目的 探讨高血压病(EH)及合并2型糖尿病(T2DM)患者24 h动态血压水平及与心踝血管指数(CAVI)、踝臂指数(ABI)的相关性.方法 随机入选90例高血压病患者,分为单纯高血压病组(EH组,n=47),高血压病伴糖尿病组(EH+T2DM组,n=43).所有入选者进行24 h动态血压监测,CAVI、ABI指标及颈动脉超声检查.对两组上述指标进行比较,并对动态血压与CAVI、ABI进行直线相关分析.结果 与EH组患者比较,EH+T2DM组患者各时段的平均收缩压(SBP)、脉压(PP)、收缩压负荷(SBP-L)及CAVI呈增高趋势,而ABI和夜间血压下降率降低,两组比较均有统计学差异(P均＜0.05).EH组患者杓型血压占42.5%,EH+T2DM杓型血压占23.3%,两组比较有统计学差异(P＜0.05).CAVI与24 h平均收缩压(24 hSBP)、夜间平均收缩压(nSBP)、24 h平均脉压差(24 hPP)、日间平均脉压差(dPP)、夜间平均脉压差(nPP)、夜间收缩压负荷(nSBP-L)、夜间舒张压负荷(nDBP-L)呈正相关,ABI与24 hSBP、白天平均收缩压(dSBP)、dPP、白天收缩压负荷(dSBP-L)、nSBP-L等指标呈负相关.结论 合并T2DM可增加EH患者收缩压、脉压及收缩压负荷水平,并加速动脉硬化的进展.%Objective To investigate the correlation among 24-hour ambulatory blood pressure ( BP ), cardio-ankle vascular index ( CAVI ) and ankle-brachial index ( ABI ) in the patients with essential hypertension ( EH ) complicating type 2 diabetes mellitus ( T2DM ). Methods All EH patients ( n = 90 ) were randomly divided into simple hypertension group ( EH group, n = 47 ) and hypertension complicating T2DM group ( EH + T2DM group, n = 43 ), and they were all given detections of 24-hour ambulatory BP, CAVI and ABI and carotid ultrasonography. All indexes were compared in two groups,and the changes of ambulatory BP,CAVI and ABI were given linear correlation analysis. Results Compared with EH group, mean systolic BP ( SBP ), pulse pressure ( PP ), systolic BP-load ( SBP-L ) and CAVI trended to increase, and ABI and descent rate of nocturnal BP decreased in EH + T2DM group ( all P <0. 05 ). The patients with dipper BP accounted for 42. 5% in EH group and 23. 3% in EH + T2DM group ( P <0. 05 ). CAVI was positively correlated to 24-hour mean SBP, mean nocturnal SBP, 24-hour mean PP, day mean PP, mean nocturnal PP, nocturnal SBP-L and nocturnal diastolic BP-load. ABI was negatively related to 24-hour SBP,mean day SBP,day PP, day SBP-L and nocturnal SBP-L. Conclusion The levels of SBP, PP and SBP-L, and development of atherosclerosis are increased in the patients with EH complicating T2DM.
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