兰州大学机构库 >第二临床医学院
绝经对女性高血压患者中心动脉压及动脉硬化的影响
Alternative TitleThe Effect of Menopause on Central Blood Pressure and Arterial Stiffness in Female Patients with Hypertension
张晓芳
Subtype硕士
Thesis Advisor余静
2017-03-01
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword高血压 绝经 性激素 中心动脉压 动脉硬化
Abstract

目的:随着绝经时间的延长、女性高血压的患病率进一步增高、动脉硬化的程度也应进一步加重。本研究探讨不同绝经年限高血压女性患者相比同龄男性其中心动脉压及相关动脉硬化参数变化的特点,为女性绝经后高血压的管理提供理论依据。方法:选取2014年11月—2015年11月就诊于兰州大学第二医院高血压病科的高血压患者118人(女性 N=51人;男性 N=67人)年龄58.62±8.31,依据女性绝经年限分为近期绝经组(绝经年限小于5年,N=25人;年龄52.20±3.70)及远期绝经组(绝经年限大于5年,N=26人;年龄65.15±5.92)。同时分别纳入与上述两组女性换着年龄一致的男性高血压患者作为对照,其中近期对照组(N=34人;年龄51.62±4.62),远期对照组(n=33人;年龄65.55±5.23)。检测所有患者的身高、体重、腹围、血糖,血脂,并检测女性患者的性激素水平(雌二醇 Estrogen、睾酮 Testosterone、孕激素 Progesterone),用欧姆龙电子血压计测量外周肱动脉血压,用使用Sphygmocor 脉搏波分析系统间接测量中心动脉收缩压(cSBP)、中心动脉舒张压(cDBP)、中心动脉压脉压(CPP)、增强压(AP)、反射波增益指数(AIx)、75次心率增益指数校正指数(AIx75HR)及颈股动脉脉搏波传导速率(cf-PWV)。结果:(1)对于绝经年限小于5年的女性高血压患者(绝经年限=2.40±1.89)与其同龄男性高血压相比较,SBP、DBP、HR、cSBP、cDBP、cf-PWV均低于同龄男性患者,且对于SBP、DBP、cDBP,两组间差异有统计学意义(P=0.024、P=0.007、P=0.007)。绝经年限小于5年的女性高血压患者其PP、AP、CPP、AIx和AIx75HR均高于同龄男性高血压组,仅AIx75HR两组间差异具有统计学意义P<0.05(P=0.035)。(2)对于绝经年限大于5年的女性高血压患者(绝经年限=16.35±6.07),与同龄男性高血压患者相比,女性组SBP、PP、HR、cSBP、CPP、AP、AIx、AIx75HR、cf-PWV均大于男性组,且两组间SBP、PP、cSBP、CPP 、AP、AIx75HR差异具有统计学意义(P=0.010、P=0.001、P=0.017、P=0.002、P=0.045、P=0.007)。(3)以绝经后女性高血压患者的cSBP、cDBP、CPP、AIx75HR、cf-PWV为因变量变量,以年龄、绝经年限、高血压病史、BMI、腰围,血糖、血脂、性激素及外周血压为自变量,行多因素逐步回归发现,对于绝经后高血压女性,其中心动脉压的变化主要与SBP、DBP及HR有关,而与性激素并无统计学关联,同时女性高血压患者的脉搏波传导速率与绝经年限有关。(4)对于绝经年限小于5年的女性患者,其雌二醇(eE2)。睾酮(TSTO)及孕激素(PRGE)水平均大于绝经年限大于5年的女性患者,且两组间雌二醇水平的差异具有统计学意义(P=0.043)。而且绝经年限大于5年的高血压患者具有更高的外周血压水平和中心动脉压水平,且两组间SBP、PP、cSBP、CPP的差别均具有统计学意义,说明绝经年限较长的女性具有更高的外周及中心动脉压水平,但是其激素水平却较低。结论:对于高血压女性患者,绝经年限较短的女性患者与男性相比外周血压及中心动脉压水平均较低,而绝经年限较长的女性其外周血压及中心动脉压明显高于同龄男性患者,尽管绝经后女性患者雌激素水平下降明显,但近期绝经的的女性其体内的雌激素水平要高于远期绝经的女性患者,说明对于绝经年限较短的女性,雌激素水平仍可维持在一定的水平,使得雌激素对心血管系统的有益作用得以维持,同时研究也发现,雌激素不仅对外周血压,对中心动脉压也有保护作用。而女性组相比个男性对照组动脉硬化更为明显,可能与围绝经期及绝经期后雌激素水平异常引起的血管舒张功能异常及血管内皮炎症反应增强引起动脉硬化有关。

