高血压病患者血压变异性与冠脉粥样硬化斑块病变严重程度的关系研究

纪欣强; 赵润涛; 单冬凯; 王凡

doi:10.3969/j.issn.2095-5227.2023.03.001

高血压病患者血压变异性与冠脉粥样硬化斑块病变严重程度的关系研究

doi: 10.3969/j.issn.2095-5227.2023.03.001

纪欣强^{1, 2,},
赵润涛^{1, 2},
单冬凯³,
王凡^2, ,

1.
解放军医学院，北京　100853
2.
解放军总医院第二医学中心心内科，国家老年疾病临床医学研究中心，北京　100853
3.
解放军总医院心血管病医学部，北京　100048

基金项目: 国家老年疾病临床医学研究中心开放课题(NCRCG-PLAGH-2019020)

详细信息

作者简介:
纪欣强，男，硕士，医师。研究方向：心血管疾病无创影像诊断与临床研究。Email: xinqiangji@foxmail.com

通讯作者:
王凡，女，博士，副主任医师，硕士生导师。Email: wangfan2022@126.com

中图分类号: R541.4
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出版历程
- 收稿日期: 2022-04-23
- 网络出版日期: 2023-03-16
- 刊出日期: 2023-03-28

Relationship between blood pressure variability and coronary atherosclerotic plaque severity in patients with hypertension

JI Xinqiang^{1, 2
,},
ZHAO Runtao^{1, 2},
SHAN Dongkai³,
WANG Fan^{2
, ,}

1.
Chinese PLA Medical School, Beijing 100853, China
2.
Department of Cardiology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
3.
Department of Cardiovascular Medicine, Chinese PLA General Hospital, Beijing 100048, China

