高血压患者血脂和脂蛋白水平与冠状动脉狭窄的关系

目的探讨高血压患者血脂和脂蛋白水平与冠状动脉狭窄的关系。方法本研究回顾性分析1140例因胸痛住院接受冠状动脉造影且规则接受药物治疗的高血压病患者的血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL C)水平与冠状动脉狭窄的相关性。结果①除高密度脂蛋白胆固醇(HDL C)外,高血压病患者严重冠状动脉狭窄的发生与年龄、病程、收缩压(SBP)、舒张压(DBP)、血糖、体重指数(BMI)、吸烟和TC、LDL-C相关(P<0.001)。②随着TC、LDL-C水平增高,冠状动脉狭窄级数、狭窄≥75%血管支数和狭窄≥75%的例数均明显增加(P<0.01)。③Logistic回归分析显示,TC、LDL-C与高血压病患者严重冠状动脉狭窄(≥75%)发生存在明显的相关性,TC、LDL-C每增加0.51mmol/L(分别以5.17mmol/L和3.10mmol/L为基线),严重冠状动脉狭窄发生率增加32%及33%(95%CI:1.25～1.39及1.23～1.43,P均<0.0001);在对年龄、性别、SBP、DBP、高血压病程、吸烟、糖尿病进行校对后,TC、LDL-C每增加0.51mmol/L仍显示增加严重冠状动脉狭窄发生率19%及21%(95%CI:1.12～1.23及1.15～1.27,P均<0.0001)。结论高血压合并高血脂患者血清TC、LDL-C水平与冠状动脉狭窄呈正相关关系,在高血压合并高血脂防治中,应重视血压的降低及TC、LDL C水平的改善。

Relationship between lipids, lipoproteins and coronary stenosis in hypertensive patients

Objective To investigate the relationship between lipids, lipoproteins and coronary stenosis in hypertensive patients.Methods Parameters of blood pressure, serum lipids and lipoproteins,clinical features and coronary angiographic findings were analyzed retrospectively in 1 140 patients with essential hypertension associated with hyperlipoidemia under standard antihypertensive treatment. Results ①The severity of the coronary stenosis was positively related to the increased TC and LDL-C (P<0.01). ②Coronary stenosis(≥75%) had a positive correlation with age, duration of hypertention, SBP,DBP,blood glucose,BMI,smoking, TC and LDL-C (P<0.001)but no relationship with HDL-C. ③Logistic regression analysis showed that TC and LDL-C were strongly correlated with coronary stenosis(≥75%) in essential hypertensive patients,with every incremental 0.51 mmol/L for a 32% and 33% increase of coronary stenosis risk(95% CI:(1.25)～1.39, P<0.000 1 and 1.23～1.43,P<0.000 1). After adjustment for age, duration of hypertention, SBP,DBP, smoking and diabetes, an increment of 0.51 mmol/L in TC or LDL-C led to a 19% or 21% increase of coronary stenosis risk(95%CI:1.12～1.23, P<0.000 1 and 1.15～1.27,P<0.000 1).Conclusion TC and LDL-C have positive correlation with coronary stenosis in essential hypertensive patients associated with hyperlipoidemia.In order to reduce cardiac damage of hypertension associated with hyperlipoidemia, It is important to pay more attention to the changes of blood pressure ,serum lipids and lipoproteins.