应用动脉硬化指标评价老年单纯收缩期高血压患者的血管健康状况

目的应用脉搏波传导速度（PWV）、踝臂指数（ABI）和颈动脉内膜中层厚度（IMT）评价老年单纯收缩期（ISH）高血压在杓型与非杓型血压昼夜节律变化时的血管健康状况。方法按照动态血压仪检测结果，分为非杓型组（74例）、杓型组（78例）和正常血压组（72例），观察试验组和对照组baPWV、ABI、IMT。结果非杓型组肱-踝脉搏波速度（baPWV）、IMT值显著高于杓型组（baPWV1801．614±314．27，1658．674±274．80，P〈0．01；IMT0．964±0．22，0．874±0．19，P〈0．05），ABI值显著低于杓型组（1．034±0．17，1．12±0．18，P〈0．01）。当baPWV〉1400cm／s、ABI〈0．9时，三组检出数依次为61例、59例、41例，以及18例、9例、5例，差异有统计学意义（χ^2=12．57，P〈0．01；χ^2=9．74，P〈0．01）；三组颈动脉斑块检出数依次为43例、32例、18例，差异有统计学意义（χ^2=16．49，P〈0．01）。结论老年ISH患者易出现外周动脉损害，非杓型高血压尤为明显，无创性baPWV、ABI、IMT指标可较好的评价血管健康状态。

Pulse wave velocity, ankle-brachial index and carotid intima-media thickness measurement in the assessment of vascular status in elderly patients with isolated systolic hypertension

Objective To evaluate the relation of circadian blood pressure rhythm with vascular status in elderly patients with isolated systolic hypertension. Methods Ankle-brachial index （ABI）, brachial-ankle pulse wave velocity （baPWV） and carotid intima-media thickness （IMT） were measured in 74 elderly patients with non-dipper hypertension （non-dipper group）, 78 elderly patients with dipper hypertension （ dipper group ） , and 72 healthy controls （ control group ）. Results In comparison with the dipper group,baPWV and IMT of the non-dipper group were significantly increased baPWV （1801.61±314.27） vs （1658.67±274.80） （cm/s）],P〈0.01; IMT： （0.96±0.22） vs （0.87±0.19） （mm）, （ P 〈 0. 05 ） ,while ABI of the non-dipper group was deereased （ 1.03 ± 0. 17 vs 1.12 ± 0. 18, P 〈 0. 01 ）. Identification rate was significantly different among 3 groups when baPWV 〉 1400 cm/s （χ^2= 12.57, P 〈 0. 01 ） or ABI 〈 0. 9 （χ^2=9. 74, P 〈 0. 01 ）. The detection of carotid plaques was also significantly different （χ^2= 16. 49 ,P 〈 0.01 ）. Conclusions These findings suggest that vaseular damage could be found in elderly patients with isolated systolic hypertension, especially in those with non-dipper hypertension. ABI, baPWV and IMT measurement may be helpful for the assessment of vascular status.