原发性高血压患者血清碱性磷酸酶与颈股动脉脉搏波传导速度的关系  

Association between serum alkaline phosphatase and carotid femoral pulse wave velocity in patients with essential hypertension

作　　者：刘风玲 商黔惠 王晓春 张杰梅 杨光磊 张庚 LIU Fengling;SHANG Qianhui;WANG Xiaochun;ZHANG Jiemei;YANG Guanglei;ZHANG Geng(Clinical Medicine Institute,Cardiovascular Disease Institute,Hypertension Research Institute;Department of Cardiology,Affiliated Hospital of Zunyi Medical University,Zunyi,Guizhou 563003,China)

机构地区：[1]遵义医科大学附属医院临床医学研究所高血压研究室,心血管病研究所,贵州遵义563003 [2]遵义医科大学附属医院心内科,贵州遵义563003

出　　处：《中华高血压杂志》2023年第4期360-366,共7页Chinese Journal of Hypertension

基　　金：国家自然科学基金(81160041,81460077)。

摘　　要：目的探讨原发性高血压患者血清碱性磷酸酶(ALP)水平与颈股动脉脉搏波传导速度(cfPWV)的关系。方法选取2019年1月至2022年1月于遵义医科大学附属医院高血压门诊就诊的未经治疗或自行停服降压药1个月以上的原发性高血压患者1014人作为研究对象,收集基本资料,测定cfPWV、血压、心率,检测血清ALP水平。根据ALP水平四分位将所有研究对象分为4组:第1四分位组(ALP≤78 U/L,n=264)、第2四分位组(>78~92 U/L,n=260)、第3四分位组(>92~110 U/L,n=249)和第4四分位组(ALP>110 U/L,n=241)。比较不同组间研究对象临床资料的差异,采用多因素回归分析血清ALP与原发性高血压患者cfPWV的关系。结果随着ALP四分位水平的升高,cfPWV逐渐升高[(7.5±1.2)比(8.0±1.4)比(8.3±1.4)比(8.7±1.3)m/s,F=40.286,P<0.001],各组间高血压患者动脉硬化(cfPWV>10 m/s)的检出率逐渐升高[3.0%(8/264)比8.5%(22/260)比10.4%(26/249)比16.2%(39/241),χ^(2)=26.258,P<0.001]。多因素线性回归分析结果显示,血清ALP每增加1 U/L,cfPWV增加0.014 m/s(P<0.001)。多因素logistic回归分析校正收缩压、舒张压、天冬氨酸氨基转移酶、丙氨酸氨基转移酶等混杂因素后,以ALP第1四分位组为参照,第2~4四分位组出现cfPWV>10 m/s的OR值(95%CI)分别为2.406(1.028~5.633)、2.767(1.191~6.427)、4.474(1.978~10.117);ALP每增加1 U/L,原发性高血压患者出现cfPWV>10 m/s的OR值(95%CI)为1.016(1.007~1.025);ALP每增加1个标准差(24.75 U/L),OR值(95%CI)为1.495(1.201~1.860)。敏感性分析显示,分别除外吸烟、饮酒、糖尿病以及服用降脂药人群后,随着血清ALP水平的升高,高血压患者出现cfPWV>10 m/s的风险仍升高(均P<0.05)。结论血清ALP是原发性高血压患者cfPWV增快的独立影响因素。Objective To explore the association between serum alkaline phosphatase(ALP)level and carotid femoral pulse wave velocity(cfPWV)in patients with essential hypertension.NMethodsA total of 1014 patients with essential hypertension who were untreated or had stopped taking antihypertensive drugs for more than one month in the hypertension clinic of Zunyi Medical University Affiliated Hospital from January 2019 to January 2022 were selected.The basic information was collected.CfPWV,blood pressure and heart rate were measured,and serum ALP level was detected.According to the quartile of ALP level,all subjects were divided into four groups:Q1(ALP<78 U/L,n=264),Q2(ALP>78-92 U/L,n=260),Q3(ALP>92-110 U/L,n=249)andQ4 group(ALP>1l0 U/L,n=241).The difference of clinical data among four groups was compared.Multivariate regression analysis was used to analyze the relationship between serum ALP and cfPWV in patients with essential hypertension.Results With the increase of ALP level,the cfPWV increased gradually[Q1(7.5±1.2)us Q2(8.0±1.4)us Q3(8.3±1.4)us Q4(8.7±1.3)m/s,F=40.286,P<0.001],and the occurrence of arterial stiffness(cfPWV>10 m/s)gradually increased[3.0%(8/264)us 8.5%(22/260)vs 10.4%(26/249)us 16.2%(39/241),χ^(2)=26.258,P<0.001].Multivariate linear regression analysis showed that for every 1 U/L increase in ALP,cfPWV increased by 0.014 m/s(P<0.001).After adjusting for confounding factors such as systolic blood pressure,diastolic blood pressure,aspartate aminotransferase(ALT)and alanine aminotransferase(AST),multivariate logistic regression analysis showed that compared with Q1 group,the ORs(95%CI)of cfPWV>10 m/s in Q2,Q3 and Q4 group were 2.406(1.028-5.633),2.767(1.191-6.427)and 4.474(1.978-10.117)respectively.The OR(95%CI)of cfPWV>10m/s was 1.016(1.007-1.025)for every1U/L and1.495(1.201-1.860)for 1 standard deviation(24.75 U/L)increase in ALP.The results of sensitivity analyses showed the risk of cfPWV>10 m/s remained increased with the increase of ALP after excluding smokers,drinkers,patients with diabetes and tak

关 键 词：原发性高血压 血清碱性磷酸酶 动脉硬化 颈股动脉脉搏波传导速度 

分 类 号：R544.11[医药卫生—心血管疾病]