【摘要】 目的：探究原发性高血压患者血压变异性(BPV)及脂蛋白相关磷脂酶A2(Lp-PLA2)、小而密低密度脂蛋白胆固醇(sdLDL-C)与颈动脉硬化程度的相关性。方法：回顾性分析2021年1月-2022年5月郑州大学第二附属医院收治的151例高血压患者的临床资料为高血压组，根据颈动脉内膜中层厚度(IMT)将高血压组分为单纯高血压组54例、高血压颈动脉硬化组97例；另随机选择同期体检的64例健康人为对照组。比较三组Lp-PLA2、sdLDL-C水平，并行24 h动态血压监测及彩色多普勒颈动脉超声检查，分析BPV与Lp-PLA2、sdLDL-C及颈动脉硬化程度的关系。结果：单纯高血压组和高血压颈动脉硬化组24 h平均收缩压(24 h SBP)、24 h平均舒张压(24 h DBP)、白天平均收缩压(dSBP)、白天平均舒张压(dDBP)、夜间平均收缩压(nSBP)、夜间舒张压均值(nDBP)均高于对照组，差异均有统计学意义(P<0.05)。高血压颈动脉硬化组24 h SBP、dSBP、nSBP水平均高于单纯高血压组，差异均有统计学意义(P<0.05)。高血压颈动脉硬化组24 h收缩压标准差(24 h SSD)、24 h舒张压标准差(24 h DSD)、白天收缩压标准差(dSSD)、夜间收缩压标准差(nSSD)、夜间舒张压标准差(nDSD)均高于对照组，差异均有统计学意义(P<0.05)。高血压颈动脉硬化组24 h SSD、dSSD、nSSD均高于单纯高血压组，差异均有统计学意义(P<0.05)。高血压颈动脉硬化组Lp-PLA2、sdLDL-C水平均高于对照组和单纯高血压组，且单纯高血压组均高于对照组，差异均有统计学意义(P<0.05)。高血压组患者的颈动脉硬化程度与Lp-PLA2、sdLDL-C、24 h SBP、dSBP、nSBP、24 h SSD、dSSD、nSSD均呈正相关(P<0.05)。logistic回归分析显示，sdLDL-C是高血压患者颈动脉硬化的独立危险因素(OR=15.672，P<0.05)。结论：sdLDL-C是颈动脉硬化的危险因素，在高血压颈动脉硬化的过程中发挥了重要作用。更多还原

【Abstract】 Objective:To study the relationship between blood pressure variability (BPV),lipoprotein-related phospholipase A2 (Lp-PLA2),small and dense low-density lipoprotein cholesterol (sdLDL-C) and carotid artery stiffness in patients with primary hypertension.Method:The clinical data of 151 hypertensive patients admitted to the Second Affiliated Hospital of Zhengzhou University from January 2021 to May 2022 were retrospectively analyzed as hypertension group,according to carotid intima-media thickness (IMT),hypertension group was divided into simple hypertension group (54 cases) and hypertensive carotid atherosclerosis group (97 cases);a total of 64 healthy people were randomly selected as control group.The levels of Lp-PLA2 and sdLDL-C were compared among thee groups,and the relationship between BPV and Lp-PLA2,sdLDL-C and the degree of carotid atherosclerosis was analyzed by 24-hour ambulator-blood pressure monitoring and color Doppler carotid ultrasound.Result:The 24 h systolic blood pressure (24 h SBP),24 h diastolic blood pressure (24 h DBP),daytime systolic blood pressure (dSBP),daytime diastolic blood pressure (dDBP),nighttime systolic blood pressure (nSBP) and nighttime diastolic blood pressure (nDBP) in the simple hypertension group and hypertensive carotid atherosclerosis group were higher than those in the control group,the differences were statistically significant (P<0.05).The 24 h SBP,dSBP and nSBP levels in the hypertensive carotid atherosclerosis group were higher than those in the simple hypertension group,the differences were statistically significant (P<0.05).The standard deviation of 24 h systolic blood pressure (24 h SSD),the standard deviation of 24 h diastolic blood pressure (24 h DSD),the standard deviation of daytime systolic blood pressure (dSSD),the standard deviation of nighttime systolic blood pressure (nSSD) and the standard deviation of nighttime diastolic blood pressure (nDSD) in the hypertensive carotid atherosclerosis group were higher than those in the control group,the differences were statistically significant (P<0.05).The 24 h SSD,dSSD and nSSD in hypertensive carotid atherosclerosis group were higher than those in simple hypertension group,the differences were statistically significant (P<0.05).The levels of Lp-PLA2 and sdLDL-C in hypertensive carotid atherosclerosis group were higher than those in control group and simple hypertension group,the levels of simple hypertension group were higher than those in control group,the differences were statistically significant (P<0.05).The degree of carotid atherosclerosis in hypertensive group were positively correlated with Lp-PLA2,sdLDL-C,24 h SBP,dSBP,nSBP,24 h SSD,dSSD and nSSD (P<0.05).logistic regression analysis showed that sdLDL-C was an independent risk factor for carotid atherosclerosis in hypertensive patients (OR=15.672,P<0.05).Conclusion:sdLDL-C is a risk factor for carotid atherosclerosis and plays an important role in the process of hypertension carotid atherosclerosis.更多还原