【作者】 梁志芳；

【导师】 胡世红；

【作者基本信息】 广西医科大学 ， 心血管内科， 2012， 硕士

【摘要】 目的：探讨老年高血压患者肱踝脉搏波传导速度和胱抑素C的关系。方法：2011年04月至2011年11月选择在柳州市人民医院心内科住院的老年高血压患者80例,其中男41例,女39例,年龄范围65～79岁,平均年龄(69.26±3.92)岁。高血压诊断按《中国高血压防治指南》(2010)标准。根据胱抑素C是否正常(正常为<1.16mg/L)将高血压组分为：胱抑素C正常组40例(A组)；胱抑素C升高(≥1.16mg/L)组40例(B组)。对照组C组：为同期体检的年龄匹配的非高血压老年40例,其中男24例,女16例,年龄在65～79岁,平均年龄(67.90±3.49)岁。分别测定相关的人体测量学指标、空腹血生化指标、臂踝脉搏波速度、胱抑素C等。结果：(1)三组性别、年龄、身高、体重、腰围、体质指数、C反应蛋白、空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血肌酐、尿素氮、踝臂指数水平比较,差异无统计学意义(p<0.05)。A组与B组的收缩压、舒张压、脉压、心率、尿酸、臂踝脉搏波速度均高于C组(p<0.05),B组臂踝脉搏波速度高于A组,而A、B组的收缩压、舒张压、脉压、心率、尿酸的差异无统计学意义(p<0.05)；B组的胱抑素C高于A组与C组,A、C组胱抑素C的差异无统计学意义(p<0.05)。(2)直线相关分析：对臂踝脉搏波速度、胱抑素C进行直线相关分析,相关系数r=0.439,p<0.001,臂踝脉搏波速度与胱抑素C呈正相关趋势。逐步回归分析：以臂踝脉搏波速度为因变量,以年龄、身高、体重、腰围、体质指数、收缩压、舒张压、脉压、心率、C反应蛋白、空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、-血肌酐、尿素氮、尿酸、踝臂指数、胱抑素C为自变量,进行逐步回归分析,结果显示年龄、胱抑素C、舒张压、体重、总胆固醇、甘油三酯、心率进入方程(p<0.05),回归方程为：Y=8.715×AGE+410.21×CysC+4.840×DBP-8.279×WT+148.286×TC-91.426×TG+4.684×HR(各回归系数均p<0.05)。结论：老年高血压患者脉搏波速度与胱抑素C密切相关,胱抑素C可能是动脉硬化的独立影响因素。更多还原

【Abstract】 Objective:To investigate the relation of brachial-ankle pulse wave velocity to cystatin C in the older patients with hypertension.Methods:Totally,80older hypertensive patients who were65to79years in the cardiovascular internal medicine department of Liuzhou People’S Hospital from April to November in2011were selected to enter the study. According to the level of cystatin C, the hypertensive groups were divided into the A groups(cystatin C<1.16mg/L) and the B groups(cystatinC≥1.16mg/L),each group included40cases. In the same time,40older physical examinees who also were65years to79years in the health examination department of Liuzhou People’S Hospital were enrolled and considered as the C group (control group). Composition of age and gender in the three groups were no significant difference (p>0.05).Anthropometry parameters, fasting blood biochemistry,cystatin C, brachial-ankle pulse wave velocity and ankle-brachial index were measured.Results:(1) One Way ANOVA and Student-Newman-Keuls domonstrated that gender, age, height, weight, Waist circumference, body mass index, c-reactive protein, fasting plasma glucose,total cholesterol,triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, creatinine,urea nitrogen,ankle-brachial index level did not differ in the three groups(p>0.05for all); systolic blood pressure, diastolic blood pressure, pulse pressure, heart rate, uric acid, brachial-ankle pulse wave velocity were significantly higher in the A group and B group than C group(p<0.05for all),baPWV were significantly higher in the B group than A group (p<0.05),while systolic blood pressure, diastolic blood pressure, pulse pressure, heart rate, uric acid level did not differ between the A and B groups(p>0.05for all); cystatin C were significantly higher in the B group than A group and B group (p<0.05),but it was not different about cystatin C level between the A and C groups(p>0.05).(2)A positive relationship between brachial-ankle pulse wave velocity and cystatin C (r=0.439,p<0.001) was found in older hypertensive patients. Stepwise multivariate regression analysis in older hypertensive patients showed that age, cystatin C, diastolic blood pressure, weight, total cholesterol, triglyceride,heart rate were independent contributors to brachial-ankle pulse wave velocity, regression equation:Y=8.715×AGE+410.21×CysC+4.840×DBP-8.279×WT+148.286×TC-91.426×TG+4.684×HR(p <0.05for all).Conclusion:Cystatin C is strongly associated with brachial-ankle pulse wave velocity in the older hypertensive patients.cystatin C could be a independent determinant factor of arterial stiffness.更多还原