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H型高血压患者血清Hcy、尿微量白蛋白/肌酐比值与血压变异及靶器官功能受损的关系

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摘要:

目的 探讨H型高血压患者血清同型半胱氨酸(Hcy)、尿微量白蛋白/肌酐比值和血压变异 情况,并分析其与靶器官功能受损的关系。方法 选取2017年1月至2018年12月期间就诊于郑州大学附属 郑州中心医院和河南省人民医院诊治的408例原发性高血压作为研究对象。根据血清Hcy水平将其分为正 常高血压组(Hcy<10 μmol/L,n=238)和H型高血压组(Hcy≥10 μmol/L,n=170)。收集两组患者血 清Hcy、24 h尿微量白蛋白、尿肌酐、24 h收缩压及变异性、24 h舒张压及变异性、颈动脉内膜中膜厚度 (IMT)、左室质量指数(LVMI)和肾小球过滤率(eGFR)和血肌酐水平。以H型高血压组患者尿微量 白蛋白/肌酐比值均值、24 h收缩压变异性均值和24 h舒张压变异性均值为标准,比较分析不同Hcy、尿微 量白蛋白/肌酐比值和血压变异患者靶器官功能受损,采用Logistic回归分析探讨H型高血压靶器官功能受 损的影响因素。结果 与正常高血压组比较,H型高血压组24 h尿微量白蛋白/尿肌酐比值、24 h收缩压变 异性、24 h舒张压变异性及靶器官功能受损率(肾受损和颈动脉受损)均升高,差异有统计学意义(P <0.05)。以H型高血压尿微量白蛋白/肌酐比值的均值作为分界点,大于或等于该值为高值组,低于该 值为低值组,高值组肾受损率明显高于低值组,差异有统计学意义(P<0.05),但在心受损、脑受损及 颈动脉受损率上比较差异无统计学意义(P>0.05)。以24 h收缩压变异性和24 h舒张压变异性均值作为 分界点,大于或等于该值分别为高收缩组和高舒张组,低于该值则为低收缩组和低舒张组,高收缩组和 高舒张组心受损率分别明显高于低收缩组和低舒张组,差异有统计学意义(P<0.05),但在其它器官受 损上比较差异无统计学意义(P>0.05)。经Logistic回归分析结果显示,高血压分级(3级)、高Hcy和 高收缩压变异性是影响H型高血压靶器官功能受损的关键危险因素(P<0.05)。结论 H型高血压患者尿 微量白蛋白/肌酐比值和血压变异均明显增大,其靶器官功能受损率也相应升高,高Hcy和高收缩压变异 性是H型高血压靶器官功能受损的关键危险因素。

Abstract:

Objective To investigate the serum homocysteine (Hcy), urine microalbumin / creatinine ratio and blood pressure variation in patients with H-type hypertension, and to analyze their relationship with impaired target organ function. Methods A total of 408 patients with primary hypertension who were treated in Zhengzhou Central Hospital affiliated to Zhengzhou University and Henan Provincial People's Hospital from January 2017 to December 2018 were selected as the research subjects. They were divided into normal hypertension group (Hcy <10 μmol/L, n=238) and type H hypertension group (Hcy≥10 μmol/L, n=170) according to serum Hcy levels. Serum Hcy, 24-hour urine microalbumin, urine creatinine, 24-hour systolic blood pressure and variability, 24-hour diastolic blood pressure and variability, carotid intima-media thickness (IMT), and left ventricular mass index (LVMI) And glomerular filtration rate (eGFR) and serum creatinine levels were collected. Based on the mean value of urine microalbumin / creatinine ratio, mean value of 24 h systolic blood pressure variability, and mean value of 24 h diastolic blood pressure variability in patients with type H hypertension, patients with different Hcy, urine microalbumin / creatinine ratio, and blood pressure variability were compared and analyzed. Target organ function was impaired. Logistic regression analysis was used to explore the influencing factors of target organ function impairment in H-type hypertension. Results Compared with the normal hypertension group, the 24-hour urine microalbumin / urinary creatinine ratio, 24-hour systolic blood pressure variability, 24-hour diastolic blood pressure variability, and target organ function impairment rate (renal injury and carotid artery) (Damaged) were increased, and the difference was statistically significant (P<0.05). The mean value of the urine microalbumin / creatinine ratio of H-type hypertension was used as the cut-off point. The value was greater than or equal to the high value group, and lower than the low value group. The renal damage rate in the high value group was significantly higher than that in the low value group. The difference was statistically significant (P<0.05), but there was no significant difference in the rates of heart damage, brain damage, and carotid artery damage (P>0.05). Take the mean value of 24 h systolic blood pressure variability and 24 h diastolic blood pressure variability as the cut-off point. Values greater than or equal to this value are the high systolic group and high diastolic group respectively. Below this value are the low systolic group and low diastolic group. The rates of heart injury in the two groups were significantly higher than those in the low-systolic group and the low-diastolic group. The difference was statistically significant (P<0.05), but there was no significant difference in other organ damage (P>0.05). Logistic regression analysis showed that hypertension grade (Grade 3), high Hcy and high systolic blood pressure variability were the key risk factors that affected the function of target organs of type H hypertension (P<0.05). Conclusion The urine microalbumin / creatinine ratio and blood pressure variation in patients with type H hypertension were significantly increased, and the target organ function impairment rate was also increased accordingly. High Hcy and high systolic blood pressure variability are key risk factors for impaired target organ function in H-type hypertension.

基金项目:

河南省医学科技攻关计划项目(162102310302)

参考文献:

  • 2008

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