高血压患者脉压、颈动脉内膜中层厚度和颈股动脉脉搏波传导速度的关系

目的探讨高血压患者脉压、颈动脉内膜中层厚度(CIMT)与颈股动脉脉搏波传导速度(cfPWV)的关系。方法选择2016年1月至2017年6月期间就诊于福建医科大学附属第一医院全科医学和老年科门诊、住院部的原发性高血压患者469例,正常血压者274人。按2×2设计方法,将所有对象分为高血压组及正常血压组,然后以cfPWV 10 m/s为切点值,分别各自分为cfPWV增高组(cfPWV≥10 m/s)和cfPWV正常组(cfPWV<10 m/s)。再次,以CIMT 1.0 mm为切点,分别各自分为CIMT正常组及CIMT增厚组。最后,以年龄65岁为切点,分别各自分为中青年组(<65岁)及老年组(≥65岁)进行分析。测量所有研究对象的血压并计算脉压。应用Pearson相关分析和多元线性回归分析cfPWV的影响因素。结果与正常血压组比较,高血压患者的cfPWV(9.56±1.93)比(8.46±1.47)m/s]、脉压(58.6±13.5)比(49.2±10.3)mm Hg]、CIMT(0.93±0.18)比(0.82±0.17) mm]升高(均P<0.05)。在高血压人群中,cfPWV增高组的脉压(66.8±14.1)比(54.1±10.7)mm Hg]、CIMT(0.98±0.16)比(0.90±0.18)mm]高于cfPWV正常组(均P<0.05);老年组的cfPWV(10.52±2.11)比(9.00±1.55)m/s]、脉压(66.1±13.7)比(54.1±11.1)mm Hg]、CIMT(1.02±0.15)比(0.88±0.17)mm]高于中青年组(均P<0.05)。多元线性回归逐步分析结果显示,脉压(β=0.346)、年龄(β=0.345)、心率(β=0.241)、性别(β=-0.142)、空腹血糖(β=0.096)是所有对象cfPWV的相关因素(均P<0.05);分层分析结果显示,无论哪个年龄段及性别,脉压均是cfPWV的相关因素;而CIMT只在中青年人群中是cfPWV的相关因素。结论脉压是高血压患者cfPWV的相关因素,CIMT只是青中年高血压患者cfPWV的相关因素。

The relationship between carotid-femoral pulse wave velocity and pulse pressure,carotid intima-media thickness in the patients with hypertension

Objective To investigate the relationships between pulse pressure, carotid intima-media thickness(CIMT) and carotid-femoral pulse wave velocity(cfPWV) in patients with hypertension. Methods A total of 469 subjects with hypertension and 274 subjects with normal blood pressure were enrolled from the Department of General Medicine and Geriatric Medicine of the First Affiliated Hospital of Fujian Medical University from January 2016 to June 2017. Firstly, based on the 2×2 design method, all the subjects were divided into hypertension group or normal blood pressure group. Then in each of the above two groups, with cfPWV 10 m/s as the cutting point, the patients were further divided into two sub-groups: the increased cfPWV group(cfPWV≥10 m/s) and the normal cfPWV group(cfPWV<10 m/s). Secondly, all subjects were divided into two groups based on the CIMT using the cut-point at 1 mm. Finally, using the age at 65 years old as cutting point, all subjects were divided into middle and young age group(<65 years old) and elderly group(≥65 years old). Blood pressure was measured in all subjects and pulse pressure was calculated. Pearson correlation analysis and multiple linear regression analysis was used to analyze the influencing factors of cfPWV. Results cfPWV, pulse pressure, CIMT in patients with hypertension were higher than those in patients with normal blood pressure (9.56±1.93) vs(8.46±1.47)m/s,(58.6±13.5) vs(49.2±10.3)mm Hg,(0.93±0.18) vs(0.82±0.17)mm, all P<0.05]. In the patients with hypertension, pulse pressure, CIMT in the increased cfPWV group were significantly higher than those in the normal cfPWV group (66.8±14.1) vs(54.1±10.7)mm Hg,(0.98±0.16) vs(0.90±0.18)mm, all P<0.05], and the cfPWV, pulse pressure in the elderly group were significantly higher than those in middle-aged and young people group (10.52±2.11) vs(9.00±1.55)m/s,(66.1±13.7) vs(54.1±11.1)mm Hg,(1.02±0.15) vs(0.88±0.17)mm, all P<0.05]. Multiple linear regression stepwise analysis showed that pulse pressure, age, heart rate, gender and fasting blood glucose were the influencing factors of cfPWV in all subjects(β: 0.346, 0.345, 0.241,-0.142, 0.096, all P<0.05), and stratified analysis showed that pulse pressure was the influencing factor of cfPWV regardless of age and gender. CIMT was the influential factor of cfPWV in the middle-aged and young people(<65 years old), but not in the elderly population(≥65 years old). Conclusion Pulse pressure is an important influencing factor of cfPWV in patients with hypertension, and CIMT is associated with cfPWV only in young and middle-aged patients with hypertension.