核素运动心肌断层显像中血压的变化及其对心肌灌注异常的预测价值

目的 :通过观察运动 99m Tc- MIBI心肌断层显像试验中血压变化规律 ,探讨其与心肌灌注异常的关系及其预测价值。方法 :选择 1996～ 1998年进行运动 99m Tc- MIBI心肌扫描患者 2 0 4例 ,根据其结果分为显像阳性组12 2例及阴性对照组 82例 ,对运动前、运动高峰及运动终止后的血压进行监测 ,并计算运动后恢复期收缩压反应(SBPR)及舒张压反应 (DBPR)。结果 :两组间在年龄、性别、冠心病危险因素及基础血压值等方面均无显著性差异 (均 P >0 .0 5 )。显像阳性组与阴性对照组相比 ,前者运动后 3min收缩压〔(147± 2 3∶ 139± 19) m m Hg,P =0 .0 11〕及 SBPR(0 .841± 0 .140∶ 0 .76 8± 0 .10 1,P <0 .0 0 0 1)明显增高。对心肌灌注异常的预测 ,以 SBPR大于均值 (0 .77)的敏感性 (6 5 .6 % )较高 ;SBPR大于均值加 2个标准差 (>0 .87)的特异性最高 (84.1% ) (均 P<0 .0 2 5 )。结论 :核素心肌灌注缺血或梗死患者 SBPR升高具有一定的临床预测价值     

核素运动试验血压反应与其灌注异常程度的关系

目的:探讨核素运动试验中,心肌灌注异常患者的血压反应变化特点及其定量关系. 方法:行锝99m-MIBI心肌灌注扫描运动试验者204例,其中122例核素灌注异常,82例正常,比较核素灌注正常与异常对照组运动试验中血压反应以及灌注异常节段的数量变化及半定量关系. 结果:(1)核素灌注异常组的运动后恢复期收缩压及舒张压反应(SBPR及DBPR)均明显高于核素正常对照组(P均＜0.05);(2)在核素灌注异常组中,持续性放射减低或缺损组(梗死亚组)的SBPR明显高于可逆性放射减低或缺损组(缺血亚组)(0.885±0.161比0.814±0.119,P＜0.01);(3)核素灌注异常组中,随异常节段数增加SBPR递增(＞3段亚组0.879±0.148比1～3段亚组0.801±0.120,P＜0.01,且两者明显高于0段亚组);(4)核素灌注异常多因素逐步回归中,SBPR为进入方程相关性最强因素(β=0.27,P=0.001). 结论:心肌缺血/梗塞患者在运动试验中,SBPR不但明确增高,而且还与缺血/梗塞的心肌节段数明显相关     

卡托普利与缓释硝苯地平治疗对高血压病患者运动血压的影响

目的探讨原发性高血压(EH)降压治疗后,运动血压反应是否恢复正常及观察卡托普利与缓释硝苯地平治疗有无差异。方法以正常成人22例作为对照,44例EH患者随机分为卡托普利和硝苯地平治疗两组。卡托普利始用12.5mg,2次/d,缓释硝苯地平始用10mg,2次/d,治疗2周,血压未降至正常者,逐渐加至25mg,2次/d或20mg,2次/d;观察3个月。于观察期结束前1周,测定运动前、运动终止后即刻、5、10、15min坐位血压,并计算SBP恢复至运动前水平的时间(血压恢复时间)。结果正常组运动后SBP和DBP升高幅度分别为(12.6±3.3)mmHg和(-0·1±2.6)mmHg,血压恢复时间为(5.9±2.0)min;高血压治疗两组虽然安静血压得到满意控制,但上述参数仍明显高于对照组;与硝苯地平组比较,卡托普利组运动终止即刻SBP/DBP升幅明显更低[(14.9±3.2/8.7±3.3比18.9±7.7/11.6±4.5)mmHg,P均<0·05];血压恢复时间更短[(9.8±4.6比13.3±5.3)min,P<0·05]。结论高血压病患者即使血压得到有效控制,运动血压增幅和血压恢复时间仍明显大于正常血压者;与缓释硝苯地平比较,卡托普利治疗运动血压增幅更小、血压恢复时间更短。     

