中国循证心血管医学杂志

目的 探究原发性高血压（PH）患者动态脉压（APP）及微量元素变化与颈动脉内膜中层厚度（CIMT）的相关性。方法 选择南阳市中心医院心血管内科住院的187例PH患者为研究组，另选同期本院150例健康体检者为健康组，收集患者入院后的一般临床资料，检测APP、血清微量元素（铁、锌、钙）水平及CIMT，比较两组一般资料、APP、微量元素水平及CIMT值，根据CIMT值将患者分为CIMT正常组和CIMT增厚组两个亚组，比较两亚组APP、微量元素水平及CIMT值，采用Pearson相关系数分析APP、微量元素与PH患者CIMT的相关性，采用多因素Logistic回归分析影响PH患者CIMT的相关因素。结果 研究组年龄、体质指数（BMI）、24 h收缩压（24h SBP）、24 h舒张压（24h DBP）、血清三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、APP、血清铁元素、钙元素及CIMT水平均显著高于健康组（P<0.05），锌元素显著低于健康组（P<0.05）。两组性别、吸烟史、饮酒史、心率、空腹血糖、血清总胆固醇（TC），高密度脂蛋白胆固醇（HDL-C）水平比较，差异无统计学意义（P>0.05）。CIMT增厚组PH患者APP、血清铁元素、钙元素显著高于CIMT正常组（P<0.05），锌元素显著低于CIMT正常组（P<0.05）。Pearson相关系数分析显示，PH患者CIMT与APP、铁元素、钙元素水平均呈显著正相关（P<0.05），与锌元素呈显著负相关（P<0.05）。多因素Logistic回归分析显示，BMI、24h SBP、24h DBP、APP、微量元素铁、钙水平是影响PH患者CIMT增厚的危险因素（P<0.05），锌元素水平为保护因素（P<0.05）。结论 PH患者存在APP升高及微量元素水平异常现象，且二者均与CIMT增厚显著相关。

Objective To discuss the correlation among ambulatory pulse pressure(APP),trace element changesandcarotid artery intima-media thickness(CIMT) in patients with primary hypertension(PH). Methods PH patients were chosen into study group(n=187), and healthy controls were chosen in healthy group(n=150)in Department of Cardiovascular Medicine in Central Hospital of Nanyang City. The general clinical materials were collected after patient hospitalized. The levels of APP and serum trace elements(iron, zinc, calcium) and CIMT value were detected. The general data, levels ofAPP and trace elements and CIMT value were compared between 2 groups. The patients were divided, according CIMT value, into normal CIMT subgroup and thickened CIMT subgroup, and levels of APP and trace elements and CIMT value were compared between 2subgroups. The correlation among APP, trace elements and CIMT was analyzed by using Pearson correlation coefficient analysis.The relative factors affecting CIMT value were analyzed by using multi-factor Logistic regression analysis in PH patients. Results Age, body mass index(BMI), 24 h systolic blood pressure(24h SBP), 24 h diastolic blood pressure(24h DBP), triglyceride(TG), low-density lipoprotein-cholesterol(LDL-C), levels of APP,iron and calcium and CIMT value all were significantly higher(P<0.05), and zinc level was significantly lower(P<0.05) in study group than those in healthy group. The differences in gender, smoking and drinking history, heart rate, fasting plasma glucose(FPG), total cholesterol(TC) and high-density lipoprotein-cholesterol(HDL-C) had no statistical significance between 2 groups(P>0.05). The levels of APP andiron and calcium were significantly higher(P<0.05), and zinc level was significantly lower(P<0.05) in thickened CIMT subgroup than those in normal CIMT subgroup. The result of Pearson correlation coefficient analysis showed that CIMT was positively correlated to levels of APP,iron and calcium(P<0.05), and negatively correlated to zinc level(P<0.05). The results of multifactor Logistic regression analysis showed that BMI, 24h SBP, 24h DBP, and levels of APP,iron and calcium were risk factors for CIMT thickening(P<0.05), and zinc level was a protective factor(P<0.05) in PH patients.Conclusion Increased levelsof APP and abnormal trace elements can be observed in PHpatients, and both of them are significantly correlated to CIMT thickening.