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目的探讨不同动态血压参数与冠状动脉病变严重程度的相关性。方法可疑冠心病患者212例,行冠状动脉造影同时进行24h动态血压监测,根据造影结果分为非冠状动脉病变组(43例)和冠状动脉病变组(169例),冠状动脉病变组患者根据病变范围再分为单支血管病变组(56例)、双支血管病变组(38例)与3支血管病变组(75例),分析比较各组动态血压参数。结果冠状动脉病变组24h平均收缩压、24h平均脉压、白天平均收缩压、白天平均脉压、夜间平均收缩压、夜间平均脉压、最高收缩压、最低收缩压均明显高于非冠状动脉病变组(P<0.05),且随着狭窄支数增加而逐渐增高,以3支血管病变组明显(P<0.05);冠状动脉病变组白天平均舒张压、夜间平均舒张压、24h平均舒张压、最高舒张压均明显低于非冠状动脉病变组(P<0.05),且随狭窄支数增加有逐渐下降趋势,但差异无统计学意义(P>0.05);与杓型血压模式比较,非杓型、反杓型、超杓型血压模式患者双支和3支血管病变发生率率明显增高(P<0.05);多因素回归分析结果显示,夜间平均收缩压对冠心病有独立的预测价值(P<0.05)。结论夜间平均脉压、最高收缩压与冠状动脉病变严重程度密切相关,夜间平均收缩压是预测冠状动脉病变的最佳参数;血压模式的改变是造成冠状动脉病变的重要因素。
Objective To investigate the relationship between different dynamic blood pressure parameters and the severity of coronary artery disease. Methods 212 patients with suspected coronary heart disease underwent coronary angiography at the same time 24h ambulatory blood pressure monitoring, angiography results were divided into non-coronary artery disease group (43 cases) and coronary artery disease group (169 cases), coronary artery disease group according to the lesion The range was further divided into single vessel disease group (56 cases), double vessel disease group (38 cases) and 3 vessel disease group (75 cases). The dynamic blood pressure parameters of each group were compared. Results 24h systolic blood pressure, 24h mean pulse pressure, daytime mean systolic pressure, mean daytime pulse pressure, nighttime average systolic pressure, nighttime mean pulse pressure, maximum systolic pressure, and minimum systolic pressure were significantly higher in patients with coronary artery disease than in non-coronary artery disease (P <0.05), and gradually increased with the increase of stenosis count, which was significantly higher in 3-vessel disease group (P <0.05). The mean daytime diastolic blood pressure, nighttime mean diastolic pressure, 24h mean diastolic pressure, The maximum diastolic pressure was significantly lower than that of non-coronary artery disease group (P <0.05), and decreased gradually with the increase of stenosis count, but the difference was not statistically significant (P> 0.05). Compared with the dipper blood pressure mode, (P <0.05). The multivariate regression analysis showed that nighttime average systolic blood pressure had independent predictive value on coronary heart disease (P <0.05) P <0.05). Conclusions Nighttime mean pulse pressure and maximum systolic pressure are closely related to the severity of coronary artery disease. Nighttime average systolic pressure is the best parameter for predicting coronary artery disease. The change of blood pressure pattern is an important factor of coronary artery disease.