心电图活动平板试验阳性患者Q—T离散度变化的意义

目的　探讨心电图活动平板试验 (TET)阳性患者Q -T离散度 (QTd)变化的意义。方法　 93例受试者根据TET分为阳性组 (A组 ) 3 8例 ,男 女 =13 2 5 ,年龄 5 5± 8岁和阴性组 (B组 ) 5 5例 ,男 女 =2 6 2 9,比较两组TET前后QTd、QTcd的变化。结果　运动前QTd、QTcdA组分别为 41± 15ms和 46± 18ms,B组分别 ( 3 8± 14)ms和 ( 46±16)ms,两组比较无显著差异。达次极量运动时A组QTd为 ( 5 1± 17)ms与运动前比较有显著性差异 (P <0 0 5 ) ,QTcd为 ( 79± 2 8)ms ,与运动前比较有非常显著性差异 ( P <0 0 1) ,B组QTd、QTcd分别为 ( 3 7± 16)ms和 ( 5 1± 19)ms,与运动前比较无显著性差异。两组运动后QTd、QTcd比较有非常显著性差异 (P <0 0 1)。结论　TET阳性与QTd之间有良好的临床相关性。可反映运动负荷造成的心肌缺血     

运动心电图试验对冠脉介入治疗疗效的评价

目的探讨运动心电图试验对冠脉介入治疗术(PCI)疗效评定的价值。方法对13例冠心病患者术后1~36月进行重复运动试验(ET)和冠脉造影(CAG),作对比分析。①对比13例患者ET与CAG的结果,判断PCI后冠脉狭窄的敏感性、特异性和准确性;②对比CAG阳性组4例患者与CAG阴性组9例患者在PCI前后运动试验的各项指标。结果①运动试验预测PCI后冠脉狭窄的敏感性为100%,特异性为88·9%,准确性为92·3%;②CAG阴性组患者在治疗前后运动耐量(METs)的增高有显著性差异(5·7±1·3;7·0±0·64,P<0·05),且3例患者在术后运动中的心绞痛消失。结论运动试验对判断PCI后冠脉狭窄具有重要的临床参考价值。     

倾斜试验中晕厥患者自主神经功能的变化

目的　运用频谱法研究直立倾斜试验中血管性晕厥的发生机制。方法　对 2 7例不明原因晕厥患者行直立倾斜试验 ,运用频谱法计算低频 (LF)、高频 (HF)及LF/HF的变化。结果　 15例发生晕厥或先兆晕厥 (阳性组 ) ,12例未出现症状 (阴性组 ) ,倾斜前两组LF、HF和LF/HF差异无显著性 ;阴性组倾斜后即刻HF明显下降 ,LF/HF显著升高 ,平卧后恢复到倾斜前水平 ,阳性组晕厥或先兆晕厥发作时 ,HF突然升高 (10 4 7± 4 0 4→ 32 95± 10 4 8) ,明显高于倾斜前 (2 3 4 4± 4 2 0→32 95± 10 4 8,P <0 0 5 ) ,LF/HF显著下降 (3 2 8± 0 39→ 1 0 7± 0 31,P <0 0 1) ,试验终止平卧后 ,HF和LF/HF恢复 ,两组LF在倾斜前后不同阶段均无明显变化。结论　在平卧、静息状态下 ,阳性患者和阴性患者的自主神经功能差异无显著性 ,倾斜后阳性患者迷走神经兴奋性在抑制过程中突然过度增强 ,导致晕厥或先兆晕厥发生。     

运动试验中收缩压恢复比对女性患者诊断冠心病的价值

目的　探讨运动试验中收缩压恢复比在女性患者中诊断冠心病的价值。方法　 12 1例有胸痛症状的女性患者根据冠状动脉造影结果分为非冠心病组 ( 5 3例 )和冠心病组 ( 68例 ) ,均接受心电图平板运动试验 ,比较两组患者收缩压恢复比 (运动结束后 3min与运动高峰时收缩压比值 )的差异 ;并探讨该比值在女性患者中诊断冠心病的价值。结果　在冠心病组 ,运动试验中收缩压恢复比明显高于非冠心病组 ( 0 .99± 0 .11vs0 .83± 0 .10 ,P<0 .0 1) ;在女性患者中 ,单用 ST段下移≥ 0 .1m V诊断冠心病的敏感性、特异性和阳性预测值分别为 60 .3%、5 8.6%、65 .1% ;以运动中 ST段下移≥ 0 .1m V且运动后收缩压恢复比 >0 .90为标准 ,诊断冠心病的敏感性、特异性和阳性预测值分别为 5 2 .9%、88.7%、85 .7% ,与前者比较 ,敏感性无明显变化 ( P>0 .0 5 ) ,但特异性和阳性预测值明显提高 ( P分别 <0 .0 1和 <0 .0 5 )。结论　在女性患者 ,运动试验中收缩压恢复比是判断冠心病的有用指标 ,结合 ST段下移 ,可以提高运动试验诊断冠心病的特异性和阳性预测值     

