动态血压参数与冠状动脉病变的相关性

目的探讨不同动态血压参数与冠状动脉病变严重程度的相关性。方法可疑冠心病患者212例,行冠状动脉造影同时进行24h动态血压监测,根据造影结果分为非冠状动脉病变组（43例）和冠状动脉病变组（169例）,冠状动脉病变组患者根据病变范围再分为单支血管病变组（56例）、双支血管病变组（38例）与3支血管病变组（75例）,分析比较各组动态血压参数。结果冠状动脉病变组24h平均收缩压、24h平均脉压、白天平均收缩压、白天平均脉压、夜间平均收缩压、夜间平均脉压、最高收缩压、最低收缩压均明显高于非冠状动脉病变组（P〈0.05）,且随着狭窄支数增加而逐渐增高,以3支血管病变组明显（P〈0.05）;冠状动脉病变组白天平均舒张压、夜间平均舒张压、24h平均舒张压、最高舒张压均明显低于非冠状动脉病变组（P〈0.05）,且随狭窄支数增加有逐渐下降趋势,但差异无统计学意义（P〉0.05）;与杓型血压模式比较,非杓型、反杓型、超杓型血压模式患者双支和3支血管病变发生率率明显增高（P〈0.05）;多因素回归分析结果显示,夜间平均收缩压对冠心病有独立的预测价值（P〈0.05）。结论夜间平均脉压、最高收缩压与冠状动脉病变严重程度密切相关,夜间平均收缩压是预测冠状动脉病变的最佳参数;血压模式的改变是造成冠状动脉病变的重要因素。

Correlation between ambulatory blood pressure and severity of coronary artery stenosis

Objective To study the correlation between different ambulatory blood pressure monitoring（ABPM） parameters and severity of coronary heart disease.Methods A total of 212 patients with suspicious coronary heart disease（CHD） receiving coronary angiography and 24 hours ABPM were divided into lesion group（n=169） and non-lesion group（n=43） according to coronary artery lesion,and were divided into single-vessel disease group（n=56）,double-vessel disease group（n=38） and triple-vessel group（n=75） according to coronary artery lesion range.The ABPM parameters were compared among these groups.Results The levels of 24-hour average systolic blood pressure,24-hour average pulse pressure,day average pulse pressure,day average systolic blood pressure,night average systolic blood pressure,night average pulse pressure,high systolic blood pressure and the low systolic blood pressure were higher in lesion group than those in non-lesion group（P0.05）,and increased with the increased number of stenosis vessels,especially significantly in triple vessel group（P0.05）.The levels of day average diastolic blood pressure,night average diastolic blood pressure,24-hour average diastolic blood pressure and high diastolic blood pressure were lower in the lesion group than those in the non-lesion group（P0.05）,and had the tendency of inversely decrease with the increased number of stenosis vessel,but it had no significant difference（P0.05）.The prevalence of double-vessel and triple-vessel disease was significantly higher in non-dipper,anti-dipper,over-dipper blood pressure pattern than that in normal dipper pattern blood pressure pattern（P0.05）.Multiple regression analysis showed night average systolic blood pressure had the independent predicting value to coronary artery disease.Conclusion The night average pulse pressure and high systolic blood pressure are closely correlated with severity of coronary heart disease.The night systolic blood pressure is the best parameter for predicting coronary heart disease.Ambulatory blood pressure change in the pattern is an important factor for coronary artery disease.