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目的探讨老年原发性高血压病患者动态脉压与颈动脉狭窄及斑块形成的关系。方法选择149例老年男性原发性高血压病患者进行24h动态血压监测及颅外段颈动脉超声检查,计算颅外段颈动脉斑块指数(PI)。分别以全天平均脉压(PP)第33及第67百分位数(57及67mmHg)为界值,将所有病例分为A、B、C三组,比较各组PI、颈总动脉内膜中层厚度(IMT)及颈总动脉(CCA)狭窄发生率。结果①颈动脉PI与平均收缩压、PP均呈正相关,P<0.01;②A、B、C三组间年龄及颈动脉PI呈上升趋势,C组与A、B组比较有显著性差异;CCA狭窄发生率呈递增趋势,C组与A组比较有显著性差异。③多因素分析显示,年龄(OR19.309,95%CI为2.001～186.306,P<0.05)、PP(OR2.063,95%CI为1.215～3.506,P<0.01)是CCA狭窄的独立危险因素。结论老年男性原发性高血压患者颅外段颈动脉PI与PP显著相关,年龄、PP是颈动脉狭窄的独立危险因素。
Objective To investigate the relationship between ambulatory pulse pressure and carotid artery stenosis and plaque formation in elderly patients with essential hypertension. Methods One hundred and ninety-nine elderly patients with essential hypertension were monitored for ambulatory blood pressure (24h) and extracranial carotid ultrasonography to calculate the extracranial carotid plaque index (PI). All cases were divided into three groups A, B and C respectively according to the 33rd and 67th percentiles (57 and 67mmHg) of the mean daily pulse pressure (PP) Membrane thickness (IMT) and carotid artery (CCA) stenosis incidence. Results ①The PI of carotid artery was positively correlated with mean systolic pressure and PP, P <0.01. ②The age and carotid artery PI of A, B and C groups showed an upward trend. There was significant difference between C and A and B groups. CCA The prevalence of stenosis showed an increasing trend. There was a significant difference between group C and group A. ③Multivariate analysis showed that age (OR19.309, 95% CI 2.001-186.306, P <0.05), PP (OR 2.063, 95% CI 1.215-3.506, P <0.01) were independent risk factors for CCA stenosis . Conclusion The extracranial segment of carotid artery in elderly men with essential hypertension is significantly associated with PP. Age and PP are independent risk factors for carotid artery stenosis.