无创血流动力学参数在中年与青年高血压患者中的变化及其与颈动脉病变的关系

Changes of non-invasive hemodynamic parameters in young and middle-aged patients with hypertension and their relationship with carotid arterial lesions

摘要:

目的]探讨无创血流动力学参数在中年与青年高血压患者中的变化及其与颈动脉病变的关系。 [方法]纳入2021年10月—2024年4月收治的689例高血压患者为研究对象,根据收缩压(SBP)、舒张压(DBP)水平将患者划分为高血压1级(SBP:140~159 mmHg；DBP:90~99 mmHg)、高血压2级(SBP:160~179 mmHg；DBP:100~109 mmHg)和高血压3级(SBP:≥180 mmHg；DBP:≥110 mmHg)。根据Crouse积分评估颈动脉病变程度:无病变[0分:内膜中膜厚度(IMT)＜1 mm]、IMT增厚(1分:IMT 1~1.2 mm)、斑块形成(2分:IMT 1.2~1.5 mm)、轻微狭窄(3分:IMT 1.5~2.0 mm)、显著狭窄(4分:IMT＞2.0 mm)。根据IMT值将患者分为颈动脉病变组(IMT≥1 mm,即Crouse积分≥1分)和无病变组(IMT＜1 mm,即Crouse积分＜1分)。多因素Logistic回归模型分析高血压患者颈动脉病变的危险因素。相乘模型与相加模型分析年龄与无创血流动力学参数对颈动脉病变的交互作用。限制性立方样条模型分析无创血流动力学参数与高血压患者颈动脉病变的水平-反应关系。 [结果]中青年高血压患者从高血压1级到3级,冠状动脉重度狭窄(Gensini评分≥50分)占比、Crouse积分≥2分占比、胸液水平(TFC)、每搏变异率(SVV)、外周血管阻力(SVR)、外周血管阻力指数(SVRI)、加速度指数(ACI)、平均动脉压(MAP)、24 h平均收缩压(24h-mSBP)、24 h平均舒张压(24h-mDBP)、24 h收缩压变异性(24hSBPV)和24 h舒张压变异性(24hDBPV)逐渐升高(P＜0.05)。且与无病变组比较,颈动脉病变组年龄以及上述指标均升高(P＜0.05)。中年、高血压分级3级、TFC＞32 kΩ－1、SVR＞1 534 dyne·s/cm⁵、ACI＞91、24h-mSBP＞167 mmHg、24hSBPV＞12.9 mmHg是影响颈动脉病变的独立危险因素(P＜0.05)。年龄与TFC、SVR、ACI对颈动脉病变具有相乘交互作用(OR＞1)和相加交互作用(RERI＞0,AP＞0,SI＞1)。TFC、SVR和ACI水平与青年(P_non-linearity＝0.002、0.016、0.028)和中年(P_non-linearity＝0.003、0.007、0.015)高血压患者颈动脉病变均呈非线性水平-反应关系。 [结论]中青年高血压患者TFC、SVR和ACI水平均随血压分级的升高而升高,且各指标升高均是颈动脉病变的独立危险因素。

Abstract:

Aim To explore the changes of non-invasive hemodynamic parameters in young and middle-aged patients with hypertension and their relationship with carotid arterial lesions. Methods A total of 689 hypertensive patients admitted to our hospital from October 2021 to April 2024 were enrolled as the research subjects. Patients were divided into hypertension grade 1 (systolic blood pressure (SBP):140～159 mmHg; diastolic blood pressure (DBP):90～99 mmHg), hypertension grade 2 (SBP:160～179 mmHg; DBP:100～109 mmHg) and hypertension grade 3 (SBP:≥180 mmHg; DBP:≥110 mmHg) according to their levels of SBP and DBP. The severity of carotid artery lesions was evaluated using the Crouse score, with the grading criteria as follows:non-lesion (0 point:intima-media thickness (IMT) ＜1 mm), IMT thickening (1 point:IMT 1～1.2 mm), plaque formation (2 points:IMT 1.2～1.5 mm), mild stenosis (3 points:IMT 1.5～2.0 mm) and severe stenosis (4 points:IMT＞2.0 mm). In addition, patients were divided into the carotid artery lesion group (IMT≥1 mm, Crouse score≥1 point) and the non-lesion group (IMT ＜1 mm, Crouse score ＜1 point) according to IMT values. Multivariate Logistic regression model was used to identify risk factors for carotid artery lesions in hypertensive patients. Multiplicative model and additive model were used to analyze the interaction between age and non-invasive hemodynamic parameters on carotid arterial lesions. Additionally, restricted cubic spline model was used to examine the dose-response relationship between non-invasive hemodynamic parameters and carotid arterial lesions in hypertensive patients. Results In young and middle-aged hypertensive patients, the proportions of severe coronary artery stenosis (Gensini score ≥ 50 points) and Crouse score≥ 2 points, as well as thoracic fluid content (TFC), stroke volume variation (SVV), systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), acceleration index (ACI), mean arterial pressure (MAP), 24-hour mean systolic blood pressure (24h-mSBP), 24-hour mean diastolic blood pressure (24h-mDBP), 24-hour systolic blood pressure variability (24hSBPV), and 24-hour diastolic blood pressure variability (24hDBPV) all showed a gradual increase from hypertension grade 1 to grade 3 (P＜0.05). Compared with the non-lesion group, age and the above-mentioned indicators were significantly increased in the carotid artery lesion group (P＜0.05). Middle-age, grade 3 hypertension, TFC＞32 kΩ－1, SVR＞1 534 dyne·s/cm⁵, ACI＞1,4h-mSBP＞167 mmHg and 24hSBPV＞12.9 mmHg were independent risk factors for carotid arterial lesions. Age exhibited multiplicative interaction (OR＞1) and additive interaction (RERI＞0, AP＞0, SI＞1) with TFC, SVR and ACI on carotid arterial lesions. Levels of TFC, SVR, and ACI exhibited a non-linear dose-response relationship with carotid arterial lesions in young hypertensive patients (P_non-linearity＝0.2,0.6,0.028) and middle-aged hypertensive patients (P_non-linearity＝0.3,0.7,0.015). Conclusion In young and middle-aged hypertensive patients, the levels of TFC, SVR and ACI all increase with the elevated blood pressure grade, as well as the elevation of each indicator is an independent risk factor for carotid arterial lesions.