门诊患者血压昼夜节律变化及相关影响因素分析

doi:10.16150/j.1671-2870.2019.03.013

摘要/Abstract

摘要：

目的： 基于动态血压监测电子报告系统,分析门诊患者的血压昼夜节律变化情况及其相关影响因素。方法： 选取2017年2月至2018年2月上海瑞金医院高血压研究所动态血压监测门诊,通过烁云动态血压电子报告系统监测的5 545份合格数据,其中男性2 524例,女性3 021例,平均年龄为（53.0±14.3）岁,计算其夜间收缩压的下降率,并将昼夜节律分为反杓型、非杓型、杓型和超杓型。结果： ①所有研究对象中,血压昼夜节律呈杓型者最多（2 323例,41.9%）,其次为非杓型（2 318例,41.8%）,反杓型（532例,9.6%）和超杓型（372例,6.7%）较少。②不同昼夜节律分型中,反杓型人群的平均年龄最大[（60.2±13.3）岁],杓型人群的平均年龄最小[（50.9±14.1）岁]。反杓型人群的夜间平均血压、动态动脉硬化指数（ambulatory arterial stiffness index,AASI）、合并疾病比例[糖尿病（14.1%）、脑卒中（14.3%）、心肌梗死（1.7%）]以及高血压患病率均高于其他亚型（P<0.05）;杓型人群的高血压患病率（76.3%）低于其他亚型（P<0.05）;超杓型人群的白天平均血压要高于其他亚型（P<0.05）,而夜间平均血压、AASI要低于其他亚型（P<0.05）;各亚型组间的体质量指数、降压药服用比例、高脂血症比例差异均无统计学意义（P>0.05）。③Logistic回归分析显示,女性、年龄、糖尿病、高血压是血压昼夜节律异常的危险因素,而使用降压药的患者及吸烟者表现为杓型节律较多。结论： 高血压门诊患者中,约一半表现为血压昼夜节律异常;女性、年龄增长、糖尿病、高血压是异常昼夜节律的危险因素,而降压治疗及吸烟者更可能表现为正常杓型血压节律。

关键词: 动态血压, 反杓型, 非杓型, 杓型, 超杓型, 血压昼夜节律

Abstract:

Objective: Based on an electronic reporting system of ambulatory blood pressure monitoring (ABPM), the circadian blood pressure rhythm and related influencing factors in outpatients were analyzed. Methods: From February 2017 to February 2018, 5 545 outpatients with eligible ABPM data in the Shuoyun electronic reporting system were recruited. Of them there were 2 524 males and 3 021 females, with an average age of (53±14.3) years. The rate of nocturnal systolic blood pressure(SBP) decrease was calculated, according to which the circadian rhythm was categorized into four types:reverse-dipper, non-dipper, dipper and extreme-dipper. Results: The number of dippers was the most (2 323, 41.9%), followed by non-dippers (2 318, 41.8%), and the reverse-dippers (532, 9.6%) and extreme-dippers (372, 6.7%) were much less. The reverse-dippers were the oldest [average age, (60.2±13.3) years], and the dippers were the youngest [(50.9±14.1) years]. The nighttime SBP, ambulatory arterial stiffness index (AASI), the proportion of concomitant diseases (diabetes, stroke, myocardial infarction) and the prevalence of hypertension of the reverse-dippers were higher than the others (P<0.05); the prevalence of hypertension in dippers was lower than the others.The average daytime SBP of the extreme-dippers was higher (P<0.05) than the others, while the nighttime SBP, AASI were lower(P<0.05) than the others. There were no significant differences in body mass index, proportion of taking antihypertensive drugs and hyperlipidemia among the groups (P>0.05). Logistic regression analysis showed that women, aging, diabetes mellitus and hypertension were risk factors for abnormal circadian rhythm, and patients taking antihypertensive drugs and smokers tended to be dippers (P<0.05). Conclusions: In outpatients of the Hypertension Clinic, around half have abnormal circadian blood pressure rhythm. Female, aging, the presence of diabetes and hypertension were risk factors, while patients on antihypertensive medication and smokers were more likely to be dippers.

Key words: Ambulatory blood pressure monitoring, Reverse-dipper, Non-dipper, Dipper, Extreme-dipper, Circadian rhythm

中图分类号:

R544.1

黄剑峰, 盛长生, 黄绮芳, 程艾邦, 郭芊卉, 张冬燕, 王继光, 李燕. 门诊患者血压昼夜节律变化及相关影响因素分析[J]. 诊断学理论与实践, 2019, 18(03): 313-318.

HUANG Jianfeng, SHENG Changsheng, HUANG Qifang, CHENG Yibang, GUO Qianhui, ZHANG Dongyan, WANG Jiguang, LI Yan. Study on circadian blood pressure rhythmandrelated influencing factors in outpatients[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(03): 313-318.

