老年人脉压与动脉粥样硬化的关系

目的 探讨老年人脉压与动脉粥样硬化的关系.方法 以杨浦区中心医院及杨浦区11个街道社区卫生服务中心随访的老年人为对象,选取年龄>160岁患有动脉粥样硬化危险因素的患者2358人,记录入选者的基本情况:年龄、性别、身高、体重、吸烟史,血压、心率、冠心病、缺血性脑卒中、慢性肾脏病、糖尿病等病史.测定空腹血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血肌酐、尿酸、丙氨酸氨基转移酶.根据脉压将入选者分为脉压<60 mm Hg组和≥60 mm Hg组.分析2组脉压与年龄、体重指数、收缩压、舒张压、心率、空腹血糖、血脂、血肌酐、尿酸、丙氨酸氨基转移酶、肌酐清除率、冠心痛、缺血性脑卒中、慢性肾脏病、糖尿病等关系.结果 脉压≥60 mm Hg组与脉压<60 mm Hg组比较,血糖(6.3±2.6)mmol/L与(5.6±1.7)mmol/L]、总胆固醇(4.8±1.2)mmol/L与(4.3±1.3)mmol/L]、甘油三酯(1.9±1.1)mmol/L与(1.5±1.2)mmol/L]、低密度脂蛋白胆固醇(2.9±1.2)mmoL/L与(2.5±1.1)mmol/L]、尿酸(291.4±133.6)μmol/L与(246.8±131.2)μmoL/L]均明显升高(P均<0.01).脉压≥60mm Hg组与脉压<60 mm Hg组比较,冠心病(17.8%与10.8%)、缺血性脑卒中(31.7%与26.0%)、慢性肾脏病(16.9%与12.4%)、糖尿病(23.8%与17.6%)患病率均明显升高(P均<0.01).Logostic多元线性逐步回归分析结果 显示脉压与血糖、体重指数、年龄、低密度脂蛋白胆固醇、尿酸、高密度脂蛋白胆固醇密切相关(β分别为0.103、0.093、0.097、0.089、0.076、-0.057,P均<0.05).结论 有动脉粥样硬化基础的老年人,脉压高可促进动脉粥样硬化的发展,促进心脑血管及肾脏疾病的发生、发展.

Relationship between pulse pressure and artery atherosclerosis in elders

Objective To explore the relationship between pulse pressure (PP) and artery atherosclerosis in elders. Methods Totally 2358 eiders( > 60y) with the risk factors of artery atherosclerosis from Yangpu District DOI:10.3760/cma.j.issn.1008-6315.2009.09.006Central Hospital and 11 Community Health Service Centers were enrolled . The basic information includes age, sex, height,body mass, history of smoking, blood pressure, heart rate, history of coronary heart disease, ischemic stoke, chronic kidney diseases and diabetes,etc. The fasting blood sugar(FBS) ,blood lipid( total cholesterel,triglyceride, low-density lipreprotein, high-deusity liproprotein), serum creatinine, serum uric acid, serum alanine aminotransferase were measured. The elders were divided into two groups according to the PP( PP <60 mm Hg and PP≥60 mm Hg) to analyse the relationship between PP and age, BMI, SBP, DBP, HR, FBS, TC, TG, LDL-C, HDL-C, Cr, Ccr, UA, AST and history of coronary heart disease,ischemic stoke,chronic renal disease, and diabetes. Results Serum levels of FBS,TC,TG, LDL-C, UA in the group with PP less than 60 nun Hg were ( 5.6±1.7 ) mmol/L, (4.3±1.3 ) mmol/L, ( 1.5±1.2) mmol/L, ( 2.5±1.1 ) mmol/L, UA ( 246.8±131.2 ) μmol/L, that in the group with PP over or equal to 60 mm Hg group were (6.3±2.6) mmol/L, (4.8±1.2) mmol/L, ( 1.9±1.1 ) mmol/L, (2.9±1.2) mmol/L, (291.4±133.6) μmol/L, Serum levels of FBS, TC, TG, LDL-C, UA in the group with PP over 60 mm Hg were obviously elevated as compared with that in the group with PP lower than 60 ram Hg(P <0.01 ) ; The preven-lence rates of coronary heart disease ischemic stoke,chronic,renal disease, diabetes in the group with PP less than 60 mm Hg were 10.8% ,26.0%, 12.4%, 17.6%, that in the group with PP over or equal to 60 mm Hg group were 17.8% 、31.7% ,16.9% ,23.8% (P <0.01 ). The preveulence of coronary heart disease ischemic stoke,chronic re-nal disease, diabetes were significandy increased in the group with PP over or equal to 60 mm Hg group. Logistic re-gression analysis showed PP was closely related to FBS, BMI, age, LDL-C, UA, HDL-C ( β = 0.103,0.093.0.097, 0.089 ,0.076 , - 0.057, P < 0.05 ). Conclusions For those elders with the basis of artery atherosclerosis, high PP can inhance the development of artery atheresclerosis and also inhance the occurance and development of cardio-ce-rebrovascular and renal diseases.