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背景:脉压和主动脉僵硬度都是冠心病的预测因子,主动脉脉压与动脉粥样硬化之间是一种互为因果的关系,对经冠状动脉造影确诊的冠心病与主动脉脉压的关系进行观察。目的:观察冠状动脉粥样硬化与原发性高血压患者中央脉压的关系。设计:病例-对照观察。单位:首都医科大学宣武医院心内科。对象:选择2002-07/2005-01到首都医科大学宣武医院心内科就诊的300例原发性高血压患者,均为初发或未经正规治疗,均符合国际高血压协会的诊断标准,并除外继发性高血压、心肌病、心脏瓣膜病、心力衰竭、肝肾功能不全等。其中男170例,女130例,平均年龄(61±11)岁。所有患者均对检测项目知情同意。方法:300例原发性高血压患者入院后均给予冠状动脉造影检查,根据是否患有冠心病将纳入患者分为冠心病组(共143例,其中男性92例,占64%)和非冠心病组(共157例,其中男性82例,占52%)。所有患者均签署知情同意。收集的参数包括:由侵入性方法测得的主动脉内收缩压和舒张压,冠状动脉的病变程度以及患者的基础临床资料。所有观察指标均以x±s表示,两组之间的比较采用独立样本的t检验,P<0.05认为有显著性差异。主要观察指标:两组患者主动脉收缩压、舒张压和脉压,反映动脉僵硬度的每搏输出量与主动脉脉压的比值;冠状动脉病变的支数及狭窄程度(狭窄程度<50%的病例归入非冠心病组);患者入院后的基础临床指标和常规生化指标(包括空腹血糖、血清肌酐、血脂指标等)。结果:纳入300例高血压患者全部进入结果分析,冠心病组的主动脉收缩压和脉压明显高于非冠心病组[(150.3±26.5),(145.6±23.3)mmHg,P<0.05]和[(77.1±22.7),(70.4±19.3)mmHg,P<0.05]。冠心病组主动脉脉压与每搏输出量的比值明显高于非冠心病组(1.20±0.44,0.96±0.33,P<0.05)。冠心病组患者的空腹血糖为(1.38±0.27)mmol/L,明显高于非冠心病组(1.08±0.28mmol/L,P<0.01),冠心病组患者的血清肌酐为(11.98±2.15)μmol/L,明显高于非冠心病组(11.19±1.58μmol/L,P<0.01),而高密度脂蛋白胆固醇明显低于非冠心病组[(0.54±0.13),(0.62±0.18)mmol/L,P<0.01]。结论:动脉粥样硬化可能与原发性高血压患者的主动脉僵硬度加重有一定关系,中央脉压可能因此升高。另外,动脉粥样硬化还将损害原发性高血压患者的肾功能,并影响脂质代谢。
Background: Pulse pressure and aortic stiffness are predictors of coronary heart disease. Aortic pressure and atherosclerosis are causal relationships with each other. Coronary angiography and coronary artery disease Pressure relationship was observed. Objective: To observe the relationship between coronary atherosclerosis and central pulse pressure in patients with essential hypertension. Design: Case-control observation. SETTING: Department of Cardiology, Xuanwu Hospital, Capital Medical University. PARTICIPANTS: A total of 300 patients with essential hypertension who were admitted to the Department of Cardiology, Xuanwu Hospital, Capital Medical University between July 2002 and January 2005 were either newly diagnosed or untreated. All of them met the diagnostic criteria of the International Society of Hypertension Except for secondary hypertension, cardiomyopathy, valvular heart disease, heart failure, liver and kidney dysfunction. There were 170 males and 130 females with an average age of (61 ± 11) years. All patients were informed of the test items. Methods: All 300 patients with essential hypertension were given coronary angiography after admission. According to their coronary heart disease, the patients were divided into coronary heart disease group (143 cases, 92 males, 64%) and non-coronary Heart disease group (a total of 157 cases, including 82 males, accounting for 52%). All patients signed informed consent. The parameters collected included the intra-aortic systolic and diastolic blood pressures measured by invasive methods, the degree of coronary artery disease, and the patient’s underlying clinical data. All observations were x ± s, the comparison between the two groups using independent samples t-test, P <0.05 considered significant differences. MAIN OUTCOME MEASURES: Systolic blood pressure, diastolic blood pressure and pulse pressure were measured in two groups of patients. The ratio of stroke volume to aortic pulse pressure, which reflected arterial stiffness, the number of coronary lesions and the degree of stenosis (stenosis <50% Of patients were classified as non-coronary heart disease group); basic clinical and routine biochemical parameters (including fasting blood glucose, serum creatinine, blood lipid index) after admission. Results: All the 300 patients with hypertension were included in the result analysis. The systolic pressure and pulse pressure of aorta in CHD group were significantly higher than those in non-CHD group [(150.3 ± 26.5), (145.6 ± 23.3) mmHg, P <0.05] [(77.1 ± 22.7), (70.4 ± 19.3) mmHg, P <0.05]. Coronary heart disease group aortic pulse pressure and stroke volume ratio was significantly higher than non-coronary heart disease group (1.20 ± 0.44,0.96 ± 0.33, P <0.05). The fasting blood glucose in CHD patients was (1.38 ± 0.27) mmol / L, significantly higher than that in non-CHD patients (1.08 ± 0.28 mmol / L, P <0.01). Serum creatinine in CHD patients was (11.98 ± 2.15) (0.54 ± 0.13) and (0.62 ± 0.18) mmol / L respectively, which was significantly higher than that of non-CHD patients (11.19 ± 1.58μmol / L, P <0.01) /L,P<0.01]. Conclusion: Atherosclerosis may be related to the aggravation of aortic stiffness in patients with essential hypertension, and central pulse pressure may increase accordingly. In addition, atherosclerosis will also impair kidney function in patients with essential hypertension and affect lipid metabolism.