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参考文献 24

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项目	反杓型	非杓型	杓型	超杓型	P值
人数	532（9.6）	2 318（41.8）	2 323（41.9）	372（6.7）	/
年龄（岁）	60.2±13.3^c)	53.4±14.3^c)	50.9±14.1	52.9±13.7^a)	<0.001
男性	191（35.9）^c)	1 038 (44.8)^a)	1 118 (48.1)	177(47.6)	<0.001
24 h平均收缩压(mmHg)	130.2±14.5^b)	128.1±12.5	127.9±11.9	129.9±12.3^b)	<0.001
24 h平均舒张压(mmHg)	81.7±10.8	83.1±11.0	82.6±10.6	82.9±10.8	0.046
白天平均收缩压(mmHg)	128.5±14.2^c)	130.5±12.8^c)	133.2±12.5	138.5±13.2^c)	<0.001
白天平均舒张压(mmHg)	81.6±11^c)	85.4±11.4^c)	86.8±11.2	89.0±11.6^b)	<0.001
夜间平均收缩压(mmHg)	135.8±15.9^c)	123.1±12.4^c)	114.3±10.9	106.8±10.5^c)	<0.001
夜间平均舒张压(mmHg)	82.7±11.2^c)	77.8±10.6^c)	72.0±9.7	66.5±9.3^c)	<0.001
24 h平均心率（次/分）	71.3±9.0^c)	73.1±8.6	73.4±8.7	73.1±8.6	<0.001
夜间收缩压下降率	-0.06±0.05^c)	0.06±0.03^c)	0.14±0.03	0.23±0.03^c)	<0.001
AASI	0.57±0.16^c)	0.51±0.18^c)	0.44±0.17	0.41±0.14^c)	<0.001
体质量指数（kg/m²）	24.7±3.3	24.5±3.4	24.4±3.3	24.3±3.1	0.244
吸烟	84（15.8）	276(11.9)^b)	338(14.6)	62(16.7)	<0.001
糖尿病病史	75（14.1）^c)	203(8.8)^b)	148(6.4)	26(7.0)	<0.001
高血压	511（96.1）^c)	1 991(85.9)^c)	1 773(76.3)	308(82.8)^c)	<0.001
高血压服用降压药	84（16.4）^a)	381(19.1)	370(20.9)	66(21.4)	0.114
卒中病史	76（14.3）^c)	202(8.7)^a)	161(6.9)	24(6.5)	<0.001
心肌梗死病史	9（1.7）^b)	17(0.7)	11(0.5)	0	<0.010
高脂血症病史	119(22.4)	479(20.7)	463(19.9)	78(21.0)	0.641

项目	反杓型	非杓型	杓型	超杓型	P值
24 h平均收缩压（mmHg）
模型1	130.90±0.54^c)	128.20±0.26	127.67±0.26	129.86±0.64^a)	<0.001
模型2	130.54±0.53^c)	128.15±0.25	127.77±0.25	129.95±0.63^b)	<0.001
24 h平均舒张压（mmHg）
模型1	84.00±0.43^c)	83.22±0.20^c)	81.96±0.20	82.82±0.50	<0.001
模型2	83.94±0.42^c)	83.22±0.20^c)	81.98±0.20	82.78±0.50	<0.001
白天平均收缩压（mmHg）
模型1	129.23±0.56^c)	130.56±0.26^c)	133.03±0.26	138.42±0.66^c)	<0.001
模型2	128.88±0.55^c)	130.52±0.26^c)	133.14±0.26	138.51±0.65^c)	<0.001
白天平均舒张压（mmHg）
模型1	84.13±0.44^b)	85.60±0.21	86.14±0.21	88.92±0.52^c)	<0.001
模型2	84.08±0.44^c)	85.60±0.21	86.15±0.21	88.87±0.52^c)	<0.001
夜间平均收缩压（mmHg）
模型1	136.31±0.53^c)	123.09±0.25^c)	114.14±0.25	106.73±0.62^c)	<0.001
模型2	135.97±0.52^c)	123.09±0.24^c)	114.24±0.25	106.81±0.61^c)	<0.001
夜间平均舒张压（mmHg）
模型1	84.59±0.42^c)	77.95±0.20^c)	71.49±0.20	66.37±0.49^c)	<0.001
模型2	84.56±0.41^c)	77.96±0.19^c)	71.50±0.20	66.32±0.49^c)	<0.001
24 h平均心率（次/分）
模型1	72.55±0.37	73.18±0.17	73.01±0.17	73.06±0.43	0.478
模型2	72.51±0.37	73.19±0.17	73.02±0.17	73.02±0.43	0.420
AASI
模型1	0.54±0.01^c)	0.51±0.00^c)	0.45±0.00	0.41±0.01^c)	<0.001
模型2	0.54±0.01^c)	0.51±0.00^c)	0.45±0.00	0.41±0.01^c)	<0.001

变量	Β值	SE	Wald χ²	P值	OR值	95%CI
女性（1是,0否）	0.158	0.063	6.348	0.012	1.172	1.036~1.325
年龄（ +10岁）	0.192	0.022	74.592	<0.001	1.212	1.160~1.266
吸烟（1是,0否）	-0.193	0.089	4.736	0.030	0.825	0.694~0.981
糖尿病（1是,0否）	0.341	0.109	9.839	0.002	1.407	1.137~1.742
高血压（1是,0否）	0.930	0.077	144.867	<0.001	2.533	2.178~2.947
使用降压药（1是,0否）	-0.324	0.079	16.840	<0.001	0.723	0.620~0.844