本文選題：冠心病 + 高血壓��； 參考：《北京協(xié)和醫(yī)學院》2017年碩士論文

【摘要】：第一部分北京市成人高血壓患者脈壓及脈壓指數(shù)與冠心病的關系研究目的探討北京市成人高血壓患者的脈壓(Pulse Pressure,PP)和脈壓指數(shù)(Pulse Pressure Index,PPI)與冠心病的關系。研究方法本研究選取2011年“北京市心腦腎及糖尿病慢性病流行病學綜合調(diào)查研究”中的高血壓患者為研究對象。收集研究對象的性別、年齡、地區(qū)、受教育水平等基本資料。血壓測量選用統(tǒng)一的歐姆龍HEM/770A電子血壓計,收縮壓(Systolic Blood Pressure,SBP)≥140 mmHg(mmHg=0.133 kPa)和(或)舒張壓(Diastolic Blood Pressure,DBP)≥90 mmHg和(或)近兩周內(nèi)服用過降壓藥者定義為高血壓患者。PP為SBP與DBP之差,PPI為PP與SBP的比值。了解北京市成人高血壓患者PP和PPI的水平和特點,采用Logistic回歸模型探討PP和PPI與冠心病的關系。研究結果共有7 563例北京市成人高血壓患者納入本次研究。研究對象的平均年齡為(51.7±12.4)歲,其中有4 102例(54.2%)男性,年齡在18～59歲之間的研究對象有5 806例(76.8%),冠心病患者有799例(10.6%)。老年(60～79歲)高血壓患者的PP和PPI均高于青、中年(18～59歲)高血壓患者(PP:68.1 mmHg vs.52.4 mmHg,P0.001;PPI:0.44vs.0.36,P0.001)。高血壓合并冠心病患者的 PP 和PPI均高于高血壓未合并冠心病者(PP:61.0 mmHg vs.55.5 mmHg,P0.001;PPI:0.41 vs.0.37,P0.001),且不同性別、地區(qū)等研究對象中均存在此現(xiàn)象。Logistic回歸分析結果顯示,單因素分析中高血壓患者的PP和PPI均與冠心病相關[PP:比值比(Odds Ratio,OR)=1.25,95%置信區(qū)間(Confidence Interval,CI):1.20～1.31,P0.001;PPI:OR=1.93,95%CI:1.75～2.13,P0.001];調(diào)整年齡、性別、體質(zhì)指數(shù)、地區(qū)、受教育水平、當前吸煙和飲酒后的多因素分析結果顯示,高血壓患者的PP與冠心病的相關性無統(tǒng)計學意義,而PPI仍與冠心病相關(OR=1.18,95%CI:1.04～1.33,P=0.008);進一步調(diào)整是否服用降壓藥后,高血壓患者的PP和PPI與冠心病的相關性均無統(tǒng)計學意義。研究結論北京市成人高血壓患者中,合并冠心病者的PP和PPI均高于未合并冠心病者。調(diào)整年齡、性別、體質(zhì)指數(shù)、地區(qū)、受教育水平、當前吸煙和飲酒后,高血壓患者的PPI仍與冠心病相關;進一步調(diào)整是否服用降壓藥后,上述相關性無統(tǒng)計學意義。第二部分高血壓患者動態(tài)脈壓及脈壓指數(shù)與冠心病的關系研究目的探討高血壓患者的24小時動態(tài)脈壓(24-hour Ambulatory Pulse Pressure,24hPP)、24 小時動態(tài)脈壓指數(shù)(24-hour Ambulatory Pulse Pressure Index,24hPPI)和夜間動態(tài)脈壓指數(shù)(Night-time Ambulatory Pulse Pressure Index,NPPI)與冠心病的關系,為高血壓患者的動態(tài)脈壓及脈壓指數(shù)的臨床應用提供參考。研究方法研究對象均選自2016年5月至2016年7月在中國醫(yī)學科學院阜外醫(yī)院進行動態(tài)血壓監(jiān)測(Ambulatory Blood Pressure Monitoring,ABPM)者,ABPM 有效讀數(shù)需≥75%。詳細詢問研究對象的一般資料,記錄年齡、性別、身高、體重、近兩周內(nèi)是否服用降壓藥等基本信息。24小時平均收縮壓(24-hour Mean Systolic Blood Pressure,24hSBP)≥ 130mmHg(1 mmHg=0.133 kPa)和(或)24 小時平均舒張壓(24-hour Mean Diastolic Blood Pressure,24hDBP)≥80mmHg 和(或)近兩周內(nèi)服用降壓藥的研究對象定義為高血壓患者。根據(jù)ABPM數(shù)據(jù)計算研究對象的24hPP、24hPPI和NPPI,并分析它們與冠心病的相關性,比較各指標對冠心病的風險評估和預測價值的優(yōu)劣。24hPP為24hSBP與24hDBP之差,24hPPI為24hPP與24hSBP的比值,NPPI為夜間(22:00～次日06:00)平均PP與平均SBP的比值。研究結果共有305例在中國醫(yī)學科學院阜外醫(yī)院進行ABPM者納入本次研究。研究對象平均年齡為(58.2± 14.4)歲,其中男性172例(56.4%),高血壓患者222例(72.8%)。高血壓患者的24hPP、24hPPI和NPPI均高于血壓正常者(24hPP:49.0 mmHg vs.42.2 mmHg,P0.001;24hPPI:0.39 vs.0.37,P=0.004;NPPI:0.40 vs.0.38,P=0.009)。高血壓患者中,共有116例(52.3%)冠心病患者,冠心病患者的24hPP、24hPPI和 NPPI 均高于無冠心病者(24hPP:50.9 mmHg vs.47.0 mmHg,P=0.013;24hPPI:0.41vs.0.38,P0.001;NPPI:0.42vs.0.38,P0.001);而在血壓正常者中,冠心病患者和無冠心病者上述指標之間的差異均無統(tǒng)計學意義。Logistic回歸模型結果顯示,單因素分析中高血壓患者的24hPP、24hPPI和NPPI均與冠心病相關[24hPP:比值比(Odds Ratio,OR)=1.35,95%置信區(qū)間(Confidence Interval,CI):1.06～1.72,P=0.014;24hPPI:OR=2.46,95%CI:1.57～3.86,P0.001;NPPI:OR=2.56,95%CI:1.66～3.95,P0.001];調(diào)整年齡、性別、體質(zhì)指數(shù)、是否服用降壓藥后只有 24hPPI 和 NPPI 與冠心病相關(24hPPI:OR=1.98,95%CI:1.11～3.52,P=0.021;NPPI:OR=2.26,95%CI:1.29～3.97,P=0.004)。受試者工作特征曲線(Receiver Operator Characteristic Curve,ROC曲線)分析結果顯示高血壓患者的24hPPI和NPPI對冠心病預測價值的ROC曲線下面積均大于24hPP。研究結論高血壓患者的24hPPI和NPPI與冠心病密切相關,有助于臨床上高血壓患者合并冠心病的預測和診斷,且效果優(yōu)于24hPP。
