原发性醛固酮增多症患者心肺运动试验中运动血压与左心室后壁增厚的相关性  

The relationship between exercise-induced hypertension during cardiopulmonary exercise testing and left ventricular wall thickening in patients with primary aldosteronism

作　　者：张瑜 孔剑琼 黄雯婷 王京 王灵芝 彭艳霞 陈心笛 林泽鹏 张志伟 ZHANG Yu;KONG Jianqiong;HUANG Wenting;WANG Jing;WANG Lingzhi;PENG Yanxia;CHEN Xindi;LIN Zepeng;ZHANG Zhiwei(Department of Cardiac Rehabilitation,Fuwai Hospital Chinese Academy of Medical Sciences,Shenzhen,Shenzhen,Guangdong 518000,China;Department of Hypertension,Fuwai Hospital Chinese Academy of Medical Sciences,Shenzhen,Shenzhen,Guangdong 518000,China;Emergency Department,Fuwai Hospital Chinese Academy of Medical Sciences,Shenzhen,Shenzhen,Guangdong 518000,China;Outpatient Department,Fuwai Hospital Chinese Academy of Medical Sciences,Shenzhen,Shenzhen,Guangdong 518000,China)

机构地区：[1]中国医学科学院阜外医院深圳医院心脏康复科,广东深圳518000 [2]中国医学科学院阜外医院深圳医院高血压科,广东深圳518000 [3]中国医学科学院阜外医院深圳医院门诊部,广东深圳518000 [4]中国医学科学院阜外医院深圳医院急诊科,广东深圳518000

出　　处：《中华高血压杂志》2023年第9期856-862,共7页Chinese Journal of Hypertension

摘　　要：目的 探讨原发性醛固酮增多症(PA)患者在心肺运动试验(CPET)中运动血压与左心室后壁舒张末期厚度(LVPWD)的相关性,并比较PA与原发性高血压(EH)患者运动性高血压(EIH)发生率的差异。方法 连续纳入2017年5月至2022年5月就诊于中国医学科学院阜外医院深圳医院心脏康复科的PA患者66例及EH患者82例。EIH诊断标准采用Framingham心脏研究标准:运动中收缩压≥210 mmHg(男性),≥190 mmHg(女性)和/或运动中舒张压≥110 mmHg。通过CPET获取运动中各个时段血压、峰值摄氧量(VO_(2)peak)等参数;通过心脏彩超获取LVPWD,比较两组患者EIH发生率、LVPWD增厚比例,采用Pearson/Spearman相关分析VO_(2)peak与坐位醛固酮与肾素比值(ARR)及血钾、坐位醛固酮与LVPWD、运动血压与LVPWD之间的相关关系;采用多元线性回归分析运动血压与LVPWD之间的关系。结果 两组患者动态血压中全天血压、白天血压、夜间血压、运动峰值血压水平差异无统计学意义(均P>0.05);PA患者VO_(2)peak低于EH患者[(22.20±6.96)比(25.55±7.20)mL/(min·kg),t=-2.800,P=0.006]。PA患者的LVPWD[男:11.00(10.00~11.75)比10.00(9.00~11.00)mm,Z=-1.973,P=0.049;女:10.00(8.50~11.00)比9.00(8.00~10.00)mm,Z=-2.018,P=0.044]、EIH发生率[53.0%(35/66)比36.6%(30/82),χ^(2)=4.015,P=0.045]、LVPWD增厚占比[30.3%(20/66)比12.2%(10/82),χ^(2)=7.419,P=0.006]均较EH患者增高。Spearman相关分析显示,VO_(2)peak与坐位ARR呈负相关(r_(s)=-0.210,P=0.013),坐位醛固酮与LVPWD呈正相关(r_(s)=0.221,P=0.009),运动峰值收缩压、恢复期1 min收缩压与LVPWD呈正相关(r_(s)=0.188,P=0.027;r_(s)=0.217,P=0.009)。多元线性回归分析显示,在总样本中恢复期1 min收缩压及坐位醛固酮水平与LVPWD独立相关。结论 PA患者较EH患者更易发生EIH,在总样本中恢复期1 min收缩压及坐位醛固酮水平与LVPWD呈正相关。Objective To investigate the relationship between exercise blood pressure during cardiopulmonary exercise testing(CPET) and left ventricular posterior wall end-diastolic thickness(LVPWD) in patients with primary aldosteronism(PA), and to compare the incidence of exercise-induced hypertension(EIH) between the patients with PA and those with essential hypertension(EH). Methods Sixty-six patients with PA and 82 patients with EH from Fuwai Hostipal Chinese Academy of Medical Sciences, Shenzhen between May 2017 and May 2022 were consecutively recruited. EIH was diagnosed using Framingham Heart Study criteria, i.e, exercise systolic blood pressure ≥210 mmHg(male), ≥190 mmHg(female) and/or exercise diastolic blood pressure ≥110 mmHg. Main parameters in CPET including exercise blood pressure during each period of exercise, peak oxygen uptake(VO_(2)peak) were obtained. LVPWD was obtained by echocardiograph. The incidence of EIH, and the proportion of LVPWD thickening were compared between the two groups. Pearson/Spearman correlation analysis was used to determine the correlations of VO_(2)peak with sitting aldosterone to renin ratio(ARR), serum potassium, and sitting aldosterone with LVPWD, exercise blood pressure with LVPWD. Multiple linear regression was used to analyze the relationship between exercise blood pressure and LVPWD. Results There were no differences between the two groups in the levels of 24 hour-blood pressure, daytime blood pressure, nighttime blood pressure of ambulatory blood pressure monitoring and peak blood pressure during exercise. The PA group had a lower level of VO_(2)peak than that of EH group [(22.20±6.96) vs(25.55±7.20) mL/(min·kg), t=-2.800, P=0.006]. The LVPWD in patients with PA [male: 11.00(10.00-11.75) vs 10.00(9.00-11.00) mm, Z=-1.973, P=0.049;female: 10.00(8.50-11.00) vs 9.00(8.00-10.00) mm, Z=-2.018, P=0.044], the incidence of EIH [53.0%(35/66) vs 36.6%(30/82),χ^(2)=4.015, P=0.045], and the proportion of LVPWD thickening [30.3%(20/66) vs 12.2%(10/82), χ^(2)=7.419, P=0.006] w

关 键 词：原发性醛固酮增多症 原发性高血压 心肺运动试验 运动性高血压 左心室后壁舒张末期厚度 峰值摄氧量 峰值血压 

分 类 号：R586.24[医药卫生—内分泌]