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目的探讨尿微量白蛋白(MAU)和动态脉压(PP)与冠脉病变严重程度的关系。方法对252例入选病例均行冠脉造影术,其中男168例,女84例,年龄(57.8±11.3)岁。所有患者均用放射免疫法(RIA)测量术前晨尿MAU。且均于术后进行24h动态血压监测(ABPM)。冠脉病变的狭窄程度用病变的血管支数及Gensini积分表示。结果冠脉单支、双支及三支病变组,MAU均显著高于冠脉正常组(P<0.01);冠脉单支、双支及三支病变组,动态各收缩压(SBP)、PP均显著高于冠脉正常组(P<0.05);且MAU及PP随冠脉血管狭窄支数的增加而逐渐增加。多元线性逐步回归分析结果显示:MAU、24h动态PP、白天动态PP、夜间动态PP、年龄均与冠心病(CHD)冠脉狭窄程度的关系密切,其中以夜间动态PP的相关性最强。结论MAU与动态PP密切相关,MAU可以作为CHD冠脉狭窄程度的预测因子。动态各PP均是CHD冠脉狭窄发生发展的独立危险因素,且夜间动态PP的预测价值更佳。
Objective To investigate the relationship between urinary microalbumin (MAU) and dynamic pulse pressure (PP) and the severity of coronary artery disease. Methods A total of 252 selected patients underwent coronary angiography, including 168 males and 84 females, with an average age of 57.8 ± 11.3 years. Preoperative morning urine MAU was measured by radioimmunoassay (RIA) in all patients. And 24h after ambulatory blood pressure monitoring (ABPM). The degree of coronary artery stenosis with lesion vascular count and Gensini points expressed. Results The MAU in single coronary arteries, double stents and three lesion groups were significantly higher than those in normal coronary arteries (P <0.01). Dynamic coronary systolic pressure (SBP) PP were significantly higher than the normal coronary artery group (P <0.05); and MAU and PP increased with the increase of coronary stenosis count. Multivariate linear stepwise regression analysis showed that MAU, 24h dynamic PP, daytime dynamic PP, nocturnal dynamic PP, and age were all closely related to coronary artery stenosis (CHD) severity, of which nighttime dynamic PP had the strongest correlation. Conclusion MAU is closely related to dynamic PP, MAU can be used as a predictor of coronary stenosis. The dynamics of each PP are independent risk factors for the development of coronary stenosis, and the predictive value of dynamic PP at night is better.