【摘要】：目的:隨著絕經(jīng)時間的延長、女性高血壓的患病率進一步增高、動脈硬化的程度也應進一步加重。本研究探討不同絕經(jīng)年限高血壓女性患者相比同齡男性其中心動脈壓及相關動脈硬化參數(shù)變化的特點,為女性絕經(jīng)后高血壓的管理提供理論依據(jù)。方法:選取2014年11月—2015年11月就診于蘭州大學第二醫(yī)院高血壓病科的高血壓患者118人(女性N=51人;男性N=67人)年齡58.62±8.31,依據(jù)女性絕經(jīng)年限分為近期絕經(jīng)組(絕經(jīng)年限小于5年,N=25人;年齡52.20±3.70)及遠期絕經(jīng)組(絕經(jīng)年限大于5年,N=26人;年齡65.15±5.92)。同時分別納入與上述兩組女性換著年齡一致的男性高血壓患者作為對照,其中近期對照組(N=34人;年齡51.62±4.62),遠期對照組(n=33人;年齡65.55±5.23)。檢測所有患者的身高、體重、腹圍、血糖,血脂,并檢測女性患者的性激素水平(雌二醇Estrogen、睪酮Testosterone、孕激素Progesterone),用歐姆龍電子血壓計測量外周肱動脈血壓,用使用Sphygmocor脈搏波分析系統(tǒng)間接測量中心動脈收縮壓(cSBP)、中心動脈舒張壓(cDBP)、中心動脈壓脈壓(CPP)、增強壓(AP)、反射波增益指數(shù)(AIx)、75次心率增益指數(shù)校正指數(shù)(AIx75HR)及頸股動脈脈搏波傳導速率(cf-PWV)。結果:(1)對于絕經(jīng)年限小于5年的女性高血壓患者(絕經(jīng)年限=2.40±1.89)與其同齡男性高血壓相比較,SBP、DBP、HR、cSBP、cDBP、cf-PWV均低于同齡男性患者,且對于SBP、DBP、cDBP,兩組間差異有統(tǒng)計學意義(P=0.024、P=0.007、P=0.007)。絕經(jīng)年限小于5年的女性高血壓患者其PP、AP、CPP、AIx和AIx75HR均高于同齡男性高血壓組,僅AIx75HR兩組間差異具有統(tǒng)計學意義P0.05(P=0.035)。(2)對于絕經(jīng)年限大于5年的女性高血壓患者(絕經(jīng)年限=16.35±6.07),與同齡男性高血壓患者相比,女性組SBP、PP、HR、cSBP、CPP、AP、AIx、AIx75HR、cf-PWV均大于男性組,且兩組間SBP、PP、cSBP、CPP、AP、AIx75HR差異具有統(tǒng)計學意義(P=0.010、P=0.001、P=0.017、P=0.002、P=0.045、P=0.007)。(3)以絕經(jīng)后女性高血壓患者的cSBP、cDBP、CPP、AIx75HR、cf-PWV為因變量變量,以年齡、絕經(jīng)年限、高血壓病史、BMI、腰圍,血糖、血脂、性激素及外周血壓為自變量,行多因素逐步回歸發(fā)現(xiàn),對于絕經(jīng)后高血壓女性,其中心動脈壓的變化主要與SBP、DBP及HR有關,而與性激素并無統(tǒng)計學關聯(lián),同時女性高血壓患者的脈搏波傳導速率與絕經(jīng)年限有關。(4)對于絕經(jīng)年限小于5年的女性患者,其雌二醇(eE2)。睪酮(TSTO)及孕激素(PRGE)水平均大于絕經(jīng)年限大于5年的女性患者,且兩組間雌二醇水平的差異具有統(tǒng)計學意義(P=0.043)。而且絕經(jīng)年限大于5年的高血壓患者具有更高的外周血壓水平和中心動脈壓水平,且兩組間SBP、PP、cSBP、CPP的差別均具有統(tǒng)計學意義,說明絕經(jīng)年限較長的女性具有更高的外周及中心動脈壓水平,但是其激素水平卻較低。結論:對于高血壓女性患者,絕經(jīng)年限較短的女性患者與男性相比外周血壓及中心動脈壓水平均較低,而絕經(jīng)年限較長的女性其外周血壓及中心動脈壓明顯高于同齡男性患者,盡管絕經(jīng)后女性患者雌激素水平下降明顯,但近期絕經(jīng)的的女性其體內(nèi)的雌激素水平要高于遠期絕經(jīng)的女性患者,說明對于絕經(jīng)年限較短的女性,雌激素水平仍可維持在一定的水平,使得雌激素對心血管系統(tǒng)的有益作用得以維持,同時研究也發(fā)現(xiàn),雌激素不僅對外周血壓,對中心動脈壓也有保護作用。而女性組相比個男性對照組動脈硬化更為明顯,可能與圍絕經(jīng)期及絕經(jīng)期后雌激素水平異常引起的血管舒張功能異常及血管內(nèi)皮炎癥反應增強引起動脈硬化有關。
[Abstract]:Objective: with the prolongation of menopause time, the prevalence of hypertension in women is further increased and the degree of arteriosclerosis should be further aggravated. This study explores the characteristics of the changes of central arterial pressure and related arteriosclerosis parameters in women with different age of menopause compared to the same age male, and provides a rational management of postmenopausal hypertension for women. Methods: 118 people (female N=51 people, male N=67 people) aged 58.62 + 8.31 from November 2014 to November 2015 in the Department of hypertension, Second Hospital Affiliated to Lanzhou University, were divided into short term menopause group (menopause less than 5 years, 25 N=; age 52.20 + 3.70) and long term menopause group (menopause age big). In 5 years, N=26 people; age 65.15 + 5.92). At the same time, the male hypertension patients with the same age in the two groups were taken as the control, including the recent control group (N=34 person; age 51.62 + 4.62), the forward control group (n=33 person; age 65.55 + 5.23). The height, weight, abdominal circumference, blood sugar, blood lipid of all the patients were detected and the female patients were detected. The level of sex hormone (estradiol Estrogen, testosterone Testosterone, progesterone Progesterone), the peripheral brachial artery blood pressure measured with a OMRON sphygmomanometer, and indirect measurement of central arterial systolic pressure (cSBP), central artery diastolic pressure (cDBP), central artery