24 h动态血压变异与心脏结构和功能的关系
收稿日期: 2018-11-01
网络出版日期: 2019-04-25
基金资助
上海市卫生和计划生育委员会面上项目课题(201840064)
Association between 24-h ambulatory blood pressure variability and cardiac structure and function
Received date: 2018-11-01
Online published: 2019-04-25
目的：探讨24 h动态血压变异与心脏结构及功能间的关系。方法：纳入未经降压药物治疗的初发或疑似高血压的门诊患者80例，行24 h动态血压监测及超声心动图检查，计算24 h血压标准差（standard deviation，SD）、变异系数（coefficient of variation，CV）、平均实际血压变异（average real variability, ARV）、血压最大与最小差值（maximum-minimum difference, MMD）及独立于血压水平的血压变异（variability independent of the mean, VIM）。应用多元线性回归，将血压变异参数与血压水平同时放入模型，计算血压变异参数、血压水平与心超指标关联的标准偏回归系数（standardized β）及偏决定系数。结果：24 h血压水平与左心室质量指数（收缩压， β为6.8~8.0，P<0.01;舒张压， β为6.7~7.8，P<0.01）、左心室纵向应变（收缩压， β为-0.76~-0.71，P<0.05;舒张压， β为-0.81~-0.71，P<0.05）及室间隔E/e’比值（收缩压， β为0.44~0.57，P<0.05）独立相关，解释了8.3%~35.1%的心脏结构和功能变异，而24 h血压变异参数在校正了血压水平后， 除了24 h收缩压CV、VIM与左室质量指数（β=3.3，P=0.048， β=3.4，P=0.049）微弱相关，24 h舒张压MMD与室间隔E/e’比值相关（β=0.46，P=0.034），解释了1.2%~6.0%的心脏结构和功能变异外，其余参数均不相关。结论：24 h短时血压变异与心脏结构功能有关，但血压水平仍可能是影响心脏结构和功能的主要因素。
徐婷嬿, 杨龑, 李晶晶, 张冬燕, 王颖, 王继光, 李燕 . 24 h动态血压变异与心脏结构和功能的关系[J]. 诊断学理论与实践, 2019 , 18(2) : 193 -198 . DOI: 10.16150/j.1671-2870.2019.02.014
Objective: To investigate the association between 24-h ambulatory blood pressure variability and cardiac structure and function in untreated patients. Methods: The association between 24-hour ambulatory blood pressure (BP) recordings and echocardiography in 80 untreated patients referred to a hypertension clinic was assessed. BP variability indices were standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), maximum-minimum difference (MMD), and average real variability (ARV). Effect sizes (standardized β)and partial coefficient of determination were computed using multivariable regression models. Results: Left ventricular mass index(LVMI) (systolic BP: β=6.8—8.0, P<0.01; diastolic BP: β=6.7—7.8, P<0.01), longitudinal strain(LS) (systolic BP: β=-0.76—-0.71, P<0.05; diastolic BP: β=-0.81—-0.71, P<0.05) and septal E/e' (systolic BP: β=0.44—0.57, P<0.05) were associated independently with BP, whereas the association with BP variability was not significant except for those of LVMI with systolic BP CV and VIM ( β=3.3, P=0.048, β=3.4, P=0.049), and of septal E/e' with diastolic BP MMD ( β=0.46, P=0.034). Conclusion: Short-term 24-h blood pressure variability is associated with cardiac structure and function, but blood pressure might be a major factor affecting these cardiac indices.
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