More Information

Corresponding author: WANG Fan. Email: wangfan2022@126.com

摘要

摘要: 背景既往研究显示高血压病患者动态血压监测体现的血压变异性等指标能够准确地预测心脑血管事件和死亡风险，但血压变异性与冠脉粥样硬化斑块病变严重程度的关系尚不明确。目的探讨高血压病患者血压变异性与冠脉粥样硬化斑块病变严重程度的关系。方法选择2017年12月 - 2022年3月因高血压合并疑似冠心病(coronary artery disease，CAD)行动态血压监测和冠状动脉计算机断层扫描血管成像(coronary computed tomographic angiography，CCTA)的患者，根据Leiden评分进行分组，＜5分为低危组，5 ~ 20分为中危组，＞20分为高危组，比较三组临床资料。采用Spearsman相关和单因素、多因素logistic回归，明确血压变异性与冠脉粥样硬化斑块病变严重程度之间的关系。结果 783例患者中，男性523例，平均年龄(62.85 ± 10.17)岁。三组间24 h平均收缩压、夜间平均收缩压、收缩压变异性、收缩压变异系数、舒张压变异系数和夜间收缩压下降率的差异均有统计学意义(P均＜0.05)。低危组中夜间收缩期下降率(r=-0.178，P=0.039)与Leiden评分存在关联，中高危组中舒张压变异性(r=0.189，P=0.015)、收缩压变异系数(r=-0.167，P=0.029)、舒张压变异系数(r=-0.156，P=0.038)、夜间舒张压下降率(r=0.167，P=0.029)与Leiden评分存在关联。多因素logistic分析显示，年龄(OR=0.958，95% CI： 0.936 ~ 0.981，P＜0.001)、血脂异常(OR=0.293，95% CI： 0.159 ~ 0.541，P＜0.001)、24 h平均收缩压(OR=0.992，95% CI： 0.984 ~ 1.000，P=0.032)、夜间平均收缩压(OR=0.989，95% CI： 0.981 ~ 0.997，P=0.004)、收缩压变异性(OR=1.054，95% CI：1.026 ~ 1.084，P＜0.001)、收缩压变异系数(OR=0.842，95% CI： 0.752 ~ 0.943，P=0.003)、夜间收缩压下降率(OR=1.004，95% CI： 1.000 ~ 1.008，P=0.037)与Leiden评分中高危独立关联。结论高血压病患者收缩压变异性越大，Leiden评分越高，冠脉粥样硬化斑块病变程度越严重，监测收缩压变异性对预测冠脉粥样硬化斑块病变严重程度及预防冠脉粥样硬化斑块病变进展有一定意义。
- 血压变异性 /
- 冠状动脉CT血管造影 /
- Leiden评分 /
- 冠脉粥样硬化斑块 /
- 高血压病
Abstract: Background Previous studies show that parameters such as blood pressure variability reflected by ambulatory blood pressure monitoring can predict the risk of cardiovascular and cerebrovascular events and death accurately in patients with hypertension, but no studies have been conducted to determine the relationship between blood pressure variability and coronary atherosclerotic plaque severity. Objective To explore the relationship between blood pressure variability and coronary atherosclerotic plaque severity in patients with hypertension. Methods Patients who underwent ambulatory blood pressure monitoring and coronary computed tomographic angiography (CCTA) due to hypertension complicated with suspected angina pectoris from December 2017 to March 2022 were selected and they were divided into three groups according to the Leiden score, including low risk group (<5pts), medium risk group (5-20pts) and high risk group (>20pts), the clinical characteristics of the three groups were compared. Spearsman correlation and univariate/multivariate Logistics regression were used to determine the relationship between blood pressure variability and coronary atherosclerotic plaque severity progression. Results A total of 783 cases were involved, including 523 males, with an average age of (62.85 ± 10.17) years old. The differences in mean systolic blood pressure (SBP), daytime mean DBP, nighttime mean SBP, SBP variability, SBP loading value, diastolic blood pressure (DBP), decrease of nighttime SBP between the groups were statistically significant (P<0.05). The low-risk Leiden score group was associated with decrease of nighttime SBP (r=-0.178, P=0.039), and the medium-risk and high-risk group were associated with DBP variability (r=0.189, P=0.015), SBP loading value (r=-0.167, P=0.029), DBP loading value (r=-0.156, P=0.038) and decrease of nighttime DBP (r=0.167, P=0.029). Age (OR=0.958, 95%CI: 0.936-0.981, P<0.001), dyslipidemia (OR=0.293, 95%CI: 0.159-0.541, P<0.001), mean SBP (OR=0.992, 95%CI: 0.984-1.000, P=0.032), nighttime mean SBP (OR=0.989, 95%CI: 0.981-0.997, P=0.004), SBP variability (OR=1.054, 95%CI: 1.026-1.084, P<0.001), SBP loading value (OR=0.842, 95%CI: 0.752-0.943, P=0.003) and decrease of nighttime SBP (OR=1.00, 95%CI: 0.94-1.08, P=0.037) were independent risk factors for medium-risk and high risk of Leiden score. Conclusion The greater the SBP variability in hypertensive patients, the higher the Leiden score and the severer the coronary atherosclerotic plaque. Monitoring SBP variability has a certain significance for predicting and preventing coronary atherosclerotic plaque severity progression.
- blood pressure variability /
- coronary computed tomographic angiography /
- Leiden score /
- coronary atherosclerotic plaque /
- hypertension.

