本文選題：動態(tài)血壓　切入點：單純夜間高血壓　出處：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討單純夜間高血壓患者的靶器官損害情況及其與動態(tài)血壓監(jiān)測指標(biāo)的相關(guān)性,以及動態(tài)血壓監(jiān)測相關(guān)指標(biāo)與單純夜間高血壓患者發(fā)生心腦腎不良事件的關(guān)系。方法:入選單純夜間高血壓患者(動態(tài)血壓監(jiān)測白天平均血壓135/85mmHg和夜間平均血壓≥120/70 mmHg)77例、全天高血壓患者(動態(tài)血壓監(jiān)測白天平均血壓≥135/85mmHg和夜間平均血壓≥120/70 mmHg)75例和動態(tài)血壓正常者(動態(tài)血壓監(jiān)測白天平均血壓135/85mmHg和夜間平均血壓120/70 mmHg和血壓晝夜節(jié)律為10%~20%,晨峰血壓35mmHg)79例。動態(tài)血壓監(jiān)測指標(biāo)包括全天平均收縮壓、全天平均舒張壓、白天平均收縮壓、白天平均舒張壓、夜間平均收縮壓、夜間平均舒張壓、白天收縮壓標(biāo)準(zhǔn)差、白天舒張壓標(biāo)準(zhǔn)差、夜間收縮壓標(biāo)準(zhǔn)差、夜間舒張壓標(biāo)準(zhǔn)差、收縮壓晝夜節(jié)律、舒張壓晝夜節(jié)律、晨峰血壓、動態(tài)動脈僵硬指數(shù)。頸動脈斑塊、左心室肥厚和擴大、血清肌酐和尿微量白蛋白分別用于評估血管、心臟和腎臟損害。隨訪不良事件包括心腦腎事件(包括急性心肌梗死、心力衰竭、腦卒中、慢性腎衰及由此原因引起的患者死亡)。結(jié)果:1.單純夜間高血壓患者的左心室肥厚和擴大檢出率(22.1%)和頸動脈斑塊檢出率(55.8%)與全天高血壓患者的左心室肥厚和擴大檢出率(32.0%)和頸動脈斑塊檢出率(68.0%)之間差異無統(tǒng)計學(xué)意義,但兩者均高于正常組的左心室肥厚和擴大檢出率(7.6%)和頸動脈斑塊檢出率(32.9%)(P0.0167);單純夜間高血壓患者的血清肌酐(68.0±23.5μmol/L)和尿微量白蛋白(15.9±19.6mg/L)與正常組之間差異無統(tǒng)計學(xué)意義,兩者均小于全天高血壓組患者的血清肌酐(80.9±43.1μmol/L)和尿微量白蛋白(53.5±80.0mg/L)(P0.05)。2.單純夜間高血壓患者有無頸動脈斑塊的動態(tài)血壓相關(guān)指標(biāo)差異無統(tǒng)計學(xué)意義;單純夜間高血壓左心室肥厚和擴大的患者夜間平均舒張壓(77.6±5.5mmHg)高于沒有左心室肥厚和擴大的患者(74.9±4.6 mmHg)(P0.05);單純夜間高血壓患者有無血清肌酐異常的動態(tài)血壓相關(guān)指標(biāo)無統(tǒng)計學(xué)意義;單純夜間高血壓尿微量白蛋白異常的患者夜間收縮壓標(biāo)準(zhǔn)差(14.1±3.9mmHg)和舒張壓標(biāo)準(zhǔn)差(10.6±3.0mmHg)均大于尿微量白蛋白正常的患者(11.3±3.2mmHg和8.6±2.6mmHg)(P0.05)。3.單純夜間高血壓組患者的心腦腎不良事件發(fā)生率(10.4%)和全天高血壓組患者的心腦腎不良事件發(fā)生率(10.7%)均高于正常組(1.3%)(P0.0167)。單因素二分類非條件logistic回歸分析結(jié)果表明,單純夜間高血壓組患者的夜間平均收縮壓130mmHg[OR=10.889,95%CI=(1.268,93.512)]和舒張壓晝夜節(jié)律呈反杓型(0%)[OR=6.548,95%CI=(1.394,30.755)]是心腦腎不良事件發(fā)生的危險因素。多因素logistic回歸分析顯示夜間平均收縮壓130mmHg[OR=4.095,95%CI=(0.352,47.698)]和舒張壓晝夜節(jié)律呈反杓型(0%)[OR=2.112,95%CI=(0.290,15.390)]與心腦腎不良事件發(fā)生的獨立相關(guān)性無統(tǒng)計學(xué)意義。結(jié)論:動態(tài)血壓監(jiān)測可用于評估單純夜間高血壓患者的靶器官損害。夜間平均收縮壓和舒張壓晝夜節(jié)律與心腦腎風(fēng)險相關(guān),尚未達(dá)到獨立預(yù)測水平。
[Abstract]:Objective: To explore the simple night target organ damage in hypertensive patients and its correlation with ambulatory blood pressure monitoring index, and the relationship between ambulatory blood pressure monitoring in patients with isolated nocturnal hypertension cardiovascular and renal adverse events. Methods: the patients with isolated nocturnal hypertension patients (mean daytime ambulatory blood pressure monitoring and blood pressure 135/85mmHg average blood pressure at night more than 120/70 mmHg) 77 cases of patients with hypertension, all day long (ambulatory blood pressure monitoring during the daytime average blood pressure more than 135/85mmHg and average blood pressure at night more than 120/70 mmHg) and 75 cases of normal ambulatory blood pressure (ambulatory blood pressure monitoring and blood pressure 135/85mmHg mean daytime nighttime mean blood pressure and circadian rhythm of blood pressure was 120/70 mmHg 10%~20%, Mbps 35mmHg) in 79 cases. Ambulatory blood pressure monitoring indicators include all day long the average systolic blood pressure, all day long average diastolic blood pressure, daytime average systolic blood pressure, daytime average diastolic blood pressure, nighttime average closing Systolic pressure, night diastolic blood pressure, daytime systolic blood pressure standard deviation, standard deviation of daytime diastolic blood pressure, nighttime systolic blood pressure standard deviation, standard deviation of nocturnal diastolic blood pressure, systolic blood pressure, diastolic blood pressure circadian rhythm, circadian