Other Abstract

Aim: With the increased of duration of menopause , the incidence of hypertension and the status of arterial stiffness were worse. So, the purpose of this study is to make sure the characteristics of central blood pressure and arterial stiffness in female hypertension with different menopause period .Found the evidence for antihypertensive strategy in menopause female.Methods: One hundred and eighteen subjects of essential hypertension were selected from Lanzhou University Second Hospital during November 2014 to November 2015. Fifty-one patients were female while Sixty-seven were male ,with the age 58.62±8.31. All female patients divided into two groups by the duration of menopause, one was short-term group (N=25,average age 52.20±3.70, duration of menopause is less than or equal five years). And at same time, Thirty-four male patients whose age similar to female (average age is 51.62±4.26) were selected as the short duration controls . Another twenty-six female hypertensive patients was long-term postmenopausal group (average age is 65.15±5.92), equally, thirty-there male patients of similar age were also selected as the long term control subjects(average age is 65.55±5.23).Body height, weight, waist circumference, fast plasma glucose, plasma lipid, sex hormone of female ,peripheral brachial blood pressure were measured. Central aortic systolic blood pressure(cSBP), central diastolic pressure(cDBP), central aortic pulse pressure(APP), central aortic pressure augmentation index(AIx), augmentation index adjusting for a heart rate of 75 beats/min(AIx75HR), carotid-femoral pulse wave velocity(cf-PWV) were detected by SphygmoCor Clinical Assessment .Then ,compared the difference of central blood pressure parameters and arterial stiffness between female and male in two groups by t-test ,if the P value less than 0.05,the difference was regarded as significantly.Results:(1)In short-term group, SBP ,DBP ,HR ,cSBP ,cf-PWV in male were higher than in female,and the differences of SBP,DBP, cDBP were significant. For females, the parameters of PP, AP, CPP, AIx and AIx75HR were higher than those of males. The difference of AIx75HR between males and females were statistical significant(P=0.035). However, there was no statistically significance for PP, CPP ,AP ,AIx .This result demonstrated that there were significant difference in central blood pressure parameters between males and females. (2) But in long-term group, the parameter of SBP, DBP,PP, HR, cSBP , CPP, AP, AIx , AIx75HR and cf-PWV in females were higher than those of in males ,and the differences of SBP(P=0.010) ,PP(P=0.001) ,cSBP(P=0.0170) ,CPP(P=0.002) ,AP(P=0.045) ,AIx75HR(P=0.007)were statistical significant .However, there were no statistical significance for DBP ,HR ,cDBP ,AIx and cf-PWV. For the females whose duration of menopause was more than 5 years, the peripheral brachial blood pressure and central blood pressure was higher than in males, those arterial stiffness was also worse than in males. (3)In multiple stepwise regression analysis ,regard the cSBP,cDBP,CPP,AIx75HR,cf-PWV as the dependent variable, the age, hypertensive history ,duration of menopause, BMI, waist circumference, fast plasma glucose, plasma lipid, sex hormone of female ,peripheral brachial blood pressure were independent variable,   the influence factor of central blood pressure were SBP, DBP ,PP and HR. For cf-PWV ,the duration of menopause is also the influence factor. (4)For the female of short-term groups ,The estrogen of estradiol (eE2) ,Testosterone ( TSTO ) progesterone( PGRE ) were higher than long-term groups, and the difference of eE2 is significant  .This result demonstrated that the deficiency of estrogen was milder for short-term female. However ,the patients in long-term group had higher peripheral brachial blood pressure and central blood pressure, the differences of SBP ,PP, cSBP , CPP were significant .Conclusion: In female patients of essential hypertension, short-term group females ,their peripheral brachial blood pressure and central blood pressure were lower than males whose age similar to them but this phenomenon was adverse for long-term females .Additional long-short females group have higher arterial stiffness parameter than males group ,but not found in short-term group .Demonstrated the protective effect of estrogen were existed in short-term postmenopausal women,this effect not only protect the peripheral brachial blood pressure but also the central blood pressure. However the arterial stiffness in females was worse than males ,reveal the factors of arterial stiffness were diverse ,and the deficiency of estrogen may play a important role by attenuated endothelium-dependent vasodilatation and increased the inflammatory reaction of vascular endothelium.

URL查看原文
Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/200982
Collection第二临床医学院
Recommended Citation
GB/T 7714
张晓芳. 绝经对女性高血压患者中心动脉压及动脉硬化的影响[D]. 兰州. 兰州大学,2017.
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