心外膜脂肪体积对高血压患者昼夜血压节律异常的诊断研究

目的：探讨高血压患者心外膜脂肪体积（EATV）对血压昼夜模式的诊断价值。方法纳入高血压非急症患者80例，进行24小时动态血压监测，按照血压昼夜模式分为杓型血压组（正常血压模式组，n=36）、非杓型血压组（n=24）和反杓型血压组（n=20），后两组亦合称异常血压模式组。所有患者均常规检测血压、血脂和血糖水平，并接受心脏双源CT测定EATV，对EATV和高血压模式进行相关分析。结果三组患者血脂、血糖水平无统计学差异，（P＞0.05）。杓型血压组、非杓型血压组和反杓型血压组患者夜间血压以及24小时平均血压呈增高趋势，日间血压则无统计学差异；杓型血压组、非杓型血压组和反杓型血压组EATV逐渐增加，分别为（91.3±29.4）cm3、（116.2±31.06）cm3和（124.8±28.5）cm3，且杓型血压组与后两组异常血压模式组均有统计学差异（P＜0.01）。双变量相关分析结果显示EATV与异常血压模式相关系数为0.50（P＜0.001），校正腰围和体质量指数后偏相关系数为0.469（P＜0.001）。Logistic回归分析表明，EATV每增加30 cm3，异常血压模式发生率增加4.99（P＜0.001）倍，校正年龄、身体质量指数和腰围后为4.14（P＜0.001）倍。ROC曲线表明，以EATV 95.17 cm3为阈值时异常血压模式的诊断敏感性和特异性分别为75.0％和72.7％。结论EATV增加与异常血压模式相关，对于昼夜血压节律异常有较好的诊断价值。

Diagnostic value of epicardial adipose tissue volume to hypertensive patients with abnormal circadian rhythm of blood pressure

Objective To investigate the influence of epicardial adipose tissue volume （EATV） on circadian mode of blood pressure （BP） in hypertensive patients. Methods The patients （n=80） with non-acute hypertension were divided into dipper hypertension group （n=36）, non-dipper hypertension group （n=24） and reverse-dipper hypertension group （n=20） according to 24-hour monitoring of ambulatory BP and circadian mode of BP. All patients were given routine detections of BP, levels of blood fat and blood glucose, and EATV was determined by using cardiac double source CT. The relationship was reviewed between EATV and hypertensive model. Results There was no statistical difference in blood fat and blood glucose among three groups. The nighttime BP and 24-hour average BP increased gradually in three groups but daytime BP had no statistical difference. EATV increased gradually in three groups （91.3±29.4） cm3, （116.2±31.06） cm3 and （124.8±28.5） cm3], and there was statistical difference between dipper hypertension group and non-dipper hypertension group or reverse-dipper hypertension group （P〈0.01）. The results of bivariate correlation analysis showed that the correlation coefficient was 0.500 （P〈0.001）, and partial correlation coefficient was 0.469 （P〈0.001） between EATV and abnormal BP mode after revising waistline and body mass index. The results of Logistic regression analysis showed that each additional 30 cm3 of EATV increased the incidence of abnormal BP mode by 4.99 times （P〈0.001）, and increased by 4.14 times （P〈0.001） after revising age, body mass index and waistline. The curve of receiver operating characteristic （ROC） indicated that the diagnostic sensitivity and specificity of abnormal BP mode were respectively 75.0%and 72.7% when taking EATV 95.17 cm3 as threshold value. Conclusion The increase of EATV is correlated to abnormal BP mode, which has a higher diagnostic value to abnormal circadian rhythm of BP.