高血压病患者动态脉压与颈动脉粥样硬化关系的研究

为了探讨动态脉压与颈动脉粥样硬化之间的关系 ,将 172名高血压病人分为两组 ,2 4h平均脉压在 40～ 5 5mmHg者为一组 ,2 4h平均脉压 >5 5mmHg者为一组。所有病人同时经超声检测颈总动脉、颈内动脉和颈动脉分叉处的内膜中层厚度、血管内径及斑块发生率 ,并以颈总动脉最大内膜中层厚度作为评价颈动脉粥样硬化程度的指标。结果观察到 ,在同一平均动脉压水平下 ,脉压 >5 5mmHg者颈总动脉内径、颈总动脉最大内膜中层厚度及粥样斑块发生率均明显大于脉压为 40～ 5 5mmHg者 (P <0 .0 0 1)。Pearson相关分析显示平均脉压、年龄、平均收缩压、高血压病程与颈总动脉最大内膜中层厚度呈明显正相关 (r =0 .5 40 ,r=0 .470 ,r =0 .44 3 ,r =0 .2 31,P <0 .0 0 1) ,而平均舒张压与颈总动脉最大内膜中层厚度呈负相关 (r=- 0 .2 8,P <0 .0 5 )。逐步回归分析表明 ,夜间脉压、年龄与颈动脉粥样硬化独立相关。研究结果提示 ,动态脉压是颈动脉粥样硬化发展中的重要参数 ,可作为评估颈动脉粥样硬化程度的有效指标。

The Association of Ambulatory Pulse Pressure with Carotid Arteries Atherosclerosis in Essential Hypertension

Aim To determine the relationship between ambulatory pulse pressure and carotid arteries atherosclerosis in essential hypertension. Methods 172 patients with hypertension were divided into two groups, group A: 24 h mean pulse pressure range from 40 to 55 mmHg. group B: 24 h mean pulse pressure over 55 mmHg. Carotid ultra sonography were also performed to measure intima-media thickness, lumen diameter and plaque. Maximal intima-media thickness(IMTmax) were determined as the index of carotid atherosclerosis severity. Results At the same level of mean arterial pressure (MAP), patients in group B had greater IMTmax and Lumen diameter and higher incidence of plaque than those in group A(P<0.001). Correlation analysis showed that mean pulse pressure, age, mean systolic blood pressure, years of hypertension were post correlated significantly with the IMTmax (r=0.540, r=0.470, r=0.443, r=0.231, all P<0.001), Whereas mean diasystolic blood pressure were negatively correlated with IMTmax (r=-0.28, P<0.05). Multivariate analysis showed that night pulse pressure and age were associated independently with IMTmax. Conclusion Our date showed that ambulatory pulse pressure was the most important Bp parameter during the development of carotid atherosclerosis in hypertension, and it canalso work as a effective index of evaluation severity degree of carotid atheroselerosis.