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目的 :探讨病情控制状况对原发性高血压冠脉血流储备(CFR)的影响。方法 :选取经CT或冠状动脉造影检查确诊各支血管管腔直径狭窄均<50%的患者210例,其中非高血压患者56例作为对照组,高血压患者154例。按照患者体检测量的血压水平高低,将高血压患者分为正常组(30例,血压水平控制得较好,收缩压/舒张压<120/80 mm Hg)、达标组(71例,血压水平控制达标,120 mm Hg≤收缩压<140 mm Hg,且舒张压<90 mm Hg)与未达标组(53例,血压水平控制未达标,收缩压≥140 mm Hg和(或)舒张压≥90mm Hg)。统计分析四组患者CFR、脉搏波速度(PWV)等临床指标的差异,多元线性回归分析原发性高血压CFR的影响因素。结果 :(1)未达标组年龄(64.6±6.2)高于对照组(57.9±12.1)、正常组(59.4±10.6)和达标组(60.6±9.5)。(2)未达标组(9.4±1.62)舒张末期室间隔厚度(IVST)高于对照组(8.2±1.3)、正常组(8.5±1.1)和达标组(8.6±1.5);未达标组(7.6±1.9)与达标组(7.3±2.1)的二尖瓣舒张早期血流速度E峰/二尖瓣环侧壁舒张早期运动速度E’峰(E/E’)明显高于正常组(6.4±1.8)、对照组(6.1±1.6)。(3)未达标组b PDV(0.28±0.09)高于对照组(0.24±0.05)和正常组(0.24±0.04)。未达标组CFR最低(2.56±0.47),其次是达标组(2.81±0.51),正常组(3.23±0.72)和对照组(3.29±0.66)最高。未达标组PWV最高(12.96±1.51),其次是达标组(10.83±1.22),正常组(9.15±1.43)和对照组(8.92±1.24)最小。(4)高龄、PWV升高、血压控制差是CFR下降的危险因素。结论 :血压控制在120/80 mm Hg以下、PWV水平下降、低龄有利于改善无明显冠状动脉狭窄的原发性高血压患者的CFR水平。
Objective: To investigate the effect of disease control on coronary blood flow reserve (CFR) in patients with essential hypertension. Methods: Totally 210 patients were diagnosed by CT or coronary angiography. The patients with non-hypertensive patients as the control group and the hypertensive patients as the control group. Hypertensive patients were divided into normal group (30 cases, control of blood pressure level is good, systolic blood pressure / diastolic blood pressure <120/80 mm Hg) according to the level of blood pressure measured by the patient’s examination. The standard group (71 cases, control of blood pressure level Up to the standard of 120 mm Hg ≤ systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg) were compared with those in the non-compliance group (n = 53, blood pressure level not up to standard, systolic blood pressure ≥ 140 mm Hg and / or diastolic blood pressure ≥ 90 mm Hg ). Statistical analysis of four groups of patients CFR, pulse wave velocity (PWV) and other clinical indicators of differences, multiple linear regression analysis of essential hypertension CFR factors. Results: (1) The age of non-compliance group (64.6 ± 6.2) was higher than that of control group (57.9 ± 12.1), normal group (59.4 ± 10.6) and standard group (60.6 ± 9.5). (2) The interventricular septum thickness (IVST) of the non-compliance group (9.4 ± 1.62) was higher than that of the control group (8.2 ± 1.3), the normal group (8.5 ± 1.1) and the compliance group (8.6 ± 1.5) ± 1.9), and E (E / E ’) of mitral early mitral diastolic mitral early diastolic velocities and mitral annular velocities were significantly higher than those of normal group (6.4 ± 1.8), control group (6.1 ± 1.6). (3) PDV (0.28 ± 0.09) in non-compliance group was higher than that in control group (0.24 ± 0.05) and normal group (0.24 ± 0.04). The lowest CFR (2.56 ± 0.47) in the non-compliance group, followed by the compliance group (2.81 ± 0.51), the normal group (3.23 ± 0.72) and the control group (3.29 ± 0.66) were the highest. The PWV in the non-compliance group was the highest (12.96 ± 1.51), followed by the compliance group (10.83 ± 1.22), the normal group (9.15 ± 1.43) and the control group (8.92 ± 1.24). (4) elderly, PWV increased, poor blood pressure control is a risk factor for decreased CFR. CONCLUSIONS: Blood pressure is controlled below 120/80 mm Hg, PWV is decreased, and younger age is beneficial to improve CFR in patients with essential hypertension without obvious coronary stenosis.