影响平板运动试验诊断冠心病准确性的因素分析

目的　对照平板运动试验与冠状动脉造影结果 ,旨在探讨影响运动试验正确诊断冠心病的因素 ,从而提高冠心病诊断的准确性。方法　选择同期内 (相距时间 <1周 )行平板运动试验和冠状动脉造影检查的住院病人 83例 ,男 6 4例 ,女 19例 ,平均年龄 5 2± 10岁。运动试验阳性诊断标准为运动中或后出现ST段水平型或下斜型下移≥ 0 .1mV且持续 1分钟以上 ,或呈损伤缺血型抬高≥ 0 .2mV。冠状动脉造影以冠状动脉狭窄≥ 5 0 %为阳性 ,对比平板运动试验与冠状动脉造影结果。结果　 1) 83例病人中冠状动脉造影阳性 2 2例 ,其中运动试验阳性 13例 (真阳性 ) ,阴性 9例 (假阴性 ) ;冠状动脉造影阴性 6 1例 ,其中运动试验阴性 45例 (真阴性 ) ,阳性 16例 (假阳性 )。 2 ) 6 1例冠状动脉造影阴性病例中女性 18例 ,假阳性 4例 (2 2 .2 %) ;男性 43例 ,假阳性 12例 (2 7.9%)。总假阳性率为 2 6 .2 %。 2 2例冠状动脉造影阳性中 9例假阴性 ,假阴性率为 40 .9%。 3) 13例真阳性组病人 7例在ST段发生缺血型改变同时伴随胸痛症状 (5 3.8%) ,16例假阳性组仅 3例伴胸痛 (18.7%) ,P <0 .0 5。 9例假阴性组 4例出现胸痛 (44 .4%) ,高于真阴性组 8.9%(P <0 .0 5 )。 4)真阳性组病人运动量 (6 .6± 1.8METs)及运动时间 (2 85 .7± 10     

卡维地洛与地尔硫(卓)对X综合征伴冠状动脉血流储备异常患者疗效的对比研究

目的　比较卡维地洛与地尔硫对伴冠状动脉血流储备减低心脏X综合征患者的疗效。方法　 30例心脏X综合征且冠状动脉血流储备减低患者随机接受卡维地洛 (15例 ,卡维地洛组 )或地尔硫治疗 (15例 ,地尔硫组 ) ,随访治疗 3个月后的临床情况并复查平板运动试验。结果用药后两组平板运动试验到达终点时间明显延长 [卡维地洛组 :(7 2± 1 2 ) ,min和 (5 4± 0 8)min ;地尔硫组 :(5 3± 1 8)min和 (4 6± 1 1)min ,P均 <0 0 5 ]。卡维地洛组用药后临床胸痛 (用药前后分别为 :15例和 5例 ,P =0 0 0 1)、平板运动试验阳性 (用药前后分别为 :15例和 6例 ,P =0 0 0 1)显著减少 ;与地尔硫组比较 ,卡维地洛组平板运动试验中血压心率乘积减小 (175± 19和 196± 19,P <0 0 5 ) ,到达运动终点时间显著延长 [(7 2± 1 2 )min和 (5 3± 1 8)min ,P <0 0 5 ]。结论　卡维地洛能提高心脏X综合征患者的运动耐量 ,且较地尔硫更为有效。     

