动态动脉硬化指数与难治性高血压患者靶器官损害的相关性及影响因素  

Clinical application of ambulatory arterial stiffness index in resistant hypertensive target organ damage

作　　者：孔羽[1] 蔺洁[2] 匡泽民[3] 余振球[1] 

机构地区：[1]首都医科大学附属北京安贞医院高血压科,北京100029 [2]心血管重塑相关疾病教育部重点实验室 [3]中南大学湘雅三医院临床药理中心

出　　处：《中华高血压杂志》2013年第9期861-864,共4页Chinese Journal of Hypertension

基　　金：国家自然科学基金(81170793);北京市卫生系统高层次卫生技术人才培养计划(2009-3-345)

摘　　要：目的研究难治性高血压(RH)患者动态动脉硬化指数(AASI)与估算的肾小球滤过率(eGFR)、左心室质量指数(LVMI)和臂踝动脉脉搏波传导速度(baPWV)等高血压靶器官损害的相关性及影响因素。方法回顾性分析2008-10-2013-05北京安贞医院高血压科住院患者302例的临床资料(其中RH患者179例,非RH患者123例),进行24h动态血压监测计算AASI(1-舒张压对收缩压回归直线的斜率);通过"肾脏病膳食改良试验"公式评估肾功能;行超声心动图检查,计算LVMI;测定baPWV作为评估大动脉弹性功能的指标。结果与非RH患者比较,RH患者体质量指数(BMI)[(28.2±4.1)比(25.1±3.6)kg/m2]、高血压病程[(13.3±1.2)比(9.0±1.7)年]、24h收缩压[(134.8±13.6)比(119.7±9.4)mm Hg]、24h舒张压[(81.4±12.2)比(74.1±14.4)mm Hg]、24h脉压[(53.2±13.1)比(45.7±10.2)mm Hg]和AASI[(0.56±0.20)比(0.24±0.10)]较高(均P<0.05)。Pearson相关分析结果显示,AASI与年龄、高血压病程、收缩压、脉压、baPWV呈正相关(均P<0.01);与舒张压、eGFR呈负相关(均P<0.05)。Logistic回归分析结果显示,24h收缩压、高血压病程和baPWV是AASI增高的独立危险因素,使用他汀类药物和24h舒张压增高是AASI增高的保护性因素。结论 RH患者的AASI水平明显增高,与高血压靶器官损害中的动脉硬化和肾功能损害相关。Objective To investigate the relationship between ambulatory arterial stiffness index （AASI） and estimated glomerular filtration rate （eGFR）, left ventricular mass index （LVMI） and brachial-ankle pulse wave velocity （baPWV） in resistant hypertensive（RH） patients. Methods From October, 2008 to May, 2013, the clinical data of 302 primary hypertensive patients in gelling Anzhen Hospital, including 179 RH patients and 123 nomRH patients, were retrospectively analyzed. 24 h ambulatory blood pressure monitoring was performed and AASI was obtained, eGFR was assessed by the modification of diet in renal disease （MDRD） formula. LVMI was calculated by echocardiography, and baPWV was measured as the indicator of arterial elasticity. Results Compared with those in non RH patients, the body mass indexes （BMI） [（28.2±4.1） vs （25. 1±3.6） kg/m2], hypertension duration [（13.3±1.2） vs （9.0± 1.7）year], 24-hour systolic blood pressure （SBP） [（134.8±13.6） vs （119.7±9.4} mm Hg], 24 hour diastolic blood pressure（DBP） [（81.4±12.2） vs {74.1±14.4}mm Hg], 24-hour pulse pressure [（53.2±13.1） vs （45.7±10.2）mm Hg] and AASIlevel [{0.56±0.20） vs {0.24±0.10）] were all higher （all P〈0.05） in RH patients. Pearson linear correlation analysis showed that AASI was positively correlated with age, hypertension duration, SBP, pulse pressure, and baPWV （all P〈0.01 ）, while was negatively correlated with DBP and eGFR （all P〈0.05）. Logistic multiple regression analysis indicated that 24 h SBP, hypertension duration and baPWV were independent risk factors for AASI, while the increase in 24 h DBP and usage of statins were its protective factors. Conclusions RH patients have significantly higher levels of AASI, and the AASI increase in RH patients is associated with target organ damage.

关 键 词：难治性高血压 动态动脉硬化指数 肾小球滤过率 左心室质量指数 臂踝动脉脉搏波传导速度 

分 类 号：R544.1[医药卫生—心血管疾病]