原发性高血压肝阳上亢证患者的24h血压变异性、心功能、血管重构状况及临床意义

张南龙 江丹娜 陈磊

[摘要] 目的 探討原发性高血压肝阳上亢证患者24 h血压变异性、心功能、血管重构状况及意义。 方法 选取我院2019年6月至2020年6月接诊的40例原发性高血压肝阳上亢证患者为研究组，另选取同期40名体检人群作对照组。检测两组24 h平均收缩压（SBP）、舒张压（DBP）、脉压、白昼和夜间SBP和DBP等24 h动态血压及其血压变异性、日间和夜间平均心率、24 h平均心率及血管总面积（TVA）、颈动脉的管腔面积（LA）、颈动脉内径（ID）、斑块面积（PA）、面积狭窄率（S）、颈动脉内膜-中层厚度（IMT）、颈总动脉 IMT 与内径ID比值（IMT/ID）等血管重构指标。 结果 研究组24 h平均SBP和DBP、平均脉压、白昼SBP和DBP、夜间SBP和DBP等24 h动态血压均明显高于对照组，差异有统计学意义（P<0.05）。研究组24 h平均SBP和DBP变异、平均脉压变异、白昼SBP和DBP变异、夜间SBP和DBP变异等24 h血压变异性均明显高于对照组，差异有统计学意义（P<0.05）。研究组日间、夜间平均心率、24 h平均心率均明显高于对照组，差异有统计学意义（P<0.05）。两组TVA、LA、ID相比，差异无统计学意义（P>0.05），研究组PA、S、IMT、IMT/ID指标明显高于对照组，差异有统计学意义（P<0.05）。 结论 血压变异性、心功能、血管重构多个临床指标与原发性高血压患者肝阳上亢证存在一定相关性，对病情的诊断、靶向治疗可提供重要的参考意义。

[关键词] 原发性高血压;肝阳上亢证;血压变异性;心功能;血管重构

[中图分类号] R544.11          [文献标识码] A          [文章编号] 1673-9701（2021）30-0026-03

[Abstract] Objective To explore the 24-hour blood pressure variability，cardiac function，vascular remodeling in patients with primary hypertension with liver-yang hyperactivity syndrome. Methods Patients with primary hypertension with liver-yang hyperactivity syndrome admitted to our hospital from June 2019 to June 2020 were selected as the study group（n=40），and other healthy people undergoing physical examination in the same period were selected as the control group（n=40）.The 24-hour ambulatory blood pressure and blood pressure variability，including 24-hour average systolic blood pressure（SBP），diastolic blood pressure（DBP），pulse pressure，daytime and nighttime SBP，DBP，etc.，daytime and nighttime average heart rate，24-hour average heart rate，total vascular area （TVA），lumen area（LA） of carotid artery，inner diameter（ID） of carotid artery，plaque area（PA），area stenosis rate （S），intima-media thickness（IMT）of carotid artery and the ratio of IMT/ ID of common carotid artery，etc.，were measured between the two groups. Results The 24-hour average SBP and DBP，average pulse pressure，daytime SBP and DBP， nighttime SBP and DBP，etc.In the study group were all significantly higher than those in the control group （P<0.05）.The 24-hour blood pressure variability，including 24-hour average SBP and DBP variation，average pulse pressure variation，daytime SBP and DBP variation and nighttime SBP and DBP variation，etc.In the study group were all significantly higher than those in the control group（P<0.05）.The average heart rate during daytime and nighttime and 24-hour in the study group were all significantly higher than those in the control group（P<0.05）.There were no statistically significant differences in TVA，LA and ID between the two groups （P>0.05），but indices of PA，S，IMT and IMT/ID in the study group were significantly higher than those in the control group（P<0.05）. Conclusion Blood pressure variability，cardiac function，vascular remodeling and other clinical indices are related to the patients with primary hypertension with liver-yang hyperactivity syndrome，which provides an important reference for the diagnosis and targeted treatment of the disease.

[Key words] Essential hypertension; Liver-yang hyperactivity syndrome; Blood pressure variability; Cardiac function; Vascular remodeling

原发性高血压是临床上常见的心血管疾病，有研究表明，其发病机制与患者先天遗传和后天生活环境有一定关联性。原发性高血压会引发心肌梗死、心力衰竭、脑出血、脑梗死、慢性肾功能衰退等并发症，给患者的正常生活带来严重的困扰[1-2]。……