【摘要】 目的探讨动态脉压(pulse pressure,PP)对颈动脉粥样硬化病变进展的影响。方法选择102例老年男性原发性高血压患者,所有患者均做动态血压监测(ABPM)及颈动脉超声,随访2年后复查颈动脉超声,出现以下三者之一即为颈动脉病变进展(total progress of carotid,TPC)病例:①颈动脉狭窄加重(PCS);②新出现颈动脉复杂斑块(CP);③颈动脉内-中膜厚度(IMT)进展(IIMT)。统计分析动态PP对TPC的影响。根据ABPM测量,102例老年男性高血压患者依次被分为24小时PP升高组(51例)与对照组(51例),白天PP(dPP)升高组(55例)与对照组(47例),夜间PP(nPP)升高组(40例)与对照组(62例)。结果①102例患者中,总计TPC 71例(69.6%),其中,PCS病例28例(27.5%),新出现CP病例52例(51.0%),IIMT病例22例(21.6%),所有患者在随访期间未出现急性心肌梗死及有后遗症的脑血管病,无死亡病例。②全天PP(24PP)升高组TPC(80.4%vs 58.8%,χ2=5.607)及PCS(39.2%vs 15.7%,χ2=7.089)的患者比例均显著高于对照组(P<0.05);dPP升高组TPC(80.0%vs 57.4%,χ2=6.093)及PCS(36.4%vs 17.0%,χ2=4.761)的患者比例均显著高于对照组(P<0.05);nPP升高组TPC(87.5%vs 58.1%,χ2=9.958,P<0.01)、PCS(42.5%vs 17.7%,χ2=7.482,P<0.05)及新出现CP(65.0%vs 41.9%,χ2=5.176,P<0.05)的患者比例显著高于对照组。③多因素分析结果:nPP≥60mmHg(OR=5.909,95%CI=1.860～18.733,P<0.01)为TPC的独立危险因素(P<0.01)。结论动态PP尤其是nPP可以预测老年男性高血压患者2年后的TPC程度。更多还原

【Abstract】 Objective To investigate whether ambulatory pulse pressure(PP) can be used to predict the progression of carotid arteriosclerosis. Methods A total of 102 elderly hypertensive men with carotid arteriosclerosis were enrolled in this study.All the patients underwent ambulatory blood pressure monitoring(ABPM) at baseline.Carotid ultrasound investigations at baseline and after a median of 23 months(range,20 to 29 months) were performed to identify patients with progressive carotid arteriosclerosis.Total progression of carotid disease(TPC) was defined as according to any one of the follows:①progression of carotid artery stenosis(PCS);②new complex plaques(CP) of any arteries(CCA and extracranial ICA);③increasing of carotid artery intima-media thickness(IIMT).Then,the effect of ambulatory PP to predict the progression of carotid arteriosclerosis was evaluated.According to ABPM measure,102 elderly hypertensive men were respectively divided into two paired match groups,24 h PP raised group(n=51) vs control group(n=51),day PP(dPP) raised group(n=55) vs control group(n=47),night PP(nPP) raised group(n=40) vs control group(n=62). Results ①In all 102 patients,TPC was found in 71 patients(69.6%) by ultrasound with PCS in 28 patients(27.5%),new CP in 52 patients(51.0%) and IIMT in 22 patients(21.6%).All the patients had no AMI or disabling cerebrovascular desease and no patients died in the follow-up.②Patients with elevated 24 hPP had significantly increased risk for TPC(80.4% vs 58.8%,χ2=5.607) and PCS(39.2% vs 15.7%,χ2=7.089) compared with the patients in the control group(P<0.05).Patients with elevated dPP had significantly increased risk for TPC(80.0% vs 57.4%,χ2=6.093) and PCS(36.4% vs 17.0%,χ2=4.761) compared with the patients in the control group(P<0.05).Patients with elevated nPP had significantly increased risk for TPC(87.5% vs 58.1%,χ2=9.958,P<0.01),PCS(42.5% vs 17.7%,χ2=7.482,P<0.05) and new CP(65.0% vs 41.9%,χ2=5.176,P<0.05) compared with the patients in the control group.③Multivariable analysis showed nPP≥60 mmHg(OR=5.909,95%CI=1.860-18.733,P<0.01) was independent factor for TPC(P<0.01). Conclusion Ambulatory PP especially nPP can be used to predict the progression of carotid arteriosclerosis in two years in the elderly men with hypertension.更多还原