[Abstract]:Part 1 the relationship between pulse pressure and pulse pressure index (PPI) and coronary heart disease (CHD) in adults with high blood pressure in Beijing, the relationship between pulse pressure (Pulse Pressure, PP) and pulse pressure index (Pulse Pressure Index, PPI) and coronary heart disease in adults with high blood pressure in Beijing city was studied. The research methods selected "Beijing cardio brain kidney and diabetes chronic disease" in 2011 Basic data on the sex, age, area and education level of the subjects were collected. The blood pressure measurement was selected by a unified OMRON HEM/770A electronic sphygmomanometer, Systolic Blood Pressure (SBP) or more than 140 mmHg (mmHg=0.133 kPa) and (or) diastolic pressure (Diastolic Blo). Od Pressure, DBP) more than 90 mmHg and (or) those who had taken antihypertensive drugs within nearly two weeks were defined as the difference between SBP and DBP in hypertensive patients and the ratio of PPI to PP and SBP. To understand the level and characteristics of PP and PPI in adult hypertensive patients in Beijing, the relationship between them and coronary heart disease was investigated with the regression model. The results of the study included 7563 cases in Beijing. The average age of the subjects was (51.7 + 12.4) years, including 4102 (54.2%) men, 5806 (76.8%) and 799 (10.6%) for coronary heart disease (10.6%). The PP and PPI of the elderly (60~79 years old) high blood pressure patients were higher than those of young people (18~59 years old). PP:68.1 mmHg vs.52.4 mmHg, P0.001; PPI:0.44vs.0.36, P0.001). The PP and PPI in patients with hypertension and coronary heart disease are higher than those of hypertension without coronary heart disease (PP:61.0 mmHg vs.55.5). In the analysis of hypertension, PP and PPI were all associated with the [PP: ratio of coronary heart disease (Odds Ratio, OR) =1.25,95% confidence interval (Confidence Interval, CI): 1.20 ~ 1.31, P0.001; PPI:OR=1.93,95%CI:1.75 ~ 2.13, adjusted age, sex, body mass index, area, education, current smoking and alcohol consumption analysis results showed that There is no statistically significant correlation between PP and coronary heart disease in hypertensive patients, but PPI is still associated with coronary heart disease (OR=1.18,95%CI:1.04 ~ 1.33, P=0.008). There is no significant correlation between the correlation of PP and PPI with coronary heart disease in patients with hypertension. The conclusion is that in Beijing adult patients with hypertension, coronary heart disease is associated with coronary heart disease. Both PP and PPI were higher than those without coronary heart disease. Adjustment of age, sex, body mass index, area, education level, current smoking and drinking, the PPI of hypertensive patients is still associated with coronary heart disease; further adjustment is not statistically significant after taking antihypertensive drugs. Second the dynamic pulse pressure and pulse pressure index of partial hypertension patients The relationship between the 24 hours dynamic pulse pressure (24-hour Ambulatory Pulse Pressure, 24hPP), the 24 hour dynamic pulse pressure index (24-hour Ambulatory Pulse Pressure Index, 24hPPI) and