急性心肌梗死时心电图ST段抬高恢复时间对预测溶栓治疗后心室壁运动的临床意义

目的　探讨急性心肌梗死时 (AMI)心电图ST段抬高恢复时间对预测溶栓治疗后心室壁运动的临床意义。方法　将监护病房 (CCU)收治并接受静脉尿激酶溶栓治疗且符合梗死相关血管再通标准的 36 0例AMI患者 ,根据溶栓后心电图ST段抬高达到稳定性下移 5 0 %的时间 ,分成A组 (时间在 30min内 ,n =92 )、B组(6 0min内 ,n =12 6 )及C组 (90min ,n =14 2 ) ,分别测定 3组的梗死血管室壁运动的幅度。结果　ST段抬高达到稳定性下移 5 0 %所需要的时间不同 ,梗死相关心室壁运动幅度存在差异 [急性前壁心肌梗死 (AAMI)相关室间隔运动幅度A、B、C 3组分别为 (8 15± 1 6 2 )、(7 84± 1 4 3)及 (6 5 6± 2 15 )mm ,P <0 0 5 ;急性下壁心肌梗死 (AI MI)相关左室后壁运动幅度 3组分别为 (8 78± 1 92 )、(7 32± 1 5 4 )及 (6 15± 2 0 5 )mm ,P <0 0 5 ,且随需要的时间延长 ,梗死相关的心室壁运动幅度有下降的趋势。结论　抬高的ST段恢复时间越短 ,梗死相关的心室壁运动改善越明显     

34例肾上腺醛固酮瘤切除术前安体舒通治疗围手术期血压的临床疗效观察

目的:研究高血压人群中发现的肾上腺醛固酮瘤切除手术前安体舒通治疗围手术期降压的临床疗效。方法:回顾34例肾上腺醛固酮瘤临床资料,分析术前安体舒通试验性治疗效果围手术期血压变化。结果:安体舒通治疗有效组(18例)比无效组(16例)围手术期收缩压和舒张压都显著下降[收缩压:(125.7±7.0)mmHgvs(140.9±15.6)mmHg,舒张压:(75.8±7.0)mmHgvs(86.2±8.9)mmHg,P<0.01]。与安体舒通试验性治疗前的血压相比,安体舒通治疗有效组围手术期收缩压和舒张压都显著下降[收缩压:(144.7±7.5)mmHgvs(125.7±7.0)mmHg,P<0.01,舒张压:(93.6±6.9)mmHgvs(75.8±7.0)mmHg,P<0.01],而无效组则均无统计学差异[收缩压:(144.6±11.3)mmHgvs(140.9±15.6)mmHg,(91.2±10.4)mmHgvs(86.2±8.9)mmHg,P<0.05]。将围手术期血压变化与安体舒通治疗效果进行偏相关分析,控制所有与安体舒通治疗相关和影响围手术期血压的因素,安体舒通试验治疗收缩压和舒张压改变分别与围手术期血压改善呈正相关(r=0.434,P=0.03;r=0.716,P=0.001)。结论:在高血压人群中筛选的肾上腺醛固酮瘤,术前安体舒通治疗(抗醛固酮治疗)的有效性与围手术期血压改善呈正相关。     

Exercise Stress Testing in Angina Patients with Positive Response to Hyperventilation Testing: Influence of the Coronary Artery Tone

ABSTRACT We studied the exercise stress test and the coronary artery tone in two groups of angina patients with comparable coronary atherosclerosis. Group I (20 males and 5 females, mean age 53.5 years) with a positive, and group 11 (22 males and 3 females, mean age 52.5 years) with a negative response to the hyperventilation test (HVT). A positive exercise stress test (ST depression ≥1 mm) was found in 24 patients in group 1 vs. 15 in group II (p<0.01), despite a lower maximal rate pressure product (198±11.2 vs. 236±10.1, p<0.05) and maximal work load (110 W±7.1 vs. 136±7.4 W, p<0.02) in group I. A high coronary artery tone (dilatation (DIL %) of the coronary arteries after nitroglycerin ≥ 10%) was found in 18 patients in group I and in 4 in group II (p<0.01). DIL % was 22.6±3.8 vs. 5.8±1.4 in groups I and II, respectively (p<0.005). DIL% was significantly related to persistence of ST depression after exercise (r=0.36, p<0.05), and 21 of 22 patients with high tone had a positive exercise stress test vs. 18 of 28 with low tone (p<0.05). These findings suggest that the coronary artery tone influences the response to exercise in some patients with angina. Since the patients in group I were identified by HVT, our results underline the clinical relevance of this test.     