pressure pulse pressure (CPP), enhanced pressure (AP), and reflected wave gain by using the Sphygmocor pulse wave analysis system. Index (AIx), 75 heart rate gain index correction index (AIx75HR) and cervical femoral pulse pulse wave conduction rate (cf-PWV). Results: (1) compared to the same age male hypertension in women with menopause less than 5 years (=2.40 + 1.89), SBP, DBP, HR, cSBP, cDBP, cf-PWV were lower than those of the same age male patients, and DBP, SBP, DBP. BP, the difference between the two groups was statistically significant (P=0.024, P=0.007, P=0.007). The PP, AP, CPP, AIx and AIx75HR in women with menopause less than 5 years were higher than those of the same age male hypertension group, but the difference between the AIx75HR two groups was statistically significant (P=0.035). (2) for women with menopause for more than 5 years (menopause years) SBP, PP, HR, cSBP, CPP, AP, AIx, AIx75HR, cf-PWV in the female group were more than the male group, and the two groups of SBP, PP, cSBP, 0.002, respectively. (3) the female hypertensive patients after menopause For variable variables, age, menopause, history of hypertension, BMI, waist circumference, blood sugar, blood lipids, sex hormones and peripheral blood pressure were independent variables, and multiple factors stepwise regression was found. For postmenopausal women with hypertension, the changes in central arterial pressure were mainly related to SBP, DBP and HR, but had no statistical correlation with sex hormones. The pulse wave conduction rate was related to the period of menopause. (4) for women with menopause less than 5 years, the levels of estradiol (eE2), testosterone (TSTO) and progesterone (PRGE) were greater than those of women with menopause for more than 5 years, and the difference of estradiol levels between the two groups was statistically significant (P=0.043). And the period of menopause was higher than 5 years. The blood pressure patients have higher peripheral blood pressure level and central arterial pressure level, and the differences of SBP, PP, cSBP and CPP between the two groups are statistically significant, indicating that women with longer menopausal years have higher peripheral and central arterial pressure levels, but their hormone levels are low. Conclusion: for women with hypertension, the menopause is shorter. Female patients have lower peripheral blood pressure and central arterial pressure compared with men, while women with longer menopausal women have higher peripheral blood pressure and central arterial pressure than men of the same age. Although estrogen levels in postmenopausal women have a significant decrease in estrogen levels, the levels of estrogen in the recent menopause women are higher than those of long-term menopause. The female patients showed that the estrogen level still maintained at a certain level for women with shorter menopause, which kept the beneficial effects of estrogen on the cardiovascular system, and the study also found that estrogen not only had peripheral blood pressure, but also had a protective effect on central arterial pressure, while the female group was more hard than a male control group. It is more obvious that it may be associated with abnormal vasodilatation and increased vascular endothelial inflammatory reaction caused by abnormal estrogen level in perimenopause and postmenopausal period.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R544.1

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