本文選題：頸動(dòng)脈內(nèi)中膜厚度　切入點(diǎn)：踝臂指數(shù)　出處：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過(guò)檢測(cè)頸動(dòng)脈內(nèi)中膜厚度(IMT)、踝臂指數(shù)(ABI)、脈搏波傳導(dǎo)速度(PWV)評(píng)估中青年高血壓患者的動(dòng)脈硬化狀況,并分析其與血壓的關(guān)系,從而為早期預(yù)測(cè)及防治中青年高血壓患者心血管病變提供可能的依據(jù)。方法:自9858例體檢人群中選取中青年高血壓患者(高血壓組)及同年齡段非高血壓者(對(duì)照組)各600例,高血壓組男性308例,女性292例,平均年齡(47.81±7.83)歲,對(duì)照組男性317例,女性283例,平均年齡(47.48±7.98)歲。高血壓患者又分為單純舒張壓增高(A組,n=125)、單純收縮壓增高(B組,n=223)及收縮壓和舒張壓均增高(C組,n=252)三組。排除繼發(fā)性高血壓、糖尿病、惡性腫瘤、主要臟器功能?chē)?yán)重衰竭等患者。采用現(xiàn)場(chǎng)問(wèn)卷調(diào)查方式收集研究對(duì)象的年齡、性別、高血壓史、吸煙史、飲酒史等信息,測(cè)量所有入選者的體重指數(shù)(BMI)、收縮壓(SBP)、舒張壓(DBP),空腹取血檢測(cè)總膽固醇(TC)、甘油三酯(TG)、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)、總膽紅素(TB)、直接膽紅素(DB)、尿酸(UA)、肌酐(Cr)、尿素氮(BUN)、血糖(FBS)等血清學(xué)指標(biāo)。應(yīng)用頸動(dòng)脈彩超觀察頸動(dòng)脈斑塊,測(cè)量頸動(dòng)脈IMT,計(jì)算斑塊積分。應(yīng)用動(dòng)脈硬化檢查儀測(cè)定ABI及PWV,數(shù)據(jù)采用SPSS22.0軟件包和SAS9.3軟件包進(jìn)行統(tǒng)計(jì)分析,以雙側(cè)p0.05界定差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:⑴高血壓組與對(duì)照組間性別、年齡無(wú)明顯差異(p0.05)。高血壓組BMI、SBP、DBP均高于對(duì)照組(p0.05)。高血壓組有吸煙或飲酒習(xí)慣者及有糖尿病、高血壓或冠心病家族史者占比顯著大于對(duì)照組(p0.05)。⑵高血壓組TG、UA、BUN、Cr、FBS均高于對(duì)照組,HDL-C低于對(duì)照組(p0.05);而TC、LDL-C、TB、DB兩組間均無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)。⑶與對(duì)照組相比高血壓組頸動(dòng)脈IMT水平、IMT增厚者占比及頸動(dòng)脈斑塊檢出率明顯增高(p0.05);斑塊積分明顯增大,其中斑塊積分≥5.0者顯著增多(均p0.05)。⑷高血壓組ABI、ba PWV水平及ABI、ba PWV異常者檢出率均高于對(duì)照組(p0.05)。⑸經(jīng)多元Logistic分析,BMI、TG、Cr、BUN、FBS的升高為高血壓患病的危險(xiǎn)因素。吸煙、有糖尿病或高血壓家族史者更易罹患高血壓。⑹高血壓、年齡與ABI呈顯著正相關(guān)而LDL-C與ABI呈顯著負(fù)相關(guān)(p0.05);高血壓、TG、FBS與ba PWV呈顯著正相關(guān)(p0.05);高血壓、年齡、BMI、LDL-C、UA、FBS與頸動(dòng)脈IMT呈顯著正相關(guān)而HDL-C與其呈負(fù)相關(guān)(p0.05);相比于女性,男性中ba PWV升高及IMT增厚者更為多見(jiàn)。⑺ABI、ba PWV在A、B、C三組呈逐漸增高趨勢(shì);B組頸動(dòng)脈IMT高于A、C二組。⑻分別以SBP、DBP、脈壓(DP)評(píng)估ABI、ba PWV及IMT,曲線(xiàn)下面積在ba PWV為SBPDBPDP;在ABI和IMT均為SBPDBP≈DP。評(píng)估ABI、ba PWV、IMT異常的對(duì)應(yīng)AUC(OCP)分別為0.76(137.5mm Hg)、0.80(132.5mm Hg)和0.72(127.5mm Hg)。結(jié)論:⑴BMI,TG、Cr、BUN、FBS、吸煙、飲酒、糖尿病及/或高血壓家族史可能為中青年高血壓患者動(dòng)脈硬化的危險(xiǎn)因素。⑵中青年高血壓患者存在動(dòng)脈壁的結(jié)構(gòu)改變,表現(xiàn)為頸動(dòng)脈IMT增厚及斑塊積分增大。⑶中青年高血壓患者ABI、ba PWV水平及其ABI、ba PWV異常者檢出率均高于同齡血壓正常對(duì)照組,提示其動(dòng)脈硬化和鈣化的存在更為明顯。⑷C組ABI、ba PWV改變較A、B組更顯著,提示SBP和DBP均高對(duì)動(dòng)脈硬化具有更大的危害性。⑸單純SBP增高患者IMT增厚最為明顯,且以SBP評(píng)價(jià)ABI、ba PWV的曲線(xiàn)下面積最大,提示SBP的升高可能與動(dòng)脈硬化的關(guān)系更為密切。⑹頸動(dòng)脈超聲、ABI、ba PWV無(wú)創(chuàng)評(píng)估動(dòng)脈硬化方便可行,但鑒于本研究例數(shù)尚少,部分結(jié)果尚需加大樣本進(jìn)一步證實(shí)。
