尿毒症患者冠状动脉钙化与血压变异性的相关性研究

Association between blood pressure variability and vascular calcification in uremic patients

摘要:

目的探讨尿毒症患者血管钙化与血压变异性的相关性。方法收集患者的一般资料，利用24 h动态血压仪检测脉压、血压变异系数及昼夜节律变化，利用双源螺旋CT 对心脏平扫，计算冠状动脉（冠脉）钙化评分，分析冠脉钙化评分与血压变异的相关性。结果72例尿毒症患者，冠脉钙化阳性组与阴性组相比，24 h脉压、日间脉压、夜间脉压、独立于夜间收缩压的变异系数及独立于夜间舒张压的变异系数升高，差异有统计学意义（P <0.05）；按冠脉钙化评分分组，中度钙化组与阴性组比较，24 h脉压、日间脉压及夜间脉压升高，差异有统计学意义性（P <0.05）。相关性分析显示，冠脉钙化评分与24 h收缩压变异系数（r =0.468，P=0.028）、夜间收缩压变异系数（ r=0.641， P=0.001）、独立于24 h 收缩压的变异系数（ r=0.540，P =0.009）及独立于夜间收缩压的变异系数（r =0.756， P=0.000）均正相关。结论尿毒症患者冠脉钙化阳性组的脉压及夜间血压变异系数高于阴性组；尿毒症患者冠脉钙化评分与收缩压变异系数正相关。

Abstract:

Objective To investigate the association between vascular calcification and blood pressure variability (BPV) in uremic patients. Methods Medical history and laboratory values of the uremic patients were collected. Pulse pressure (PP), blood pressure variability and circadian rhythm of each patient were recorded by ambulatory blood pressure monitoring (ABPM). Coronary artery calcification score (CACS) of each patient was calculated by plain scan dual-resource spiral CT, and correlation between CACS and BPV was analyzed. Results In 72 uremic patients who received coronary CT scan and ABPM, coronary calcification positive group presented significantly higher 24 hPP, dPP, nPP, nCVS and nCVD (P < 0.05) compared with coronary calcification negative group. Moderate calcification group presented significantly higher 24 hPP, dPP and nPP (P < 0.05) compared with coronary calcification negative group. The CACS was significant positive correlated with 24 h CVSBP (r = 0.468, P= 0.028), nCVSBP (r =0.641, P= 0.001), 24 h CVS (r = 0.540, P=0.009) and nCVS (r = 0.756, P= 0.000) respectively. Conclusions Coronary calcification positive group presents higher PP and night blood pressure variability coefficient over negative group. CACS and systolic pressure variability coefficient are positively correlated.