老年高血压合并心房颤动患者脉压与血栓前状态分子标志物的关系研究被引量：19

Association Between Pulse Pressure of Elderly Hypertensive Patients Combined With Atrial Fibrillation and Prethrombotic State Molecular Markers

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摘要目的探讨老年高血压合并心房颤动患者脉压与血栓前状态分子标志物的关系。方法选取2014年12月—2015年6月到南昌大学第二附属医院心内科就诊的老年高血压患者405例。根据是否合并心房颤动,将其分为心房颤动组(n=202)和窦性心律组(n=203);根据心房颤动类型,将心房颤动组患者分为阵发性心房颤动组(n=99)和持续性心房颤动组(n=103)。记录各组患者的动态血压监测指标和血栓前状态分子标志物水平。结果 3组患者性别、平均年龄、吸烟史比例、BMI、空腹血糖(FPG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)比较,差异无统计学意义(P>0.05);阵发性心房颤动组、持续性心房颤动组患者同型半胱氨酸(Hcy)高于窦性心律组,差异有统计学意义(P<0.05)。阵发性心房颤动组患者24 h平均收缩压(24 h SBP)、24 h平均舒张压(24 h DBP)高于窦性心律组,差异有统计学意义(P<0.05);持续性心房颤动组患者24 h SBP、24 h DBP、24 h平均脉压(24 h PP)高于窦性心律组,24 h SBP高于阵发性心房颤动组,差异有统计学意义(P<0.05)。阵发性心房颤动组患者血管内皮功能指数(RHI)低于窦性心律组,血浆D-二聚体(D-dimer)、纤维蛋白原(Fib)、红细胞比容(HCT)高于窦性心律组,差异有统计学意义(P<0.05);持续性心房颤动组患者RHI低于窦性心律组、阵发性心房颤动组,D-dimer、Fib、HCT高于窦性心律组、阵发性心房颤动组,差异有统计学意义(P<0.05)。Pearson相关分析结果显示,24 h PP与RHI、D-dimer、Fib、HCT均呈线性正相关(P<0.05)。结论老年高血压合并心房颤动患者的脉压与血栓前状态分子标志物均相关,其可能为患者血栓前状态的预测指标之一。 Objective To investigate the association between pulse pressure of elderly hypertensive patients combined with atrial fibrillation and prethrombotic state molecular markers. Methods From December 2014 to June 2015,we enrolled 405 elderly hypertensive patients who received treatment in the Department of Cardiology of the Second Affiliated Hospital of Nanchang University. According to whether atrial fibrillation existed,the patients were divided into two groups： atrial fibrillation group（ n= 202） and sinus rhythm group（ n = 203）; according to the type of atrial fibrillation,the patients were divided into paroxysmal atrial fibrillation group（ n = 99） and persistent atrial fibrillation group（ n = 103）. Ambulatory blood pressure monitoring indicators and prethrombotic state molecular markers of patients in each group were recorded. Results The three groups were not significantly different in gender,average age,proportion of patients with smoking history,BMI,FPG,TC,LDL-C and HDL-C（ P〈0. 05）; paroxysmal atrial fibrillation group and persistent atrial fibrillation group were higher than sinus rhythm group in Hcy（ P〈0. 05）. Paroxysmal atrial fibrillation group was higher than sinus rhythm group in 24 h SBP and 24 h DBP（ P〈0. 05）;persistent atrial fibrillation group was higher than sinus rhythm group in 24 h SBP,24 h DBP and 24 h PP,and was higher than paroxysmal atrial fibrillation group in 24 h SBP（ P〈0. 05）. Paroxysmal atrial fibrillation group was lower in RHI and higher in D- dimer,Fib and HCT than sinus rhythm group（ P〈0. 05）; persistent atrial fibrillation group was lower in RHI and higher in D- dimer,Fib and HCT than sinus rhythm group and paroxysmal atrial fibrillation group（ P〈0. 05）. Pearson correlation analysis showed that 24 h PP had positive linear correlation with RHI,D- dimer,Fib and HCT（ P〈0. 05）. Conclusion The pulse pressure of elderly hypertensive patients combined with atrial fibrillation has correlation with prethrombotic state molecular mark