高血压及原发性醛固酮增多症患者血清钾及低钾血症与心电图左心室肥大的关系  

Association between serum potassium or hypokalemia and electrocardiographic left ventricular hypertrophy in patients with hypertension and primary aldosteronism

作　　者：王梦卉 王梦茹 骆秦[2] 朱晴[2] 李南方[2] Wang Menghui;Wang Mengru;Luo Qin;Zhu Qing;Li Nanfang(Graduate School of Xinjiang Medical University,Uygur 830001,China;Hypertension Center of People′s Hospital of Xinjiang Uygur Autonomous Region,Xinjiang Hypertension Institute,National Health Committee Key Laboratory of Hypertension Clinical Research Key Laboratory,Xinjiang Uygur Autonomous Region Hypertension Research Laboratory,Xinjiang Clinical Medical Research Center for Hypertension(Cardio-Cerebrovascular)Diseases,Uygur 830001,China)

机构地区：[1]新疆医科大学研究生院,乌鲁木齐830001 [2]新疆维吾尔自治区人民医院高血压中心、新疆高血压研究所、国家卫生健康委高血压诊疗研究重点实验室、新疆维吾尔自治区重点实验室、新疆高血压病研究实验室、新疆高血压(心脑血管)疾病临床医学研究中心,乌鲁木齐830001

出　　处：《中华诊断学电子杂志》2024年第1期18-24,共7页Chinese Journal of Diagnostics(Electronic Edition)

基　　金：新疆维吾尔自治区重大科技专项项目(2022A03012-2)。

摘　　要：目的在高血压或原发性醛固酮增多症(PA)患者中明确血清钾、低钾血症与心电图左心室肥大(ECG-LVH)的关系。方法回顾性分析2010年1月至2014年1月就诊于新疆维吾尔自治区人民医院高血压中心,规范进行PA筛查并完善血钾、心电图检查的1107例高血压患者,确诊PA患者177例,采用Logistic回归分析高血压或PA患者血清钾、低钾血症与ECG-LVH的关系;使用受试者工作特征(ROC)曲线下面积(AUC)评价血清钾或低钾血症筛查ECG-LVH风险的准确性。结果在高血压患者中血清钾(OR=0.482,P=0.033)、低钾血症(OR=1.819,P=0.033)独立于血压、肾素活性、醛固酮/肾素等指标与ECG-LVH相关;在PA患者中,血清钾(OR=0.070,P=0.004)、低钾血症(OR=6.472,P=0.007)独立于收缩压与ECG-LVH相关。血清钾筛查高血压或PA患者ECG-LVH的AUC为0.607及0.784,PA患者血钾<3.28 mmol/L时,筛查ECG-LVH的敏感度、特异度分别为71.4%及89.6%。结论高血压或PA患者,血清钾、低钾血症与ECG-LVH独立相关;特别在PA患者中,低钾血症与心肌肥厚有关。Objective To investigate the association between serum potassium/hypokalemia and electrocardiographic left ventricular hypertrophy(ECG-LVH)in patients with hypertension or primary aldosteronism(PA).Methods A retrospective analysis was performed in 1107 patients with hypertension admitted to the Hypertension Center of Xinjiang Uygur Autonomous Region People′s Hospital between January 2010 and January 2014,who underwent standardized PA screening and simultaneously measured blood potassium and electrocardiogram,and 177 patients were diagnosed with PA.Logistic regression analysis was used to evaluate the association between serum potassium/hypokalemia and ECG-LVH in patients with hypertension or PA.Area under the operating characteristic curve(AUC)was used to assess the accuracy of serum potassium/hypokalemia to predict the ECG-LVH risk.Results Serum potassium(OR=0.482,P=0.033)and hypokalemia(OR=1.819,P=0.033)were respectively associated with ECG-LVH,independent of blood pressure,renin activity,and aldosterone-to-renin.And in PA patients,these associations were significantly independent of systolic blood pressure[(OR=0.070,P=0.004)and(OR=6.472,P=0.007)],respectively.Moreover,serum potassium can screen for ECG-LVH risk with AUCs of 0.607 and 0.784 in patients with hypertension or PA.When serum potassium<3.28 mmol/L in patients with PA,the predict value of ECG-LVH risk were high,with sensitivity and specificity of 71.4%and 89.6%,respectively.Conclusions Both serum potassium and hypokalemia are independently associated with ECG-LVH,regardless in patients with hypertension or PA.Especially in patients with PA,hypokalemia is associated with cardiac hypertrophy.

关 键 词：高血压 原发性醛固酮增多症 肥大 左心室 低钾血症 心电描记术 

分 类 号：R586.24[医药卫生—内分泌]