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目的分析心血管自主神经功能与高血压并2型糖尿病患者血压节律的相关性。方法选取2013年6月—2015年6月东营市河口区人民医院心内科收治的门诊高血压患者80例(高血压组)、高血压并2型糖尿病患者80例(高血压并2型糖尿病组)。比较两组患者动态血压监测指标[包括24 h收缩压(24 h SBP)、24 h舒张压(24h DBP)、昼间SBP(Dt-SBP)、昼间DBP(Dt-DBP)、夜间SBP(Nt-SBP)、夜间DBP(Nt-DBP)、昼夜SBP下降值(ΔSBP)、昼夜DBP下降值(ΔSBP)、杓型血压发生率]和标准心血管自主神经功能测试(SCAFT)指标[包括Valsalva动作反应指数、呼吸差、卧立位血压差、30∶15比值、SCAFT评分],采用Spearman秩相关分析SCAFT评分与高血压并2型糖尿病患者动态血压监测指标、糖化血红蛋白的相关性。结果两组患者24 h SBP、24 h DBP、Dt-SBP、Dt-DBP比较,差异无统计学意义(P>0.05);高血压并2型糖尿病组患者Nt-SBP、Nt-DBP高于高血压组,ΔSBP、ΔDBP及杓型血压发生率低于高血压组(P<0.05)。高血压并2型糖尿病组患者Valsalva动作反应指数、30∶15比值低于高血压组,呼吸差、卧立位血压差、SCAFT评分高于高血压组(P<0.05)。Spearman秩相关分析结果显示,SCAFT评分与高血压并2型糖尿病组患者Nt-SBP、Nt-DBP、糖化血红蛋白呈正相关(rs值分别为0.433、0.372、0.583,P<0.05),与ΔSBP、ΔDBP呈负相关(rs值分别为-0.315、-0.448,P<0.05)。结论心血管自主神经功能与高血压并2型糖尿病患者血压节律密切相关。
Objective To analyze the correlation between cardiovascular autonomic nervous function and blood pressure rhythm in patients with type 2 diabetes mellitus and hypertension. Methods From June 2013 to June 2015, 80 outpatients with hypertension (hypertension group), 80 patients with type 2 diabetes mellitus (hypertension and type 2 diabetes mellitus group) were enrolled in Department of Cardiology, Hekou District People’s Hospital of Dongying City, ). The indexes of ambulatory blood pressure monitoring including 24 h SBP, 24 h DBP, Dt-SBP, DBP Dpt and DBP at night were compared between the two groups Nt-SBP, Nt-DBP, SBP decline (ΔSBP), DBP decline (ΔSBP), incidence of dipper blood pressure, and SCAFT indicators [including Valsalva Action response index, breathing difference, lying position pressure, 30:15 ratio, SCAFT score], using Spearman rank correlation analysis of SCAFT score and patients with type 2 diabetes mellitus and ambulatory blood pressure monitoring indicators, HbA1c. Results There was no significant difference in 24 h SBP, 24 h DBP, Dt-SBP and Dt-DBP between the two groups (P> 0.05). The levels of Nt-SBP and Nt-DBP were higher in patients with type 2 diabetes mellitus Blood pressure group, ΔSBP, ΔDBP and dipper blood pressure were lower than those in hypertension group (P <0.05). Valsalva action response index in patients with hypertension and type 2 diabetes was lower than that in hypertension group at 30:15, with poor breathing and lying-on-position blood pressure. SCAFT score was higher in hypertension group than in hypertension group (P <0.05). Spearman rank correlation analysis showed that there was a positive correlation between SCAFT score and Nt-SBP, Nt-DBP, HbA1c in patients with type 2 diabetes mellitus (rs 0.433,0.372,0.583, P <0.05, respectively) (Rs = -0.315, -0.448, P <0.05 respectively). Conclusions Cardiovascular autonomic nervous function is closely related to the blood pressure rhythm of patients with type 2 diabetes mellitus and hypertension.