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表 1 Leiden评分低、中、高组临床资料比较

Table 1. Clinical characteristics in different groups of Leiden score

临床特点	低危组(n=254)	中危组(n=340)	高危组(n=189)	F/χ²值	P值
年龄/岁	57.88 ± 12.47	63.55 ± 12.65^a	69.10 ± 9.21^ab	11.473	＜0.001
男性/(例，%)	174(68.5)	207(60.9)^a	142(75.7)^ab	11.617	0.003
BMI/(kg·m^-2)	25.47 ± 3.44	25.10 ± 3.09	25.31 ± 2.65	1.015	0.363
吸烟/(例，%)	72(28.5)	115(33.7)	80(42.1)^a	9.447	0.009
CAD/(例，%)	95(45.9)	223(79.5)^a	181(95.8)^ab	160.601	＜0.001
血脂异常/(例，%)	232(91.2)	316(92.8)	171(90.2)	1.103	0.576
糖尿病/(例，%)	29(11.4)	50(14.7)	32(16.9)	2.847	0.241
脑卒中、 TIA/(例，%)	11(4.4)	19(5.7)	8(4.3)	0.706	0.703
CAD家族史/(例，%)	37(14.6)	53(15.6)	32(16.9)	0.461	0.794
FBG/(mmol·L^-1)	5.41 ± 1.09	5.82 ± 0.91	5.48 ± 0.94^a	7.619	0.001
TC/(mmol·L^-1)	3.76 ± 0.65	4.24 ± 0.76	4.56 ± 0.82^a	2.685	0.069
TG/(mmol·L^-1)	1.36 ± 0.48	1.45 ± 0.50	1.37 ± 0.91	0.825	0.439
HDL-C/(mmol·L^-1)	1.33 ± 0.53	1.23 ± 0.59	1.25 ± 0.50	1.714	0.181
LDL-C/(mmol·L^-1)	2.79 ± 0.91	2.87 ± 0.90	2.65 ± 0.86	2.248	0.107
UA/(μmol·L^-1)	334.30 ± 68.22	352.21 ± 95.47	335.80 ± 75.46	0.445	0.641
eGFR/[mL·min^-1·(1.73 m²)^-1]	86.13 ± 10.35	89.68 ± 8.47	85.10 ± 5.92	1.330	0.265
他汀类药物/(例，%)	222(87.2)	313(91.8)	167(88.3)	3.851	0.146
降压药/(例，%)	230(90.2)	308(90.6)	165(87.0)	1.672	0.433
^aP＜0.05，vs 低危组；^bP＜0.05，vs 中危组。BMI：体质量指数；CAD：冠脉疾病；TIA：短暂性脑缺血发作； FBG：空腹血糖； TC：总胆固醇；TG：三酰甘油；HDL-C：高密度脂蛋白胆固醇； LDL-C：高密度脂蛋白胆固醇；UA：尿酸；eGFR：估算肾小球滤过率。

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表 2 24 h动态血压监测指标在三组间的比较

Table 2. 24 h ambulatory blood pressure monitoring parameters in different groups of Leiden score

24 h动态血压监测指标	低危组(n=254)	中危组(n=340)	高危组(n=189)	F值	P值
诊室收缩压/mmHg	131.84 ± 21.96	135.96 ± 21.93	139.53 ± 21.85^a	4.728	0.125
诊室舒张压/mmHg	76.77 ± 29.62	79.27 ± 29.57	72.59 ± 30.10	2.620	0.132
24 h平均收缩压/mmHg	127.69 ± 13.45	130.40 ± 12.54	134.80 ± 14.29^a	11.724	0.066
24 h平均舒张压/mmHg	69.93 ± 9.27	68.77 ± 7.84	70.35 ± 10.97^b	23.714	0.038
白天平均收缩压/mmHg	137.5 ± 14.50	140.0 ± 16.00	141.0 ± 24.00^a	3.852	0.105
白天平均舒张压/mmHg	72.80 ± 12.23	72.0 ± 7.75	73.0 ± 8.25	2.935	0.040
夜间平均收缩压/ mmHg	129.5 ± 10.25	135.0 ± 14.50^a	152.50 ± 12.90^ab	163.591	0.012
夜间平均舒张压/ mmHg	70.5 ± 10.38	78.0 ± 9.8a	84.0 ± 15.6^ab	16.578	0.092
24 h收缩压变异性/mmHg	12.74 ± 3.41	14.08 ± 3.09^a	16.42 ± 3.27^ab	62.329	0.002
24 h舒张压变异性/mmHg	8.56 ± 4.88	8.03 ± 2.02^a	8.31 ± 2.13^a	11.903	0.134
24 h收缩压变异系数	0.10 ± 0.03	0.11 ± 0.03^a	0.11 ± 0.03^a	7.606	0.011
24 h舒张期变异系数	0.14 ± 0.04	0.15 ± 0.04	0.14 ± 0.03^a	4.389	0.504
夜间收缩压下降率/%	1.55 ± 6.26	5.20 ± 7.00^a	0.80 ± 4.63^ab	29.534	0.113
夜间舒张期下降率/%	2.50 ± 9.80	1.51 ± 10.28	2.12 ± 11.35	0.461	0.715
^aP＜0.05，vs 低危组；^bP＜0.05，vs 中危组。

