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目的研究高同型半胱氨酸(homocysteine,Hey)的高血压的动态血压模式并探讨其与左心室肥厚的关系。方法选择2014年3月-2015年3月,就诊于我院心内科100例H型高血压患者为H型高血压组,100例血清Hey浓度<10μmol/L的高血压患者为普通高血压组,行24h动态血压监测比较两组平均脉压差、高血压晨峰、血压变异性及血压变化节律等指标,同时比较两组左室质量指数(left ventricular mass index,LVMI),组间数值变量资料的比较用独立样本t检验,组间分类变量的比较用随机设计的χ2检验或Fisher精确概率法,利用多元线性回归分析高血压病左室肥厚的相关因素,P<0.05为差异有统计学意义。结果H型高血压组的脉压差、“非杓型”血压变化曲线的发生率[(65.2±16.7mm Hg=0.133kPa)、35.3%]显著高于普通高血压组[(56.7±15.3)mm Hg、16.4%],而夜间收缩压下降率、舒张压下降率[(11.8±8.9)%、(11.8±8.2)%]均明显低于普通高血压组[(14.9±8.7)%、(16.7±8.5)%],差异均有统计学意义(均P<0.05)。结论H型高血压脉压差大,且夜间血压下降率低,导致血压波动呈“非杓型”样曲线,而高血浆Hcy浓度、24hSBP升高、夜间SBP下降率可能导致左室肥厚。
Objective To study the dynamic blood pressure pattern of hypertension with homocysteine (Hey) and to explore its relationship with left ventricular hypertrophy. Methods From March 2014 to March 2015, 100 hypertensive patients with Hypertension who were treated in our hospital were Hypertension group and 100 Hypertensive patients with serum Hey concentration <10μmol / L were treated as normal hypertensive group , 24h ambulatory blood pressure monitoring were compared between the two groups mean pulse pressure, peak morning hypertension, blood pressure variability and blood pressure rhythm and other indicators, while two groups of left ventricular mass index (LVMI), between the two groups of numerical variables Data were compared using independent samples t-test, group comparison of categorical variables using randomized Chi-square test or Fisher exact test, using multiple linear regression analysis of hypertension-related factors of left ventricular hypertrophy, P <0.05 for the difference was statistically significant significance. Results The incidences of pulse pressure difference and non-dipper blood pressure curve in Hypertension group were significantly higher than those in the control group [(65.2 ± 16.7mm Hg = 0.133kPa), 35.3%] (56.7 ± (11.8 ± 8.9)%, (11.8 ± 8.2)%] were significantly lower than those in the common hypertension group [(14.9 ± 8.7)%] , (16.7 ± 8.5)%], the differences were statistically significant (all P <0.05). Conclusions Hypertension is associated with a large pulse pressure difference and low nocturnal decline in blood pressure, resulting in a “non-dipper” curve of blood pressure fluctuations. However, elevated plasma Hcy levels and increased 24hSBP, and nighttime SBP decline may lead to left ventricular hypertrophy .