高血压合并胸痛患者心肌微循环与微量蛋白尿的关系研究

摘要

Objective To investigate the relation between myocardial microcirculation and microalbuminuria in patients with hypertension and chest pain. Methods We enrolled 37 patients with hypertension and chest pain who were admitted into the Department of Cardiology of Huai′an First Hospital Affiliated to Nanjing Medical University from July 2014 to July 2015. Urinary albumin level was measured using immunoturbidimetry,and the ratio of urinary albumin to creatinine(ACR)was calculated;myocardial flow reserve(CFR)was measured by intracoronary pressure wire,and the patients with CFR≥2. 5 were assigned into normal group( n = 15)and patients with < 2. 5 were assigned into low blood flow reserve group( n = 22). Comparison was made between the two groups in general data,biochemical criterion,the indexes of cardiac ultrasound examination,and the indexes of intracoronary pressure wire examination, and the influencing factors for CFR were analyzed. Results The two groups were not significantly different in gender,age,waistline,BMI,24 h average systolic pressure,24 h average diastolic blood pressure,24 h average heart rate,blood glucose,TC,HDL,LDL,TG,SCr and GFR (P > 0. 05);low blood flow reserve group was higher than normal group in ACR( P < 0. 05) . The two groups were not significantly different in LAD,E and A(P > 0. 05);low blood flow reserve group was higher in LVMI and lower in E/ A than normal group(P≤0. 05). The two groups were not significantly different in diastolic blood pressure at baseline and blood flow velocity at congestion stage(P > 0. 05);low blood flow reserve group was higher in blood flow velocity,systolic pressure,pulse pressure and heart rate at baseline and lower in CFR than normal group(P < 0. 05). Negative linear correlation existed between CFR and logACR(r = - 0. 511,P < 0. 01). Multiple linear regression analysis showed that gender,ACR,LVMI and E/ A had significant influence on CFR( P < 0. 05 ) . Conclusion Microalbuminuria is an independent risk factor for myocardial microcirculation damage in patients at early stage of hypertension.%目的：探讨高血压合并胸痛患者心肌微循环与微量蛋白尿的关系。方法选取2014年7月—2015年7月在南京医科大学附属淮安第一医院心内科住院的高血压合并胸痛患者37例，采用免疫比浊法测量尿清蛋白水平，计算尿清蛋白和肌酐比值（ACR）；采用冠状动脉内压力导丝测定心肌血流储备（ CFR），以 CFR≥2.5为正常组（ n=15），<2.5为低血流储备组（n =22），比较两组一般资料和生化指标、心脏超声检查指标、冠状动脉内压力导丝检查指标，分析 CFR 的影响因素。结果两组性别、年龄、腰围、BMI、24 h 平均收缩压、24 h 平均舒张压、24 h 平均脉压、24 h 平均心率、血糖、总胆固醇（TC）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、三酰甘油（TG）、血肌酐（SCr）、肾小球滤过率（GFR）间差异均无统计学意义（P >0.05）；而低血流储备组 ACR 高于正常组，差异有统计学意义（P <0.05）。两组左心房内径（LAD）、左房室瓣口舒张早期血流峰值速度（E）、左房室瓣口舒张晚期血流峰值速度（A）间差异无统计学意义（P >0.05）；而低血流储备组左心室质量指数（LVMI）高于正常组、E/ A低于正常组，差异有统计学意义（P≤0.05）。两组基线舒张压、充血期血流速度间差异无统计学意义（P >0.05）；而低血流储备组基线血流速度、收缩压、脉压、心率均高于正常组，CFR 低于正常组，差异有统计学意义（P <0.05）。CFR与 logACR 呈线性负相关（r =-0.511，P <0.01）。多元线性回归分析结果显示，性别、ACR、LVMI 及 E/ A 对 CFR 的影响有统计学意义（P <0.05）。结论微量蛋白尿是高血压早期患者心肌微循环受损的独立危险因素。