高血压患者血压控制水平、血脂水平及颈动脉斑块与冠脉病变的关系

目的:探讨血压控制水平、血脂水平和颈动脉斑块与高血压患者冠脉病变程度和病变支数的关系。方法:回顾性分析2014年01月至2016年05月收住于南京中医药大学附属江苏省中西医结合医院心血管科的原发性高血压患者273例,按血压控制水平分为达标组和未达标组。按颈动脉超声结果判断有无斑块,冠状动脉造影结果使用Gensini评分和病变支数表示,并检测血脂指标。结果:血压控制达标者130人(47.61%),颈动脉有斑块者193例(70.70%)。与血压控制达标患者相比,血压控制不达标者冠脉病变支数及冠脉狭窄程度得分均明显增加(P0.05)。血压不达标合并斑块患者冠脉病变支数和狭窄程度与血压达标无斑块、血压达标合并斑块及血压不达标无斑块患者相比均明显增加(P0.001)。患者HDL-C水平与冠状动脉狭窄程度呈负相关(r=-0.139,P=0.022),AI与冠状动脉狭窄程度呈正相关(r=0.136,P=0.025),LDL/HDL-C和AI与冠脉病变支数均呈正相关,分别为(r=0.128,P=0.035)和(r=0.137,P=0.023)。结论:血压控制不佳,高血脂和颈动脉斑块形成可增加高血压患者冠脉病变的严重程度。

The Relationship between Blood Pressure Control, Blood Lipid Levels, Carotid Artery Plaque and Severity of Coronary Artery in Patients with Hypertension

ABSTRACT Objective: To explore the relationship between blood pressure control, blood lipid levels, carotid artery plaque and the severity and numbers of diseased coronary artery in patients with hypertension. Methods: A total of 273 cases of hospitalized patients with primary hypertension were included in the department of Cardiology, Hospital on Integration of Chinese and Western Medicine Affiliated to Nanjing University of Chinese Medicine from January 2014 to May 2016. According to the level of blood pressure control, patients were divided into good control group and poor control group. According to carotid artery ultrasonography, patients were judged with plaque or not. The results of coronary angiography were presented using Gensini scores and the number of diseased artery. Blood lipid levels were tested. Results: There were 130 patients (47.61%) with good blood pressure control, and 193 patients (70.70%) with carotid artery plaque. Compared with the good blood pressure control, poor blood pressure control patients had increased numbers of dis- eased coronary artery and higher Gensini scores (P<0.05). Compared with the patients who had good blood pressure control without plaque, good blood pressure control with plaque or poor blood pressure control without plaque, patients with poor blood pressure control and carotid artery plaque had more numbers of diseased coronary artery and higher Gensini scores (P<0.001). HDL-C was negatively cor- related with coronary artery stenosis degree (r=-0.139, P=0.022), AI and coronary artery stenosis degree was positively related (r=0.136, P=0.025). LDL/HDL-C and AI were positively correlated with the number of diseased coronary artery, respectively (r=0.128, P=0.035) and (r=0.137, P=0.023)]. Conclusion: Poor blood pressure control, hyperlipemia and carotid artery plaque could increase the severity of coronary artery disease in patients with hypertension.