rhythm, morning peak blood pressure, ambulatory arterial stiffness index. Carotid plaque, left ventricular hypertrophy and expansion, albumin serum creatinine and urine were used to assess the vascular, heart and kidney damage. The follow-up adverse events included cardiovascular and renal events (including acute myocardial infarction, heart failure, stroke, caused by chronic renal failure and the cause of death in patients with). Results: 1. isolated nocturnal hypertension with left ventricular hypertrophy and the rate of detection rate (22.1%) and the carotid plaque (55.8%) and left ventricular hypertrophy in patients with hypertension all day long and expand the detection rate (32%) and the detection rate of carotid artery plaque (68%) there was no significant difference between the two, but were higher than the normal group left Ventricular hypertrophy detection rate (7.6%) and the detection rate of carotid plaques (32.9%) (P0.0167); isolated nocturnal hypertension patients serum creatinine (68 + 23.5 mol/L) and microalbuminuria (15.9 + 19.6mg/L) with no significant difference between the two was less than normal group, serum creatinine in patients with hypertension were all day long. (80.9 + 43.1 mol/L) and microalbuminuria (53.5 + 80.0mg/L) (P0.05) had no significant difference between.2. indexes of ambulatory blood pressure in patients with isolated nocturnal hypertension without carotid plaque; isolated nocturnal hypertension and left ventricular hypertrophy and patients with enlarged night diastolic blood pressure (77.6 + 5.5mmHg) was higher than that of no left ventricular hypertrophy and patients with enlarged (74.9 + 4.6 mmHg) (P0.05); isolated nocturnal hypertension with ambulatory blood pressure related indicators of abnormal serum creatinine was not statistically significant; isolated nocturnal hypertension with abnormal urinary albumin Nocturnal systolic blood pressure standard deviation (14.1 + 3.9mmHg) and diastolic blood pressure standard deviation (10.6 + 3.0mmHg) were higher than patients with normal urinary albumin (11.3 + 3.2mmHg and 8.6 + 2.6mmHg) (P0.05).3. incidence of isolated nocturnal hypertension in patients with cardiovascular and renal adverse events (10.4%) and the incidence of hypertension group were all day long the cardiovascular and renal adverse events (10.7%) were higher than the normal group (1.3%) (P0.0167) two. The single factor classification of non conditional logistic regression analysis indicated that the isolated nocturnal hypertension patients with nocturnal mean systolic blood pressure 130mmHg[OR=10.889,95%CI= (1.268,93.512) and diastolic blood pressure circadian rhythm in anti dipper (0%) [OR=6.548,95%CI= (1.394,30.755)] is the risk factors of cardiovascular and renal adverse events. Logistic regression analysis showed that the nighttime average systolic blood pressure 130mmHg[OR=4.095,95%CI= (0.352,47.698) and diastolic blood pressure circadian rhythm in anti dipper (0% [OR=2.112,95%C) I= (0.290,15.390)] is independently associated with cardiovascular and renal adverse events was not statistically significant. Conclusion: ambulatory blood pressure monitoring can be used to evaluate the isolated nocturnal hypertension target organ damage. The nocturnal mean systolic and diastolic blood pressure circadian rhythm and cardiovascular and renal risk has not yet reached the independent prediction level.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R544.1

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