本文選題：老年高血壓病 + 血清胱抑素C��； 參考：《華北理工大學(xué)》2017年碩士論文

【摘要】：目的血清胱抑素C(Cys C)是近年來發(fā)現(xiàn)早期腎臟損害的靈敏指標(biāo),它不但能夠反映老年高血壓病早期腎臟損害,并且也能早期預(yù)測到老年高血壓病患者心血管事件。左室肥厚是老年高血壓病最常見的心臟損害之一,左室質(zhì)量指數(shù)(LVMI)是診斷左室肥厚的標(biāo)準(zhǔn)。心踝血管指數(shù)(CAVI)是反映老年高血壓病患者的主動脈僵硬程度和血管順應(yīng)性的指標(biāo)。本研究探討老年高血壓病患者血清胱抑素C、左室質(zhì)量指數(shù)、心踝血管指數(shù)與動態(tài)脈壓指數(shù)的關(guān)系及其影響因素的分析。方法選取2015年4月至2016年4月就診于華北理工大學(xué)附屬醫(yī)院老年病科住院的老年高血壓病患者符合入選標(biāo)準(zhǔn)的122例,年齡在60-86歲,入選標(biāo)準(zhǔn)均符合中國高血壓防治指南的高血壓診斷標(biāo)準(zhǔn)(2010)年版,對入選患者行24小時動態(tài)血壓監(jiān)測,并記錄動態(tài)血壓各數(shù)據(jù)。依據(jù)APPI值中位數(shù)將入選患者分為2組:取APPI≥0.41為A組,APPI0.41為B組。根據(jù)24小時動態(tài)血壓參數(shù)計算出動態(tài)脈壓指數(shù):APPI=24小時動態(tài)脈壓/24小時平均收縮壓。收集患者基本資料及病史并記錄,行生化檢查,化驗Cys C,與此同時,對入選患者行動脈硬化檢測儀測算出心踝血管指數(shù),行心臟超聲,左室質(zhì)量指數(shù)可根據(jù)Devereux公式算出。建立臨床數(shù)據(jù)庫,應(yīng)用SPSS17.0統(tǒng)計軟件完成分析。正態(tài)分布的計量資料采用均數(shù)±標(biāo)準(zhǔn)差表示。計量資料組間差異分析采用t檢驗,用率或者構(gòu)成比來表示計數(shù)資料的分布情況,不同組間差異則采用卡方檢驗分析。應(yīng)用Logistic回歸模型分析相關(guān)因素與老年人血壓變異性的相關(guān)性。變量間采用Spearman秩相關(guān)分析進(jìn)行相關(guān)性研究。在單因素相關(guān)分析中,將具有相關(guān)性的指標(biāo)(P0.05)全部作為自變量進(jìn)入多元線性回歸進(jìn)行分析,分析各因素的影響程度。P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果1 A組與B組在性別、年齡、體重指數(shù)(BMI)、心率(HR)以及生化指標(biāo)空腹血糖(FBG)、總膽固醇(TC)、甘油三酯(TG)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)、診室收縮壓(OSBP)、診室舒張壓(ODBP)方面差異均無統(tǒng)計學(xué)意義(P0.05)。2 A組Cys C、LVMI及CAVI均明顯高于B組,差異有統(tǒng)計學(xué)意義(P0.01)。3 Cys C水平的高低與動態(tài)脈壓指數(shù)(APPI)存在關(guān)系。說明Cys C水平越低,APPI水平越低;Cys C水平增高,APPI水平也隨之增大,兩個關(guān)系相當(dāng)密切。LVMI水平的高低與APPI存在關(guān)系。說明LVMI水平越低,APPI水平越低;LVMI水平增高,APPI水平也隨之增大,兩個關(guān)系十分密切。CAVI水平的高低與APPI存在關(guān)系。說明CAVI水平越低,APPI水平越低;CAVI水平增高,APPI水平也隨之增大,兩個關(guān)系相當(dāng)密切。多因素Logistic回歸分析顯示結(jié)果提示Cys C、LVMI、CAVI是動態(tài)脈壓指數(shù)的獨立危險因素(β0,OR1)。4 24h SBP、24h DBP、d SBP、n SBP均與Cys C相關(guān),其中24h SBP、24h DBP與Cys C的相關(guān)性最大,而OSBP、ODBP與Cys C無相關(guān)性。年齡、24h SBP、24h DBP、d SBP、n SBP均與LVMI相關(guān),其中24h SBP、24h DBP與LVMI的相關(guān)性最大,而OSBP、ODBP與LVMI無相關(guān)性。24h SBP、24h DBP、d SBP、n SBP、n DBP均與CAVI相關(guān),其中24h SBP、24h DBP與CAVI的相關(guān)性最大,而OSBP、ODBP與CAVI無相關(guān)性。結(jié)論1在老年高血壓病患者中,隨著血清胱抑素C、左室質(zhì)量指數(shù)、心踝血管指數(shù)水平的增大,動態(tài)脈壓指數(shù)水平的也逐步增大。2在老年高血壓病患者中,血清胱抑素C、左室質(zhì)量指數(shù)、心踝血管指數(shù)是動態(tài)脈壓指數(shù)增高的獨立危險因素。3在老年高血壓病患者中,24小時平均收縮壓、24小時平均舒張壓對Cys C、LVMI、CAVI影響最大。
[Abstract]:The purpose of serum cystatin C (Cys C) is a recently discovered sensitive indexes of early renal damage, it can not only reflect the early renal damage in elderly patients with hypertension, and also to the early prediction of elderly patients with hypertension cardiovascular events. Left ventricular hypertrophy is one of the most common cardiac damage in elderly hypertension see, left ventricular mass index (LVMI) is a diagnosis of left ventricular hypertrophy. Cardio ankle vascular index (CAVI) is a reflection of the aged patients with hypertension aortic stiffness and vascular compliance index. The study of C disease serum cystatin C in elderly patients with hypertension, left ventricular mass index, analysis the relationship and influence factors of cardio ankle vascular index and ambulatory pulse pressure index methods from April 2015 to April 2016. In North China Polytechnic University Affiliated Hospital of geriatrics Hospital of elderly patients with hypertension 122 cases, aged 60-86 Old, inclusion criteria were accorded with the diagnostic criteria of hypertension guidelines for prevention and treatment of hypertension (2010 years) of the China version, for selected patients with 24 hours ambulatory blood pressure monitoring, ambulatory blood pressure and record each data. According to the APPI value median selected patients were divided into 2 groups: APPI = 0.41, A group, APPI0.41 B group is calculated. According to the dynamic pulse