北京社区人群血压与颈动脉内中膜厚度的相关性探讨

目的探讨颈动脉内中膜厚度增厚与否对血压与颈动脉内中膜厚度相关性的影响。方法研究人群来自北京大学第一医院心内科于2011年12月至2012年4月在北京市石景山区横断面调查的动脉粥样硬化研究队列。纳入标准为问卷调查资料完整并完成颈动脉超声图像的采集且未应用过任何降压药物,研究人群(n=2 569)以最大颈动脉内中膜厚度0.9 mm为分界点分为颈动脉内中膜厚度增厚组(n=1 597)及非增厚组(n=972),分析血压与颈动脉内中膜厚度的关系。结果多重线性回归分析显示,在调整了性别、年龄、BMI、目前吸烟饮酒状况、血肌酐、空腹血糖、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、降糖降脂药物使用、心血管疾病患病情况等因素后,总体人群各项血压指标(收缩压、舒张压、脉压及平均动脉压)均与颈动脉内中膜厚度平均值呈显著正相关(收缩压:β=0.009,P0.000 1;舒张压:β=0.002,P0.000 1;脉压:β=0.007,P0.000 1;平均动脉压:β=0.009,P0.000 1);在颈动脉内中膜厚度≥0.9 mm组各项血压指标依然与颈动脉内中膜厚度平均值呈显著正相关(收缩压:β=0.006,P=0.000 1;舒张压:β=0.001,P=0.000 1;脉压:β=0.005,P0.0001;平均动脉压:β=0.005,P=0.023 8),而非增厚组中各项血压指标与颈动脉内中膜厚度平均值均无明显相关。结论本研究发现在颈动脉内中膜厚度增厚的人群中血压指标与颈动脉内中膜厚度显著相关,非增厚人群中无显著相关。提示血管壁增厚影响血压的作用机制在二者相关性机制方面可能占据更重要的地位。

The association between peripheral blood pressure and carotid intimi-media thickness (cIMT) in acommunity-based population of Beijing

Objective The aim of this study was to investigate the influence of the thickening of carotid intima-media thickness (cIMT) on the association between peripheral blood pressure and carotid intima-media thickness in a Chinese communitybased population.Methods From December 2011 to April 2012,a total of 2 569 subjects with normal blood pressure or with hypertension but not receiving antihypertensive drugs were enrolled in this study from an atherosclerosis cohort in Shijingshan district,Beijing.Subjects were divided into two groups according to whether their maximum thickness of cIMT was greater than 0.9 mm.The association between blood pressure and cIMT was evaluated in the whole population,and in the population whose cIMT＜ 0.9 mm,and in those whose cIMT≥0.9 mm,respectively.Results In the whole population,systolic blood pressure(SBP,β=0.009,P＜0.000 1),diastolic blood pressure (DBP,β=0.002,P＜0.000 1),pulse pressure(PP,β=0.007,P＜0.000 1) and mean arterial pressure (MAP,β=0.009,P＜0.000 1) were positively correlated with the average of cIMT respectively after adjusting for sex,age,BMI,current smoking and drinking,serum creatinine,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,total triglycerides,fasting blood glucose,cardiovascular disease history,antidiabetic medications and hypolipidemic medications.In the subjects with maximum cIMT ≥0.9 mm,the association between blood pressure and cIMT remained significant (SBP:β=0.009,P=0.000 1;DBP:β=0.001,P=0.000 1;PP:β=0.009,P＜0.000 1;MAP:β=0.005,P=0.023 8).Conclusion The study showed that blood pressurewas correlated with cIMT only in the subjects with thickening cIMT.It is suggested that the influence of the artery thickening on peripheral blood pressure may have a major position for the association between them.