Arm-crank ergometry: a new method for the evaluation of coronary artery disease

We have developed an electrocardiographic stress test to evaluate coronary heart disease using an arm-crank device (modified bicycle ergometer) in patients unable to perform leg exercise. With an initial work load of 200 kg-m/min at 40 revolutions/min for 3 minutes, followed by 100 kg-m/min increments every 3 minutes to a maximum of 700 kg-m/min at the same speed, a linear relation between the increase in heart rate and work load was observed. Twenty-one patients underwent both conventional treadmill exercise (modified Bruce protocol) and arm-crank exercise on separate days. Peak heart rate was slightly slower with arm-crank exercise (81 ± 4 [standard error] vs. 85 ± 3 percent of maximal predicted heart rate for age, P < 0.02) but peak systolic blood pressure and heart rate-systolic blood pressure product (double product) did not differ significantly (157 ± 7 vs. 154 ± 6 mm Hg, P > 0.5) and (22.0 ± 1.2 vs. 22.5 ± 1.2 × 10³, P > 0.1). Ten patients with documented coronary artery disease, including 7 with angina pectoris, had an ischemie S-T segment response (0.08 second depression greater than 1 mm) by both methods and 10 patients (7 with previous myocardial infarction and 3 with normal coronary arteriograms) had negative results by both techniques. One patient with normal coronary arteriograms had a negative arm-crank test and a positive treadmill test. In 26 patients unable to perform leg exercise the mean peak heart rate, systolic blood pressure and double product with arm-crank exercise were not significantly different (P > 0.05) from those achieved by the ambulatory patients (73.2 ± 1.9 vs. 81.0 ± 4.0 percent, 167 ± 8 vs. 157 ± 7 mm Hg and 22.4 ± 1.2 vs. 22.0 ± 1.4 × 10³, respectively). Six of 26 patients unable to perform leg exercise had a positive arm-crank test. Four of these six patients had angina pectoris and three had a previous myocardial infarction. We conclude that arm-crank exercise is comparable to treadmill exercise and is a reliable alternative method for the evaluation of suspected coronary artery disease in patients unable to perform leg exercise.     

高血压病血压昼夜节律与左室肥厚关系的研究

目的 探讨血压负荷(BPL)与高血压靶器官损伤程度的关系,以及左室重量指数(LVMI)与动态血压(Ambulatory Blood Pressure,ABP)各参数之间的相关性。方法 采用无创性携带式动态血压监测仪对30例正常血压者,1级和2级高血压患者各25例进行了动态血压监测,同时用超声心动图检测左室重量指数。结果(1)正常组与1级高血压组之间血压负荷(SBP:4.83±2.95％vs59.75±22.12％;DBP:3.75±2.05％vs 61.75±18.24％)比较有显著性差异(P均<0.01);1级高血压组昼夜负荷差较大,呈杓型改变。2级高血压组的血压负荷(SBP:94.94±5.08％vs59.75±22.12％;DBP:91.75±10.08％vs61.75±18.24％)明显高于1级组(P均<0.01)。昼夜负荷呈非杓型改变。2级组左室肥厚(LVH)异常检出率76％明显高于1级组20％(P<0.01)。(2)高血压组LVMI与夜间SBP和DBP均显著正相关(P均<0.01),与夜间SBP和DBP下降率均显著负相关(P均<0.01)。结论 血压负荷对高血压靶器官损害程度的评价和预测有临床价值。夜间SBP与LVMI的相关性比DBP与LVMI的相关性更佳。     

Endorphins are related to pain perception in coronary artery disease

Plasma beta-endorphin levels were measured by radioimmunoassay before and after exercise in 25 patients with coronary artery disease. Eighteen patients were men and 7 were women; age range was 36 to 75 years (mean 60). All patients had angina pectoris, a positive treadmill test response or positive exercise radionuclide findings. The mean preexercise plasma endorphin level was 4.9 +/- 3.0 pmol/liter (range 0.7 to 13.5). The mean postexercise plasma endorphin level of 6.6 +/- 4.6 mol/liter (range 0 to 19.5) was significantly higher (p less than 0.05). A significant positive correlation was seen between postexercise endorphin levels and time to onset of angina (r = 0.4, p = 0.03). There were negative correlations between postexercise endorphin levels and occurrence (r = -0.4, p = 0.04) and duration of angina (r = -0.4, p = 0.05). No association was found for maximal heart rate-blood pressure product, workload, time to ST-segment depression or stress ejection fraction. A positive correlation was found between rest left ventricular ejection fraction and postexercise endorphin levels (r = 0.5, p = 0.02). In conclusion, in patients with exercise-induced myocardial ischemia, plasma beta-endorphin levels are increased after exercise; postexercise endorphin levels are related to timing and occurrence (presence or absence) of angina; and endorphins may alter the perception of pain caused by myocardial ischemia.     

