高原地区原发性高血压与高原高血压患者的临床特征比较  

Comparison of clinical characteristics between patients with altitude-related hypertension and essential hypertension at high altitude

作　　者：汪晓洲 边惠萍 杨蕾 徐效龙 白洁 韩琼 严萍 张晶 周茜 赵彩莲 朵杰 马占青 张伟[1,2,3] WANG Xiao-zhou;BIAN Hui-ping;YANG Lei;XU Xiao-long;Bai Jie;HAN Qiong;YAN Ping;ZHANG Jing;ZHOU Qian;ZHAO Cai-lian;DUO Jie;MA Zhan-qing;ZHANG Wei(Research Center for High Altitude Medicine,Qinghai University,Xining,Qinghai 810001,China;Key Laboratory of Ministry of Education for High Altitude Medicine;Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province;Hypertension Department,Qinghai Cardio-Cerebrovascular Hospital)

机构地区：[1]青海大学高原医学研究中心,青海西宁810001 [2]高原医学教育部重点实验室 [3]青海省高原医学应用基础重点实验室 [4]青海省心脑血管病专科医院高血压科

出　　处：《中华高血压杂志》2022年第1期51-57,共7页Chinese Journal of Hypertension

基　　金：青海省科技计划项目(2017-ZJ-754)

摘　　要：目的比较高原地区原发性高血压(EH)与高原高血压(ARH)患者的临床特征,为ARH的防治提供依据。方法选择2017年2月至2018年12月在青海省心脑血管病专科医院高血压科住院治疗、来自海拔3.0~4.5 km地区的1987例高血压患者作为研究对象,其中165例患者在居住地血压升高(收缩压≥140和/或舒张压≥90 mm Hg),到达西宁市(海拔2.26 km)10~14 d后血压恢复正常(收缩压<140和舒张压<90 mm Hg)或在同样治疗方案下血压较高海拔居住地区下降≥20/10 mm Hg,纳入ARH组;其余1822例纳入EH组。所有患者均进行一般资料、血液生化指标、心电图、心脏彩超、头颅CT、颈动脉超声等检查,比较ARH与EH患者临床特征的差异。结果与EH患者相比,ARH患者居住地海拔更高[(3587.4±329.8)比(3404.9±300.7)m,t=6.855,P<0.001]、发病年龄更早[(48.0±11.5)比(54.4±9.8)岁,t=6.925,P<0.001]、男性比例更高(77.6%比55.3%,χ^(2)=30.596,P<0.001)、舒张压较高[(115.8±18.5)比(108.6±15.4)mm Hg,t=4.849,P<0.001]、收缩压较低[(165.9±21.3)比(178.9±24.4)mm Hg,t=7.412,P<0.001]。ARH还表现为红细胞、血红蛋白、红细胞压积、尿酸水平升高(均P<0.05)。ARH患者右心房内径[(37.6±4.8)比(35.8±3.5)mm,t=4.705,P<0.001]和右心室内径[(43.4±3.8)比(36.6±3.8)mm,t=22.011,P<0.001]较EH患者增大,合并肺动脉高压比例增高(9.1%比4.9%,χ^(2)=5.397,P=0.020),但两组患者在靶器官损害及临床合并症方面差异无统计学意义(P>0.05)。多因素分析发现,男性,汉族,居住地海拔、血红蛋白和尿酸升高,肥胖与ARH发生相关。结论ARH是高原地区特有的疾病,在中青年男性中多见,其临床表现为多个系统受累,血压升高可能只是其表现之一,但仍然可以造成相应靶器官损害,需要早期识别、积极防治。Objective To investigate the clinical characteristics of essential hypertension(EH)and altitude-related hypertension(ARH)hospitalized in Qinghai,and to provide the relevant information for the prevention and treatment of ARH.Methods From February 2017 to December 2018,1987 hypertensive patients from 3.0-4.5 km altitude areas,and hospitalized in the department of hypertension in Qinghai Cardio-Cerebrovascular Hospital were enrolled in the study.One hundred and sixty-five patients who had elevated blood pressure(systolic blood pressure≥140 and/or diastolic blood pressure≥90 mm Hg)at high altitude and decreased to normal or decreased by more than 20/10 mm Hg under the same treatment regimen 2 weeks after arriving at Xining(2.26 km)were included in the ARH group.The other 1822 patients were included in EH group.The general data,blood biochemical parameters,electrocardiogram,echocardiography,head CT,carotid ultrasound were collected in all patients.Results Compared with EH,ARH patients lived at higher altitudes[(3587.4±329.8)vs(3404.9±300.7)m,t=6.855,P<0.001]and had earlier onset age[(48.0±11.5)vs(54.4±9.8)years,t=6.925,P<0.001],higher percentage of male patients(77.6%vs 55.3%,χ^(2)=30.596,P<0.001),higher diastolic blood pressure(DBP)[(115.8±18.5)vs(108.6±15.4)mm Hg,t=4.849,P<0.001]and lower systolic blood pressure[(165.9±21.3)vs(178.9±24.4)mm Hg,t=7.412,P<0.001].Erythrocytes,hemoglobin,hematocrit and uric acid levels were higher in ARH patients than in EH patients(P<0.05).Echocardiography showed that the right atrium diameter[(37.6±4.8)vs(35.8±3.5)mm,t=4.705,P<0.001]and right ventricle diameter[(43.4±3.8)vs(36.6±3.8)mm,t=22.011,P<0.001]were enlarged in ARH than that in EH(P<0.05).The proportion of pulmonary artery hypertension in ARH group was higher than that in EH group(9.1%vs 4.9%,χ^(2)=5.397,P=0.020),but there was no significant difference in the target organ damages and clinical complications caused by hypertension between the two groups.Logistic regression analysis showed that male,Han nationa

关 键 词：高原高血压 低氧 原发性高血压 临床特征 

分 类 号：R544.11[医药卫生—心血管疾病]