作者：王玎羽1，林菁榕1，吴晓瑞2，崔佳伟3 ，徐寅实4

单位：

1.100049北京市，航天中心医院教育处　2.100049北京市，航天中心医院呼吸与危重症医学科　3.100049北京市，航天中心医院信息处　 4.100049北京市，航天中心医院医务部

Units：

1.Education Cluster, Aerospace Center Hospital, Beijing 100049, China 2.Department of Respiratory and Critical Care Medicine, Aerospace Center Hospital, Beijing 100049, China 3.Information Department, Aerospace Center Hospital, Beijing 100049, China 4.Medical Department, Aerospace Center Hospital, Beijing 100049, China

关键词：

高血压；老年人；体位性高血压；血小板参数；凝血功能

Keywords：

Hypertension; Aged ; Orthostatic hypertension; Platelet parameter; Coagulation function

CLC：

　R 544.1

DOI：

10.12114/j.issn.1008-5971.2022.00.028

Funds：

摘要：

背景　体位性高血压会增加中老年人群心血管疾病发生风险，而血小板参数与凝血功能指标是评估 高血压患者缺血性心脑血管疾病发生风险的重要指标，故分析体位性高血压患者血小板参数和凝血功能指标变化有利 于体位性高血压的诊治。目的　探究血小板参数、凝血功能指标与老年高血压患者发生体位性高血压的关系。方法 选取2020年9月至2021年4月航天中心医院收治的老年高血压患者243例，其中发生体位性高血压患者107例（体位性高 血压组）、未发生体位性高血压患者136例（对照组）。比较两组患者临床资料和实验室检查指标，老年高血压患者 发生体位性高血压的影响因素分析采用多因素Logistic回归分析；老年高血压患者立位醛固酮与肾素比值（ARR）与血 小板参数、凝血功能指标的相关性分析采用Pearson相关分析。结果　体位性高血压组患者冠心病发生率及有吸烟史、 饮酒史、高血压家族史者所占比例高于对照组（P＜0.05）。体位性高血压组患者血肌酐、卧位ARR、立位ARR、血 小板计数（PLT）、血小板分布宽度（PDW）、纤维蛋白原（FIB）高于对照组，估算肾小球滤过率（eGFR）低于对 照组，平均血小板体积（MPV）大于对照组，凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间 （TT）短于对照组（P＜0.05）。多因素Logistic回归分析结果显示，血肌酐〔OR=1.135，95%CI（1.033，1.247）〕、 eGFR〔OR=1.262，95%CI（1.056，1.509）〕、立位ARR〔OR=1.251，95%CI（1.051，1.489）〕、PLT〔OR=1.642， 95%CI（1.059，2.547）〕、MPV〔OR=1.038，95%CI（1.004，1.073）〕、PDW〔OR=1.528，95%CI（1.061， 2.200）〕、PT〔OR=1.248，95%CI（1.035，1.503）〕和APTT〔OR=1.116，95%CI（1.048，1.189）〕是老年高血 压患者发生体位性高血压的独立影响因素（P＜0.05）。Pearson相关分析结果显示，老年高血压患者立位ARR与PLT （r=0.359）、MPV（r=0.336）、PDW（r=0.314）、FIB（r=0.263）呈正相关，与PT（r=-0.327）、APTT（r=-0.285）、 TT（r=-0.345）呈负相关（P＜0.05）。结论 PLT、MPV、PDW、PT和APTT是老年高血压患者发生体位性高血压的影 响因素，而立位ARR与老年高血压患者血小板参数和凝血功能指标有关。

Abstract：

Background Postural hypertension will increase the risk of cardiovascular disease in middleaged and elderly people. Platelet parameters and coagulation function indicators are important indicators to assess the risk of ischemic cardiovascular and cerebrovascular diseases in patients with hypertension. Analyzing changes of platelet parameters and coagulation function indicators in patients with postural hypertension is conducive to clinical diagnosis and treatment of postural hypertension. Objective To explore the relationship of platelet parameters and coagulation function indicators with postural hypertension in elderly patients with hypertensive. Methods A total of 243 elderly patients with hypertension treated in Aerospace Center Hospital from September 2020 to April 2021 were selected, including 107 patients with postural hypertension (postural hypertension group) and 136 patients without postural hypertension (control group) . The clinical data and laboratory indexes were compared between the two groups. The influencing factors of postural hypertension in elderly patients with hypertension were analyzed by multivariate Logistic regression analysis; Pearson correlation analysis was used to analyze the correlation between ratio of aldosterone to rennin (ARR) in standing position and platelet parameters, coagulation function indicators in elderly patients with hypertension. Results The incidence of coronary heart disease and the proportion of patients with smoking history, drinking history and family history of hypertension in postural hypertension group were higher than those in the control group (P < 0.05) . The serum creatinine, ARR in lying position, ARR in standing position, platelet count (PLT) , platelet distribution width (PDW) , fibrinogen (FIB) in postural hypertension group were higher than those in the control group, the estimated glomerular filtration rate (eGFR) was lower than that in the control group, the average platelet volume (MPV) was greater than that in the control group, and the prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) in the postural hypertension were shorter than those in the control group (P < 0.05) . Multivariate Logistic regression analysis showed that serum creatinine [OR=1.135, 95%CI (1.033, 1.247) ] , eGFR [OR=1.262, 95%CI (1.056, 1.509) ] , ARR in standing position [OR=1.251, 95%CI (1.051, 1.489) ] , PLT [OR=1.642, 95%CI (1.059, 2.547) ] , MPV [OR=1.038, 95%CI (1.004, 1.073) ] , PDW [OR=1.528, 95%CI (1.061, 2.200) ] , PT [OR=1.248, 95%CI (1.035, 1.503) ] and APTT [OR=1.116, 95%CI (1.048, 1.189) ] were independent influencing factors of postural hypertension in elderly patients with hypertension (P < 0.05) . Pearson correlation analysis showed that the ARR in standing position in elderly patients with hypertension was positively correlated with PLT (r=0.359) , MPV (r=0.336) , PDW (r=0.314) and FIB (r=0.263), and negatively correlated with PT (r=-0.327) , APTT (r=-0.285) and TT (r=-0.345) (P < 0.05) . Conclusion PLT, MPV, PDW, PT and APTT are the influencing factors of postural hypertension in elderly patients with hypertension, while ARR in standing position is related to platelet parameters and coagulation function indicators in elderly patients with hypertension.

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