯示,年齡、空腹血糖、24 h平均收縮壓及血壓晨峰為冠狀動(dòng)脈病變嚴(yán)重程度獨(dú)立危險(xiǎn)因素。結(jié)論原發(fā)性高血壓合并糖尿病患者血壓晨峰是預(yù)測(cè)冠狀動(dòng)脈病變嚴(yán)重程度的獨(dú)立危險(xiǎn)因素,有效控制該類患者的晨峰血壓及24 h長(zhǎng)效平穩(wěn)的降壓可減少對(duì)靶器官的損害,降低心血管事件發(fā)生。
[Abstract]:Objective to investigate the characteristics of morning blood pressure peak in patients with or without type 2 diabetes mellitus and its correlation with the severity of coronary artery disease. Methods from January 2014 to August 2015, we selected 244 patients with hypertension, including 118 males, who were hospitalized in our department from January 2014 to August 2015. 126 female patients, aged 64.7 鹵11.5 years, According to the results of diabetes mellitus and ambulatory blood pressure monitoring, they were divided into 4 groups: DM morning peak group (n = 36), diabetes non-morning peak group (n = 56), nondiabetic morning peak group (n = 72) and non-diabetic morning peak group (n = 80). All 244 patients were examined by coronary angiography. Results the mean systolic blood pressure (SBP) of 24 hours in the diabetic morning peak group, the diabetes non-morning peak group and the non-diabetic morning peak group was compared. The mean systolic blood pressure during the day was higher than that in the non-diabetic non-morning peak group, and the average diastolic blood pressure in the diabetic morning peak group was higher than that in the diabetic non-morning peak group at 24 h, and the mean diastolic blood pressure in the morning peak group was higher than that in the non-morning peak group. The incidence of type C lesions and the total Gensini score of morning peak group were significantly higher than those of non-diabetic morning peak group and non-diabetic morning peak group, and the correlation analysis showed that the three vessel lesion rate and the total Gensini score in the morning peak group were significantly higher than those in the non-morning peak group. The severity of coronary artery disease was positively correlated with the severity of coronary artery disease, the severity of coronary artery disease was positively correlated with the age of 0.786p 0.01m BMIR 0.284m P0.05, the fasting blood glucose 0.0.712m P 0.05 P 0.05, the degree of morning peak 0.852P0.01) and the 24 h MSBPrn 0.804P0.01), and the multiple linear regression analysis showed that age, age, and age, the degree of coronary artery disease were 0.852p0.01) and 0.804P0.01 (P 0.01), the results of multiple linear regression analysis showed that age, age, and severity of coronary artery disease were higher than those of control group. Mean systolic blood pressure (SBP) and morning peak were independent risk factors for severity of coronary artery disease in patients with essential hypertension and diabetes mellitus. Conclusion Morning peak of blood pressure is an independent risk factor for predicting severity of coronary artery disease in patients with essential hypertension and diabetes mellitus. Effective control of morning peak blood pressure and 24 h stable hypotension can reduce the damage to target organs and decrease the occurrence of cardiovascular events.
【作者單位】： 第三軍醫(yī)大學(xué)大坪醫(yī)院野戰(zhàn)外科研究所心血管內(nèi)科 重慶市心血管病研究所;
【分類號(hào)】：R544.1;R543.3

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