三酰甘油/高密度脂蛋白胆固醇比值与原发性高血压患者臂踝脉搏波速度的相关性研究

背景血脂异常是心血管疾病的主要危险因素。研究证实三酰甘油（TG）/高密度脂蛋白胆固醇（HDL-C）比值可以比单一的血脂指标或低密度脂蛋白胆固醇（LDL-C）/HDL-C比值更好地预测心血管事件的发生。关于TG/HDL-C比值在高血压人群中评估动脉硬化的临床研究较少，不同TG/HDL-C比值组患者动态血压参数特点的研究也较少。目的分析不同空腹TG/HDL-C比值原发性高血压患者的临床特点、动态血压及臂踝脉搏波速度（ba-PWV）情况，并探讨TG/HDL-C比值与ba-PWV的相关性。方法选取2014年8月至2015年12月首都医科大学附属北京安贞医院高血压科病房的439例（18~80岁）原发性高血压患者为研究对象。收集患者性别、年龄、既往史（糖尿病史、高脂血症史、吸烟史、饮酒史）等资料，测量患者身高、体质量，计算体质指数（BMI）；测定患者血肌酐、总胆固醇、TG、LDL-C、HDL-C、血尿酸、空腹血糖，并计算TG/HDL-C比值；患者在住院期间均进行24 h动态血压监测，并收集24 h、日间及夜间的平均收缩压、平均舒张压和平均心率。计算收缩压和舒张压的夜间下降率并记录勺形血压波形，所有患者的动脉硬化程度采用ba-PWV进行评估。根据TG/HDL-C比值将患者等分为低分位组（n=219）及高分位组（n=220），比较两组患者上述指标有无差异，并利用多元线性逐步回归分析探讨ba-PWV的影响因素。结果高分位组男性比例、BMI、高脂血症史比例、吸烟史比例、血肌酐水平、总胆固醇水平、TG水平、血尿酸水平、空腹血糖水平高于低分位组，年龄、HDL-C水平低于低分位组（P<0.05）。高分位组24 h平均收缩压、24 h平均舒张压、日间平均收缩压、日间平均舒张压、夜间平均收缩压、夜间平均舒张压、夜间平均心率、ba-PWV高于低分位组，收缩压夜间下降率、勺型血压比例低于低分位组（P<0.05）。多元线性逐步回归分析结果显示，年龄〔β=12.35，95%CI（10.307，14.401）〕、空腹血糖〔β=20.69，95%CI（1.532，39.854）〕、TG/HDL-C比值〔β=20.99，95%CI（6.176，35.810）〕、24 h平均收缩压〔β=7.57，95%CI（5.656，9.493）〕是ba-PWV的影响因素（P<0.05）。结论在原发性高血压患者中，TG/HDL-C比值高分位组24 h平均收缩压及舒张压均高于低分位组，且TG/HDL-C比值与ba-PWV独立相关，因此监测TG/HDL-C比值有助于早期发现动脉硬化和血压升高，促进心血管危险因素的全面管理。

TG/HDL-C Ratio and ba-PWV in Patients with Essential Hypertension

Background Dyslipidemia is a major risk factor for cardiovascular disease.Triglyceride/high-density lipoprotein cholesterol(TG/HDL-C)ratio has been proved to be more effective in predicting cardiovascular events than a blood lipid index or low-density lipoprotein cholesterol(LDL-C)/HDL-C ratio.There are few clinical studies about TG/HDL-C ratio assessing arterial stiffness in hypertensive populations.Moreover,studies on the characteristics of ambulatory blood pressure parameters by TG/HDL-C ratio are also rare.Objective To explore the association of fasting TG/HDL-C ratio with brachial-ankle pulse wave velocity(ba-PWV)in essential hypertensive patients based on analyzing these patients'clinical features,ambulatory blood pressure and ba-PWV.Methods A total of 439 essential hypertension patients(aged 18-80 years)were recruited from Hypertension Department,Beijing Anzhen Hospital,Capital Medical University from August 2014 to December 2015.Data were collected,including sex,age and medical history(diabetes history,hyperlipidemia history,smoking status,drinking status),height,weight,BMI,serum creatinine,total cholesterol,TG,LDL-C,HDL-C,serum uric acid,fasting blood glucose,calculated TG/HDL-C ratio,24 h ambulatory blood pressure parameters(mean systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate in 24 h,in the daytime and at the nighttime,prevalence of nocturnal fall in SBP and DBP,and dipper blood pressure pattern)during hospitalization,and mean heart rate.Arterial stiffness was assessed by ba-PWV.The above-mentioned indicators were compared between lower(n=219)and higher quantile groups(n=220)divided by TG/HDL-C ratio.The influencing factors of ba-PWV were investigated by multiple linear regression analysis.Results(1)Higher quantile group had higher male proportion,higher prevalence of hyperlipidemia and smokers,higher mean BMI,serum creatinine,total cholesterol,TG,serum uric acid,and fasting blood glucose,as well as lower men age,and HDL-C than lower quantile group(P<0.05).(2)Higher quantile group had higher mean 24-hour SBP and DBP,daytime SBP and DBP,nighttime SBP and DBP,nighttime heart rate and ba-PWV,and lower prevalence of nocturnal fall in SBP and DBP,and dippers than lower quantile group(P<0.05).(3)Multiple linear regression analysis showed that,age(β=12.35,95%CI(10.307,14.401)),fasting blood glucose(β=20.69,95%CI(1.532,39.854)),TG/HDL-C ratio(β=20.99,95%CI(6.176,35.810))and 24 hour mean SBP(β=7.57,95%CI(5.656,9.493))were associated with ba-PWV(P<0.05).Conclusion In essential hypertension patients,elevated 24-hour SBP and DBP were found in those with higher TG/HDL-C ratio,and TG/HDL-C ratio may be independently associated with ba-PWV.Monitoring TG/HDL-C ratio helps early detection of arteriosclerosis and elevated blood pressure,promoting comprehensive management of cardiovascular risk factors.