血醛固酮水平与高血压患者靶器官损害的关系  

Correlation of plasma aldosterone with target organ damage in patients with hypertension

作　　者：沈玉婧[1] 曾伟芳[1] 李华[1] 高平进[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院高血压科上海市高血压研究所,上海200025

出　　处：《诊断学理论与实践》2012年第6期576-579,共4页Journal of Diagnostics Concepts & Practice

摘　　要：目的:探讨原发性高血压患者血醛固酮水平与靶器官损害间的关系。方法:根据无药物影响定义(入院前停用醛固酮受体拮抗剂至少6周,停用β受体阻滞剂及利尿剂至少4周,停用血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂类药物至少2周),排除降压药物对血醛固酮检查结果造成的影响。选取2008年至2012年在我院住院的原发性高血压患者共664例,为无药物影响组;同时选取年龄、性别匹配的664例原发性高血压患者作为开放用药组。对患者进行常规生化检查、24 h时动态血压监测及心脏超声检查。结果:①简单相关分析发现,2组患者的血醛固酮水平与年龄、24 h尿钠钾比值及血钾呈负相关。②多元线性相关回归分析发现,在无药物影响组,矫正年龄、性别后,血醛固酮与尿白蛋白/尿肌酐比值(logACR)(β=0.228,P<0.001)、肾脏病膳食改良试验(β=-0.110,P=0.003)、左心室质量指数(β=0.092,P=0.032)相关,进一步矫正血钠、血钾、24 h尿钠、尿钾后,这种相关性仍存在,而在开放用药组这种相关性消失。③多元回归分析发现,在无药物影响组,矫正了相关混杂因素后,ln醛固酮与蛋白尿、肾小球滤过率下降、左心室肥厚独立相关,分别为ln醛固酮与蛋白尿(OR=2.954,95%CI:1.551～5.628,P=0.001),ln醛固酮与肾功能下降(OR=1.800,95%CI:1.174～2.761,P=0.007),ln醛固酮与左心室肥厚(OR=2.235,95%CI:1.737～2.749,P=0.006),而在开放用药组,该相关性消失。结论:血醛固酮水平与高血压患者的靶器官损害相关,但必须排除降压药物对血醛固酮检测结果造成的影响。Objective To investigate the correlation between plasma aldosterone level and target organ damage in patients with essential hypertension. Methods A total of 664 essential hypertensive inpatients without the influence of anti- hypertension drugs were included as group A. Another 664 subjects with anti-hypertension drugs taken were included as group B , the two groups were matched on sex and age. Results In group A,plasma aldosterone （Aldo） was independently correlated with log ACR （urina~ albumin/creatinine ratio）（β=0.228, P〈0.001 ）, M DRD glomerular filtration rate （β= -0.110, P=0.003 ）, LVMI （left ventricular mass index）（β=0.092 ,P=-0.032）by multiple linear regression after adjusting for sex and age. This COlTelation still exits after adjusting for sex,age, urinary Na, urinary K, blood Na, blood K, 24 h SBP （systolic blood pressure）. In group A,aldosterone was independently associated with albuminuria,renal inadequacy,and left ventricular hypertrophy after adjusting for confounders. [lnAldo and albuminuria （0R=2.954, 95% CI： 1.551-5.628, P=-0.001）, lnMdo and renal inadequacy （OR = 1.800,95% CI ： 1.174-2.761, P=0.007 ）, lnAldo and left ventricular hypertrophy （OR =2.235,95% CI： 1.737-2.749,P=0.006）]. But in group B, this trend did not exist . Conclusions Plasma aldosterone is correlated with target oraan damage in hypertensive patients, but only in condition not influenced by anti-hypertension drugs.

关 键 词：高血压 醛固酮 尿白蛋白 尿肌酐比值 肾小球率过滤 左心室质量指数 

分 类 号：R544.1[医药卫生—心血管疾病]