The significance of abnormal systolic blood pressure response during supine ergometer exercise and postexercise in ischemic heart disease, studied by exercise radionuclide ventriculography

The prognostic value of abnormal postexercise systolic blood pressure (BP) response has not been investigated. Therefore, the significance of abnormal BP response during exercise and postexercise was examined in 169 patients with ischemic heart disease subjected to supine ergometer exercise gated equilibrium radionuclide ventriculography, coronary arteriography, and follow up averaging 3.6 years. Abnormal BP response during exercise (exertional "hypotension") was defined as 1) a failure of BP to rise by at least 11 mmHg or 2) an initial rise in BP but subsequent fall by more than 10 mmHg during exercise. Abnormal BP response during postexercise (postexercise "hypertension") was defined as an increase of more than 10 mmHg above the peak exercise BP. Of 169 patients, 51 (30%) had an abnormal BP response. Four types of BP response were identified: exertional "hypotension" (group 1a, n = 11), postexercise "hypertension" (group 1b, n = 30), exertional "hypotension" with postexercise "hypertension" (group 1c, n = 10) and normal BP response (group 2, n = 118). Both average exercise duration and peak heart rate were significantly lower in groups 1a, 1b and 1c than in group 2. The severity of exercise ST-segment depression was greater in groups 1b and 1c than in group 2. However, there was no significant difference in the severity of exercise ST-segment depression between group 1a and group 2. A decline in ejection fraction occurred more frequently in groups 1b and 1c than in group 2. Patients in groups 1a, 1b and 1c had more extensive coronary artery disease (CAD) than did patients in group 2. Medically treated patients with an abnormal BP response (groups 1a, 1b and 1c) had a poorer prognosis than did those with a normal BP response (group 2). These findings suggest that an abnormal BP response during supine exercise is infrequent, but is usually associated with impaired exercise tolerance and severe CAD. An abnormal postexercise BP response is also infrequent, but is more closely associated with evidence of myocardial ischemia and global left ventricular dysfunction than exertional "hypotension". In conclusion, postexercise "hypertension" has the same value as exertional "hypotension" as a predictor of poor prognosis.     

Increased response to physical and mental stress in men with hypertensive parents.

Blood pressure and heart rate responses to isometric handgrip exercise were studied at age 31 and after 5 years in young nonhypertensive men with positive family histories of hypertension (n = 13) and in those with negative family histories of hypertension (n = 13) for two generations to test whether subjects with positive family histories established a pattern of increased blood pressure and heart rate responses during the 5-year follow-up period. At follow-up the response to mental stress (Stroop's color word test) was also studied. Baseline blood pressure and heart rate at rest did not differ, initially or at follow-up, between the groups. At the initial examination, absolute blood pressure levels were significantly higher during isometric handgrip exercise just before exhaustion in subjects with positive family histories. At follow-up the absolute blood pressure level (p < 0.001) and the blood pressure responses (p < 0.01-0.001) were found to be significantly increased during handgrip exercise in subjects with positive family histories compared with subjects with negative family histories. In subjects with positive family histories the diastolic blood pressure response was significantly higher (p < 0.01) at follow-up than initially and was significantly related (r = 0.70, p < 0.01) to changes in baseline diastolic blood pressure during the follow-up period. In subjects with negative family histories the systolic blood pressure response was somewhat lower at follow-up than initially. During the mental stress test, the blood pressure response was significantly greater in subjects with positive than with negative family histories.(ABSTRACT TRUNCATED AT 250 WORDS)     

