本文選題：高血壓　切入點：血壓晨峰　出處：《第三軍醫(yī)大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景及目的:近年來,冠心病在全球范圍內(nèi)的發(fā)病率越日益增高,致病因素多樣性導(dǎo)致不易有效預(yù)防其發(fā)生,而疾病初期無明顯癥狀導(dǎo)致其發(fā)展并預(yù)后不佳,目前我們臨床上診斷冠心病的最重要的方法為冠脈CTA檢查和冠脈造影檢查(Coronary angiography,CAG),但大多數(shù)基層或遠(yuǎn)離城市的醫(yī)療單位不能有效開展,尋找更方便易開展的檢查方法是有必要的。動態(tài)血壓監(jiān)測(Ambulatory blood pressure monitoring,ABPM)是對患者全天(包括睡眠時)不間斷進(jìn)行血壓監(jiān)測,獲取相關(guān)血壓參數(shù)并分析,可以有效的避免白大衣高血壓(White Coat Hypertension,WCH)及漏診隱匿性高血壓(Masked Hypertension,MH)。高血壓是冠心病的獨立危險因素,有研究表明,高血壓患者血壓晨峰和心腦血管疾病及高血壓靶器官損害存在相關(guān)性,且血壓晨峰也被多個研究證明可以獨立預(yù)測心血管事件的發(fā)生,而大量的研究證實合并糖尿病的高血壓患者較單純高血壓患者其相關(guān)病死率、微血管病發(fā)生率均顯著升高,同時患有糖尿病和高血壓會使心血管疾病患者心腦血管事件風(fēng)險增加,目前高血壓合并糖尿病的血壓晨峰患者對冠狀動脈影響的研究尚少。本研究旨在探討高血壓合并2型糖尿病患者血壓晨峰的特點及其與冠脈病變之間的關(guān)系,分析其影響因素及發(fā)生機(jī)制,從而為降低心血管事件的發(fā)生提供理論及臨床依據(jù)。方法:1.選擇2014年1月至2015年8月我科住院的原發(fā)性高血壓患者244例,其中男性118例,女性126例,年齡(64.7±11.5)歲;2.采集所有研究對象的臨床相關(guān)資料及實驗室檢查結(jié)果;3.患者入院后使用進(jìn)行動態(tài)血壓監(jiān)測(ABPM),記錄白天、夜間的收縮壓、舒張壓,并計算血壓晨峰值(MBPS),根據(jù)是否合并糖尿病及其動態(tài)血壓監(jiān)測結(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-nS,56例)、非糖尿病晨峰組(nD-S,72例)、非糖尿病非晨峰組(nD-nS,80例),比較四組患者動態(tài)血壓參數(shù)情況;4.入選的244例患者全部進(jìn)行冠狀動脈造影檢查(CAG,Coronary arteriography),根據(jù)造影結(jié)果記錄冠狀動脈病變支數(shù),根據(jù)病變支狹窄程度計算每例患者的冠狀動脈總積分,作為冠狀動脈狹窄程度判斷指標(biāo)的標(biāo)準(zhǔn),分別比較4組患者冠狀動脈病變嚴(yán)重程度。結(jié)果:1.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);2.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);3.Pearson相關(guān)分析顯示,冠狀動脈病變嚴(yán)重程度與年齡(r=0.786,P0.05)、BMI(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,P0.05)及24 h MSBP(r=0.804,P0.05)呈正相關(guān);4.多元線性回歸分析顯示,Age、FBG、24 hMSBP及MBPS為冠脈病變程度獨立危險因素。結(jié)論:1.原發(fā)性高血壓患者單獨合并糖尿病或MBPS時,主要表現(xiàn)為收縮壓的升高,當(dāng)兩者同時存在時,表現(xiàn)為收縮壓升高的基礎(chǔ)上舒張壓也升高,這類患者在臨床上可能更加應(yīng)該注重降壓治療,此為高血壓的治療提供了一些新思路。2.對于伴或不伴糖尿病的高血壓患者來說,有效控制該類患者的晨峰血壓及24 h長效平穩(wěn)的降壓可減少對靶器官的損害,降低心血管事件發(fā)生。3.在臨床工作中關(guān)注患者血糖和血壓治療達(dá)標(biāo)的同時,也要關(guān)注血壓晨峰現(xiàn)象,關(guān)注其對冠脈病變的影響。
[Abstract]:Background and purpose: in recent years, the morbidity of coronary heart disease in the worldwide rate is increasing, the diversity of pathogenic factors leading to difficult to effectively prevent its occurrence, and the onset of the disease had no obvious symptoms in its development and poor prognosis, the most important method we present clinical diagnosis of coronary heart disease were coronary CTA examination and coronary angiography (Coronary angiography, CAG), but the most basic or away from the city's medical units can not be effectively carried out, looking for more convenient and easy to carry out the inspection method is necessary. Ambulatory blood pressure monitoring (Ambulatory blood pressure monitoring, ABPM) is the patient all day long (including sleep) continuous blood pressure monitoring and analysis, access to relevant parameters of blood pressure and can effectively avoid the white coat hypertension (White Coat, Hypertension, WCH) and missed diagnosis of occult hypertension (Masked, Hypertension, MH). Hypertension is coronary heart disease alone Independent risk factors, studies have shown that the correlation between hypertension morning peak and cardiovascular disease and hypertension target organ damage, and the morning peak blood pressure was also shown in multiple studies can independently predict cardiovascular events, and a large number of studies have confirmed that patients with hypertension and diabetes than patients with simple hypertension related mortality, microvascular the disease incidence rate increased significantly, with diabetes and hypertension can cause cardiovascular disease in patients with increased risk of cardiovascular events, the morning surge in blood pressure in patients with hypertension and diabetes mellitus on coronary artery