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目的观察隐蔽性高血压(MHT)、白大衣性高血压(WCHT)和持续性高血压(SHT)者冠状动脉血流储备(CFR)的变化及其影响因素。方法连续入选初诊未经治疗的MHT 92人(MHT组)、WCHT103人(WCHT组)和SHT患者128例(SHT组)为观察对象,另入选同期健康体检正常血压者80人为对照组(NT组)。采用经胸超声心动图检测CFR。比较各组间CFR的差异,并分析其可能的影响因素。结果 SHT和WCHT组的诊室血压高于MHT和NT组(均P<0.05)。MHT和SHT组的24h收缩压和舒张压、白天和夜间动态血压高于WCHT组和NT组(均P<0.05)。MHT组和SHT组的CFR低于NT组和WCHT组(MHT组:2.33±0.25比SHT组:2.30±0.37比WCHT组:2.86±0.38比NT组:2.92±0.42,均P<0.05)。Pearson相关分析显示,在所有受试者中,CFR与高敏C反应蛋白(hsCRP,r=-0.243)、诊室收缩压(r=-0.164)和舒张压(r=-0.193)、24h动态舒张压(r=-0.457)和收缩压(r=-0.386)、白天动态收缩压(r=-0.455)和舒张压(r=-0.388)、夜间动态收缩压(r=-0.334)和舒张压(r=-0.265)和空腹血糖(r=-0.159)呈负相关(均P<0.05)。多因素线性回归分析结果显示,白天动态收缩压(β=-0.736)和夜间动态收缩压(β=-0.518)是CFR减少的影响因素(均P<0.05)。结论与WCHT和正常血压者比较,MHT和SHT患者的CFR明显降低,白天动态收缩压和夜间动态收缩压是CFR减少的影响因素。
Objective To observe the changes of coronary flow reserve (CFR) in hidden hypertension (MHT), white cohypertensive hypertension (WCHT) and persistent hypertensive (SHT) and its influencing factors. Methods Totally 128 MHT patients (MHT group), WCHT103 (WCHT group) and SHT group (untreated MHD group) were enrolled in the study. Totally 80 normal SH patients were enrolled as the control group (NT group) ). Transthoracic echocardiography was used to detect CFR. CFR differences between groups were compared and the possible influencing factors were analyzed. Results The clinic blood pressure in SHT and WCHT groups was higher than that in MHT and NT groups (all P <0.05). The systolic and diastolic blood pressure (24h) and the ambulatory blood pressure during day and night in MHT and SHT group were higher than those in WCHT group and NT group (all P <0.05). The CFR of MHT group and SHT group was lower than that of NT group and WCHT group (MHT group: 2.33 ± 0.25 vs SHT group: 2.30 ± 0.37 vs WCHT group: 2.86 ± 0.38 vs NT group: 2.92 ± 0.42, both P <0.05). Pearson correlation analysis showed that the ratio of CFR to high sensitive C reactive protein (hsCRP, r = -0.243), systolic blood pressure (r = -0.164) and diastolic blood pressure (r = -0.193) (r = -0.457) and systolic blood pressure (r = -0.386), daytime systolic blood pressure (r = -0.455) and diastolic blood pressure (r = -0.388) r = -0.265) and fasting blood glucose (r = -0.159) (all P <0.05). The results of multivariate linear regression analysis showed that dynamic systolic pressure (β = -0.736) and nocturnal dynamic systolic pressure (β = -0.518) were the influencing factors of CFR reduction (all P <0.05). Conclusions Compared with WCHT and normotension, the CFR of patients with MHT and SHT were significantly decreased. Dynamic systolic blood pressure and nocturnal dynamic systolic blood pressure were the influencing factors of CFR reduction.