[Abstract]:Objective: to detect the carotid artery intima-media thickness (IMT), ankle brachial index (ABI), pulse wave velocity (PWV) assessment of atherosclerosis in middle-aged hypertensive patients, and analyze its relationship with blood pressure, so as to provide the basis for early cardiovascular disease may young patients with hypertension. Methods in prediction and prevention: the selection of young patients with hypertension from 9858 cases in patients with hypertension (hypertension group) and the same age (control group) 600 cases, hypertension group male 308 cases, female 292 cases, average age (47.81 + 7.83), the control group 317 cases were male, 283 were female, the average age (47.48 + 7.98) years old. Patients with hypertension was divided into simple diastolic Ya Zenggao (group A, n=125), isolated systolic hypertension (B group, n=223) and systolic blood pressure and diastolic blood pressure were increased (group C, n=252) three groups. To exclude secondary high blood pressure, diabetes, cancer, organ function in severe failure Patients. Questionnaire survey collected the age, gender, history of hypertension, smoking history, drinking history and other information, all subjects measured body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting serum total cholesterol (TC), triglyceride (TG). Low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total bilirubin (TB), direct bilirubin (DB), uric acid (UA), creatinine (Cr), urea nitrogen (BUN), blood glucose (FBS) serum. Application of carotid artery ultrasound observation of carotid artery plaque the measurement of carotid artery IMT, plaque integral calculation. The determination of ABI and PWV application of arteriosclerosis detection instrument, data were analyzed by SPSS22.0 software and SAS9.3 software, to define the bilateral P0.05 difference was statistically significant. Results: the hypertension group and control group had no significant difference between gender, age (P0.05). The hypertension group BMI. SBP, DBP Higher than that of the control group (P0.05). The hypertension group have the habit of smoking or drinking, diabetes, family history of hypertension or coronary heart disease accounted for significantly greater than the control group (P0.05). The hypertension group TG, UA, BUN, Cr, FBS were higher than the control group, HDL-C was lower than the control group (P0.05); TC, LDL-C, TB, DB between the two groups were not statistically significant (P0.05). Results compared with the control group IMT group carotid artery hypertension, IMT and thickening of carotid artery plaque detection rate increased significantly (P0.05); plaque score increased significantly, of which more than 5 were significantly increased plaque score (P0.05). The hypertension group ABI, BA PWV and ABI Ba level, PWV abnormal detection rate was higher than that of control group (P0.05). The multivariate analysis of Logistic, BMI, TG, Cr, BUN, FBS increased as the risk factors of hypertension. Smoking, diabetes or a family history of hypertension are more likely to suffer from hypertension. Such as hypertension, age and ABI was significantly positive 鐩稿叧鑰孡DL-C涓嶢BI鍛堟樉钁楄礋鐩稿叧(p0.05);楂樿鍘，

本文編號(hào)：1691981