高血压患者自发性压力反射敏感性与靶器官损害的关系  

The relationship between the spontaneous baroreflex sensitivity and target organ damage in hypertensive patients

作　　者：常乐 李强 廖建文 杨松 刘道燕 祝之明 赵志钢 CHANG Le;LI Qiang;LIAO Jian-wen;YANG Song;LIU Dao-yan;ZHU Zhi-ming;ZHAO Zhi-gang(Center for Hypertension and Metabolic Diseases,Department of Hypertension and Endocrinology,Daping Hospital,Army Medical University,Chongqing Hypertension Institute,Chongqing 400042,China)

机构地区：[1]陆军军医大学全军高血压代谢病中心,重庆大坪医院高血压内分泌科,重庆市高血压研究所,重庆400042

出　　处：《中华高血压杂志》2018年第7期627-633,共7页Chinese Journal of Hypertension

基　　金：国家自然科学基金(81470536)

摘　　要：目的探讨自发性压力反射敏感性(BRS)在原发性高血压患者中的临床应用价值。方法入选2017年3-10月就诊大坪医院高血压内分泌科的原发性高血压患者123例,其中单纯高血压59例,高血压合并糖尿病64例,同时招募健康志愿者40人作为对照组。利用连续无创手指脉压测量仪检测BRS,采集患者的一般情况、病史资料、辅助检查等。采用受试者工作特征曲线(ROC曲线)评估诊断方法的可靠性,以及二元Logistic回归分析进行相关因素分析。结果与对照组比较,单纯高血压患者BRS显著降低[卧位:(7.69±3.16)比(9.92±4.10)ms/mm Hg;立位:(4.55±1.75)比(5.74±3.24)ms/mm Hg,均P<0.01],高血压合并糖尿病患者的下降更为明显。自发性卧、立位BRS与全部窦性心搏RR间期的标准差(SDNN)呈正相关(r=0.518、0.492,均P<0.01)。在高血压患者中,合并白蛋白尿者的立位BRS低于尿蛋白正常者[(3.53±1.66)比(4.27±1.68)ms/mm Hg];合并颈动脉粥样硬化病变者的卧、立位BRS低于无动脉病变者[卧位:(6.27±3.26)比(8.19±3.34);立位:(3.53±1.89)比(4.60±1.52)ms/mm Hg];左心室质量指数(LVMI)较高者的卧、立位BRS低于LVMI较低者[(6.16±2.72)比(8.08±3.39);(3.51±1.52)比(4.56±1.64)ms/mm Hg(均P<0.01)]。自发性BRS降低是白蛋白尿、颈动脉粥样硬化病变的独立相关因素。结论高血压患者的心脏交感神经活性增强,这与靶器官的早期损伤密切相关。Objective To investigate the clinical application value of spontaneous baroreflex sensitivity（BRS）in patients with essential hypertension. Methods From March to October in 2017,123 patients with essential hypertension,including 59 cases of isolated hypertension,64 cases of hypertension and diabetes,were enrolled from Department of Hypertension and Endocrinology,Daping Hospital. Meanwhile,40 healthy volunteers were recruited as the control group. BRS was measured with the continuous non-invasive finger pulse pressure instrument. The general conditions,history data,and auxiliary examinations of these subjects were collected. The receiver operating characteristic curve（ROC）was used to evaluate the reliability of the diagnostic method. And the binary logistic regression analysis was used to analyze the related factors. Results Compared with the control group,BRS decreased significantly in patients with isolated hypertension[lying BRS：（7.69±3.16）vs（9.92±4.10）ms/mm Hg;standing BRS：（4.55±1.75）vs（5.74±3.24）ms/mm Hg,both P〈0.01],which was more pronounced in hypertensive patients with diabetes. Spontaneous lying and standing BRS were significantly positively correlated with the standard deviation of the RR interval of all sinus beats（SDNN）（r=0.518 and 0.492,both P〈0.01）. The standing BRS in hypertensive patients with albuminuria[（3.53±1.66）ms/mm Hg]was lower than those with normal urinary protein[（4.27±1.68）ms/mm Hg]. Both lying and standing BRS in hypertensive patients with carotid atherosclerosis were lower than patients without arterial lesions[lying BRS：（6.27±3.26）vs（8.19±3.34）ms/mm Hg;standing BRS：（3.53±1.89）vs（4.60±1.52）ms/mm Hg]. Compared to patients with lower LVMI,the subjects with higher LVMI showed decreased lying and standing BRS [lying BRS：（6.16±2.72）vs（8.08±3.39）;standing BRS：（3.51±1.52）vs（4.56±1.64）ms/mm Hg]. Spontaneous BRS reduction was an independent factor for albuminuria and carotid atherosclerosis. Con

关 键 词：原发性高血压 自发性压力反射敏感性 尿白蛋白排泄率 颈动脉内膜中层厚度 左心室质量指数 

分 类 号：R544.1[医药卫生—心血管疾病]