pressure index of 24 hour ambulatory blood pressure parameters: APPI=24 hours ambulatory /24 hours average systolic blood pressure were collected. The basic information and the history and records for biochemical examination, laboratory Cys C, at the same time, the patients action arteriosclerosis detector calculates the cardio ankle vascular index, echocardiography, left ventricular mass index according to the Devereux formula. The establishment of clinical database, using SPSS17.0 statistical software to complete the analysis. The measurement data of normal distribution expressed by the mean and standard deviation analysis of the difference of measurement data between groups using t test, with the rate or The distribution of ratios of count data, differences between different groups using chi square test. The correlation analysis using Logistic regression analysis of related factors and the elderly blood pressure variability. Among the variables by Spearman rank correlation analysis correlation. In univariate analysis, with correlation index (P0.05) of all as the independent variable into the multivariate linear regression analysis, analysis of the factors affecting the degree of.P0.05 difference was statistically significant. Results of the 1 A group and B group in gender, age, body mass index (BMI), heart rate (HR) and the biochemical indexes of fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG). High density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), systolic blood pressure (OSBP), consulting room, consulting room, diastolic blood pressure (ODBP) has showed no significant difference (P0.05) of.2 group A Cys C, LVMI and CAVI were significantly higher than that of In B group, the difference was statistically significant (P0.01) level of.3 Cys and pulse pressure index in the level of C (APPI) Cys C. The relationship between the lower level, the lower the level of APPI increased; Cys C level, APPI level increases, the two level of APPI and.LVMI are closely related to the level of existence. The lower the LVMI level, APPI level is low; the levels of LVMI increased, the level of APPI increased two, a very close relationship between the level of APPI and.CAVI levels between CAVI. The lower level, the lower the level of APPI; the levels of CAVI increased, the level of APPI increases two, a very close relationship. Many factors Logistic regression analysis showed that the results suggest that Cys, C, LVMI, CAVI are independent risk factors of ambulatory pulse pressure index (beta 0, OR1).4 24h SBP, 24h DBP, D SBP, n SBP were associated with Cys C, the 24h SBP, 24h DBP and Cys C of the maximum correlation, and OSBP, there is no relationship between ODBP and Cys C years. At the age of 24h SBP, 24h, DBP, D, SBP, N and SBP were associated with LVMI, which 24h SBP, 24h DBP and LVMI OSBP, the maximum correlation, ODBP and LVMI had no correlation with.24h SBP, 24h DBP, D SBP, n SBP, n DBP was associated with CAVI, which 24h SBP, 24h and DBP the correlation between CAVI and OSBP, the largest, there is no correlation between ODBP and CAVI. Conclusion: 1 in elderly patients with hypertension, with serum cystatin C, left ventricular mass index, increase the cardio ankle vascular index level, index level of dynamic pulse pressure is gradually increased.2 in elderly patients with hypertension, serum cystatin C, left ventricular mass index, cardio ankle vascular index is dynamic pulse pressure index increased the independent risk factors of.3 in elderly patients with hypertension, 24 hour mean systolic pressure, mean diastolic blood pressure of LVMI for 24 hours, Cys C, CAVI has the greatest effect.

【學(xué)位授予單位】：華北理工大學(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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