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表 3 动态血压指标与Leiden评分的相关性分析

Table 3. Correlation between 24 h ambulatory blood pressure monitoring parameters and Leiden score

24 h动态血压监测指标	Leiden评分＜5 (n=254)		Leiden评分 ≥5 (n=529)
24 h动态血压监测指标	相关系数	P值	相关系数	P值
24 h平均收缩压/mmHg	0.051	0.564	0.089	0.209
24 h平均舒张压/mmHg	0.020	0.781	-0.110	0.155
白天平均收缩压/mmHg	0.041	0.677	0.121	0.119
白天平均舒张压/mmHg	-0.011	0.925	-0.089	0.219
夜间平均收缩压/mmHg	0.112	0.209	0.242	0.757
夜间平均舒张压/mmHg	0.067	0.427	-0.133	0.096
24 h收缩压变异性/mmHg	0.112	0.220	-0.121	0.120
24 h舒张压变异性/mmHg	0.140	0.112	0.189	0.015
24 h收缩压变异系数	0.110	0.197	-0.167	0.029
24 h舒张期变异系数	0.140	0.116	0.156	0.038
夜间收缩压下降率/%	-0.178	0.039	0.142	0.068
夜间舒张期下降率/%	-0.142	0.105	0.167	0.029

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表 4 Leiden评分的单因素与多因素分析

Table 4. Univariate and multivariate linear regression on clinical characteristics and Leiden score

临床特点	单因素分析		多因素分析
临床特点	OR (95% CI)	P值	OR (95% CI)	P值
年龄	0.958 (0.936 ~ 0.981)	＜0.001	0.958 (0.936 ~ 0.981)	＜0.001
性别	0.680 (0.427 ~ 1.082)	0.103
BMI	0.978 (0.919 ~ 1.042)	0.493
吸烟	0.945 (0.484 ~ 1.843)	0.868
血脂异常	3.601 (1.781 ~ 7.276)	＜0.001	0.293 (0.159 ~ 0.541)	＜0.001
糖尿病	1.750 (0.986 ~ 3.109)	0.056
24 h平均收缩压	0.992 (0.984 ~ 1.000)	0.034	0.992 (0.984 ~ 1.000)	0.032
24 h平均舒张压	1.003 (0.995 ~ 1.011)	0.448
白天平均收缩压	0.989 (0.977 ~ 1.001)	0.057
白天平均舒张压	1.002 (0.996 ~ 1.008)	0.480
夜间平均收缩压	0.980 (0.967 ~ 0.994)	0.005	0.989 (0.981 ~ 0.997)	0.004
夜间平均舒张压	1.004 (0.971 ~ 1.038)	0.818
24 h收缩压变异性	0.899 (0.843 ~ 0.960)	0.001	1.054 (1.026 ~ 1.084)	＜0.001
24 h舒张压变异性	0.982 (0.924 ~ 1.044)	0.556
24 h收缩压变异系数	0.011 (0.000 ~ 0.242)	0.004	0.842 (0.752 ~ 0.943)	0.003
24 h舒张期变异系数	0.061 (0.000 ~ 17.352)	0.332
夜间收缩压下降率	1.033 (1.003 ~ 1.063)	0.038	1.004 (1.000 ~ 1.008)	0.037
夜间舒张期下降率	1.003 (0.995 ~ 1.011)	0.434
降压药	1.152 (0.630 ~ 2.106)	0.647

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