effect is less. The purpose of this study was to investigate the relationship between characteristics of hypertension with morning blood pressure surge in patients with type 2 diabetes and coronary artery disease and analyze the influencing factors and mechanism, so as to provide theoretical and clinical basis for reducing cardiovascular events. Methods: 1. From January 2014 to August 2015 in our hospital 244 Cases of hypertensive patients, including 118 cases of male, female 126 cases, age (64.7 + 11.5) years; the related clinical data and laboratory results of 2. acquisition of all subjects; 3. patients admitted to the hospital after the use of ambulatory blood pressure monitoring (ABPM), recorded during the day nighttime systolic blood pressure, diastolic blood pressure, and calculate the morning blood pressure peak (MBPS), according to whether complicated with diabetes mellitus and dynamic blood pressure monitoring results will be divided into 4 groups: diabetes mellitus group morning peak (D-S, 36 cases) and non diabetes group (56 cases of morning peak D-nS), non-diabetic group (nD-S, morning peak 72 cases of non diabetes), morning peak group (nD-nS, n = 80), patients with ambulatory blood pressure parameters between the four groups; 244 Cases of 4. patients were enrolled all coronary artery angiography (CAG Coronary arteriography), according to the results of angiography records of coronary artery lesions, according to the degree of stenosis lesions The calculation of each patient's coronary artery score, as the degree of coronary artery stenosis index for judging standard, compare the 4 groups of patients, the severity of coronary artery disease. Results: 1. diabetes morning peak group, morning peak group and non diabetes group morning peak 24 h mean systolic blood pressure of non diabetes, average systolic blood pressure was higher than that of non white day non diabetes group (P0.05); morning peak morning peak diabetes group 24 h mean diastolic blood pressure, daytime average diastolic blood pressure is higher than the non diabetes group morning peak, non peak morning diabetes group and non diabetes group (P0.05) morning peak; 2. morning peak group three branch lesions, C disease rate and the morning peak group the total score of Gensini was significantly higher than that in non Mbps group (P0.01); 3.Pearson correlation analysis showed that the severity of coronary artery disease and age (r=0.786, P0.05), BMI (0.284, P0.05), fasting blood glucose (r=0.712, P0.05), LDL-C (r=0.765, P0.05), morning peak level (r=0.852, P0.05) and 24 h MSBP (r=0.804, P0.05) 4. positive correlation; multiple linear regression analysis showed that Age, FBG, hMSBP 24 and MBPS were the independent risk factors. Conclusion: the severity of coronary artery lesions in 1. patients with essential hypertension complicated with diabetes alone or MBPS, mainly for the elevated systolic blood pressure, when both exist at the same time, performance based on the diastolic systolic blood pressure the pressure also increased, these patients may be more attention should be paid to antihypertensive therapy in clinic, provides some new ideas for.2. in hypertensive patients with or without diabetes for the treatment of hypertension, effective control of the patients in the morning peak blood pressure and 24 h long-term stable pressure can reduce the damage to the target organ. To reduce the incidence of cardiovascular events in.3. on standard blood glucose and blood pressure in patients in the clinical work, but also should pay attention to morning blood pressure surge, concerned about its impact on coronary artery disease.

【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R544.1;R587.1

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