血压正常高值者动态血压变化与动脉顺应性的相关性研究

目的探讨血压正常高值者24 h动态血压变化与颈桡动脉脉搏波传导速度(crPWV)、颈动脉内膜中层厚度(IMT)的相关性。方法入选受试对象286例,其中理想血压组(血压<120/80 mm Hg,1 mm Hg=0.1 33 kPa)90例,血压正常高值组196例,对所有入选对象进行24 h动态血压监测,根据监测参数将血压正常高值组又分为杓型组103例,非杓型组93例,同时进行crPWV及颈动脉IMT检测。结果非杓型组24h收缩压均值较杓型组升高[(122.00)±9.74)mm Hg vs(11 6.74±8.66)mm Hg,P<0.05]。非杓型组夜间血压各指标均较杓型组明显升高(P<0.01),非杓型组crPWV较杓型组升高[(9.53±1.14)m/s vs(8.38±0.88)m/s.P<0.05],非杓型组IMT较杓型组升高[(0.93±0.11)mm vs(0.81±0.1 2)mm,P<0.05],多元回归分析显示,夜间收缩压均值、夜间收缩压下降率、夜间舒张压均值等是crPWV的影响因素,夜间舒张压下降率、24 h收缩压均值、甘油三酯是IMT的影响因素。结论血压昼夜节律异常与crPWV及IMT密切相关,血压正常高值者已出现血管结构与弹性功能异常。     

Abnormal Response to Exercise in Middle-aged NIDDM Patients with and without Autonomic Neuropathy

The cardiovascular response to exercise in middle-aged non-insulin-dependent diabetes mellitus (NIDDM) patients and the potential role of clinical characteristics and autonomic function were evaluated. One hundred and eight NIDDM patients, aged 40–65 years, were compared with a control group of 112 subjects, matched by age, sex, physical fitness, and presence of hypertension. All subjects performed a maximal exercise test. The diabetic patients completed cardiovascular autonomic neuropathy (CAN) tests: deep breathing, postural hypotension and lying to standing. There were no significant differences in total work capacity, heart rate, and blood pressure, either at rest or at peak exercise between the two groups. Diabetic patients showed significantly lower values of systolic and diastolic blood pressure during exercise, significantly slower recovery of heart rate (at 5th minute the average values were 102.7 ± 14.1 beats min⁻¹ vs 91.9 ± 11.1, p < 0.001); and significantly higher proportion of blunted increase of heart rate (9.2 % vs 0.9 %, p < 0.001) and systolic blood pressure (9.2 % vs 0.7 %, p < 0.001) during exercise. No correlation between the exercise results and the main clinical characteristic (presence of hypertension, BMI, duration of diabetes, treatment, microalbuminuria, total score of CAN) was observed. These findings suggest that the cardiovascular response to exercise could be impaired also in the absence of signs of CAN. This impairment was higher in patients showing a dysfunction of orthosympathetic activity.     

高龄老年人血压变异性与踝臂指数关系探讨

目的评价高龄老年人群血压变异性(BPV)与踝臂指数(ABI)的关系。方法入选年龄≥80岁高龄老人111例,按照ABI分为异常ABI组(ABI≤0.9或ABI>1.3)56例和正常ABI组(ABI>0.9)55例,比较2组24h动态血压参数和BPV参数;另根据血压将患者分为高血压组48例和非高血压组63例,观察2组BPV及ABI差异。logistic回归分析ABI独立危险因素。结果异常ABI组较正常ABI组24h舒张压、昼间舒张压和夜间舒张压明显降低(P<0.05),24h收缩压变异性[(12.80±2.66)mm Hg(1mm Hg=0.133kPa)vs(14.14±3.64)mm Hg]明显降低、夜间收缩压变异性[(11.99±4.19)mm Hg vs(9.97±4.05)mm Hg]明显增高(P<0.05)。高血压组24h收缩压变异性[(14.87±3.91)mm Hg vs(13.20±3.41)mm Hg]、夜间收缩压变异性[(12.27±5.50)mm Hg vs(10.33±3.93)mm Hg]明显增高,ABI[(0.98±0.21)vs(1.07±0.20)]明显降低(P<0.05)。logistic回归分析提示,夜间舒张压和夜间收缩压变异性为ABI的独立危险因素(P<0.05)。结论高龄老年人群24h舒张压、昼间及夜间舒张压、24h收缩压变异性、夜间收缩压变异性可能是异常ABI的危险因素。