尿酸对不同体质量指数青年高血压患者左心室肥厚及舒张功能的影响  

Relationship between uric acid and left ventricular hypertrophy and diastolic function in young hypertensive patients with different body mass indexes

作　　者：陈鑫 张晓芳[1] 王琼英[1] 余静[1] CHEN Xin;ZHANG Xiao-fang;WANG Qiong-ying;YU Jing(Hypertension Center,Lanzhou University Second Hospital,Lanzhou Gansu 730070,China)

机构地区：[1]兰州大学第二医院高血压中心,甘肃兰州730070

出　　处：《中华高血压杂志》2021年第2期149-156,共8页Chinese Journal of Hypertension

基　　金：国家自然科学基金地区科学基金项目(81960086);国家自然科学基金面上项目(81670385);博士研究生培养专项基金(YJS-BD-24);甘肃省卫生行业科研计划(GSWSKY-2019-92)。

摘　　要：目的观察尿酸对不同体质量指数(BMI)青年高血压患者左心室肥厚(LVH)及舒张功能的影响。方法选取2018年1月至2019年9月在兰州大学第二医院高血压中心确诊的青年高血压患者237例。按BMI分为体质量正常组(BMI 18.5~<24;n=82)、超重组(BMI 24~<28;n=90)、肥胖组(BMI≥28kg/m^(2);n=65);按尿酸水平三分位将患者分为低分位组(尿酸<330.00;n=78),中分位组(尿酸330.00~<412.67;n=80),高分位组(尿酸≥412.67μmol/L;n=79)。收集患者的一般资料、尿酸等生化指标及超声心动图检查结果,进行统计学分析。结果(1)随着BMI的升高,正常、超重及肥胖3组患者尿酸升高[(339.82±96.78)比(384.27±98.50)比(415.02±105.59)μmol/L],两两比较差异有统计学意义(均P<0.05);舒张末期左心室内径(LVEDd)[(45.01±5.18)比(45.82±4.40)比(48.66±5.16)mm]及二尖瓣口舒张期血流频谱E峰速度与二尖瓣瓣环运动频谱舒张早期峰值速度e’的比值(E/e’)升高[9.73(7.79~12.13)比9.94(8.66~11.64)比11.00(9.28~13.48)],正常组与肥胖组组间差异有统计学意义(P<0.05),超重组与肥胖组组间差异有统计学意义(P<0.05),而正常组、超重组两组间比较差异无统计学意义(P>0.05);舒张末期左心室后壁厚度(LVPWTd)依次升高[8.50(7.50~9.43)比8.80(8.00~9.63)比9.60(8.75~10.85)mm],正常组与肥胖组比较差异有统计学意义(P<0.05)。(2)随着尿酸水平的升高,低、中及高分位组患者的BMI升高[24.00(22.38~26.00)比24.91(22.90~28.38)比27.10(24.70~29.94)kg/m^(2)]及E/e’升高[9.90(8.36~11.63)比10.29(8.67~12.13)比10.60(9.00~13.06)],两两比较差异有统计学意义(均P<0.05)。(3)两因素方差分析显示,高尿酸水平和肥胖两因素对E/e’有交互作用(F=1.819,P=0.026),二者的结合会进一步加重LVH并损害左心室舒张功能。(4)偏相关分析显示,在肥胖组中尿酸与LVMI及E/e’均呈正相关(r=0.267,P=0.032;r=0.339,P=0.010);在正常组及超重组中,未观察到上述相关性(均P>0.05)。(Objective To investigate the effects of uric acid on left ventricular hypertrophy and diastolic function in young hypertensive patients with different body mass indexes(BMI).Methods A total of 237 young patients with hypertension diagnosed at the Lanzhou University Second Hospital from January 2018 to September 2019 were enrolled.According to BMI,they were divided into 3 groups:normal group(BMI 18.5-<24;n=82),overweight group(BMI 24-<28;n=90)and obesity group(BMI≥28 kg/m^(2);n=65).According to the tertiles of uric acid level,patients were divided into low tertile group(uric acid<330.00;n=78),middle tertile group(uric acid330.00-<412.67;n=80)and high tertile group(uric acid≥412.67μmol/L;n=79).The general information,biochemical indicators(including uric acid)and echocardiographic parameters were collected and analysed.Results(1)A tendency towards higher uric acid[(339.82±96.78)vs(384.27±98.50)vs(415.02±105.59)μmol/L]was seen with the increase of BMI(all P<0.05).Some echocardiography parameters,such as left ventricular end-diastolic diameter(LVEDd)[(45.01±5.18)vs(45.82±4.40)vs(48.66±5.16)mm]and E/e’[9.73(7.79-12.13)vs 9.94(8.66-11.64)vs 11.00(9.28-13.48)]worsened if subjects were more obese,the obesity group was significantly higher than the normal group and the overweight group(all P<0.05),but the difference between the normal group and the overweight group was not statistically significant(P>0.05).With the increase of BMI,thickness of the posterior wall of the left ventricle at the end of diastole(LVPWTd)[8.50(7.50-9.43)vs 8.80(8.00-9.63)vs 9.60(8.75-10.85)mm]increased successively,and the difference between the normal group and the obese group was significant(P<0.05).(2)With the increase of uric acid level,the BMI[24.00(22.38-26.00)vs 24.91(22.90-28.38)vs 27.10(24.70-29.94)kg/m^(2)]and E/e’[9.90(8.36-11.63)vs 10.29(8.67-12.13)vs 10.60(9.00-13.06)]of the three groups of patients in the low tertile group,middle tertile group and high tertile group increased successively,and the differences between

关 键 词：青年 尿酸 体质量指数 高血压 左心室肥厚 左心室舒张功能不全 

分 类 号：R544.1[医药卫生—心血管疾病]