the night dynamic pulse pressure index (24hPP) were used to study the relationship between the coronary heart disease and the coronary heart disease. The clinical application of dynamic pulse pressure and pulse pressure index of blood pressure patients was provided. The research methods were selected from the Ambulatory Blood Pressure Monitoring (ABPM) in Fuwai Hospital of the Chinese Academy of Medical Sciences from May 2016 to July 2016, and the general information on the effective reading of ABPM was required for the detailed inquiries of 75%.. Material, record age, sex, height, weight, basic information on.24 hourly mean systolic blood pressure (24-hour Mean Systolic Blood Pressure, 24hSBP) > 130mmHg (1 mmHg=0.133 kPa) and (or) 24 hour mean diastolic pressure (24-hour Mean), or (or) for nearly two weeks. The subjects were defined as hypertensive patients. According to ABPM data, 24hPP, 24hPPI and NPPI were calculated and the correlation between them and coronary heart disease was analyzed. The value of each index to the risk assessment and prediction of coronary heart disease was compared to the difference between 24hSBP and 24hDBP, 24hPPI was the ratio of 24hPP to 24hSBP, and NPPI was at night (22:00 ~ (22:00). The average age of 305 cases of ABPM in Fuwai Hospital of the Chinese Academy of Medical Sciences was (58.2 + 14.4) years old, including 172 men (56.4%) and 222 cases of hypertension (72.8%). The 24hPP, 24hPPI and NPPI of high blood pressure patients were higher than those of normal blood pressure (24hP) (24hP). The results of the study were 305 cases in Fuwai Hospital of the Chinese Academy of Medical Sciences. P:49.0 mmHg vs.42.2 mmHg, P0.001; 24hPPI:0.39 vs.0.37, P=0.004; NPPI:0.40 vs.0.38, P=0.009). In patients with hypertension, there are 116 cases (52.3%) of coronary heart disease. Among those with normal blood pressure, the difference between the coronary heart disease patients and those without coronary heart disease was not statistically significant.Logistic regression model results showed that the 24hPP, 24hPPI and NPPI in the univariate analysis were all with the [24hPP: ratio of coronary heart disease (Odds Ratio, OR) = 1.35,95% confidence interval (Confidence Interval, CI): 1.06 ~ 1.72, P=0.014; 24hPPI:OR=2.46,95%CI:1.57 ~ 3.86, P0.001; NPPI:OR=2.56,95%CI:1.66 ~ 3.95, P0.001]; adjustment of age, sex, body mass index, and whether only 24hPPI and NPPI were associated with coronary heart disease (24hPPI:OR=1.98,95%CI:1.11 ~ 3.52, P=0.021; NPPI:OR= 2.26,95%CI:1.29 to 3.97, P=0.004). The results of iver Operator Characteristic Curve, ROC curve) analysis showed that the area of 24hPPI and NPPI in hypertensive patients was greater than 24hPP. in the ROC curve predictive value for coronary heart disease. Conclusion the 24hPPI and NPPI of hypertension patients were closely related to coronary heart disease, which was helpful to the prediction and diagnosis of coronary heart disease in patients with hypertension, and the effect was effective. Better than 24hPP.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R544.1;R541.4

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