代谢性高血压对靶器官损害的研究

摘要

目的 观察比较单纯高血压、代谢性高血压和高血压合并代谢异常患者的一般状况及其靶器官受损情况,评估靶器官受损危险因素.方法 纳入住院高血压患者152例,按其是否合并代谢性疾病及高血压与代谢性疾病的先后关系分为单纯高血压组(n=51)、高血压合并代谢异常组(合并组,n=55)、代谢性高血压组(n=46).采用彩色多普勒超声检测颈动脉内膜-中层厚度(IMT)及左室结构,应用放射免疫法测定尿β2-微球蛋白含量,采用logistic回归分析评价引起三种靶器官受损的危险因素.结果 代谢性高血压组患者左室质量、左室质量指数及尿β2-微球蛋白均值明显高于单纯高血压组(P＜0.05)和合并组(P＜0.01),差异均有统计学意义;合并组患者左室质量、左室质量指数及尿β2-微球蛋白水平高于单纯高血压组,差异有统计学意义(P＜0.05);三组之间血肌酐、颈动脉IMT差异无统计学意义(P＞0.05);年龄是导致IMT异常的独立危险因素(P＜0.05);体重指数(BMI)和腰围(WC)是左室肥厚(LVH)异常的独立危险因素(P＜0.05).结论 单纯高血压、高血压合并代谢异常及代谢性高血压均可导致一定程度的靶器官损害,尤以代谢性高血压产生的靶器官损害最为严重;年龄BMI和WC均是导致靶器官损害的独立危险因素.%Objective To observe and compare the general condition and target organ damage among patients with simple hypertension, metabolic hypertension and hypertension complicating metabolic disorder, and review the risk factors of target organ damage. Methods The hypertensive patients ( n=152 ) were divided into simple hypertension group ( group A, n=51 ) , hypertension complicating metabolic disorder ( group B, n=55 ) and metabolic hypertension group ( group C, n=46 ) according to whether the patients had complicating metabolic diseases and order of hypertension and metabolic diseases. The carotid intima-media thickness (IMT) and left ventricular structure were detected by using color Doppler ultrasound, and the content of urine β 2-microglobiilin were detected by using radioimmnnoassay.The risk factors reducing the damage of these three organs were reviewed by applying multiple regression analysis. Results The average values of left ventricular mass ( LVM ) , left ventricular mass index ( LVM I) and urine β 2-microglobiilin were all higher in group C than those in group A (P<0.05 ) and group B ( P<0.01 ) , and those were significantly higher in group B than those in group A(P<0.05 ) . The differences in serum creatinine and carotid IMT had no statistical significance among three groups (P>0.05 ) . Age was an independent risk factor of the disorder of IMT (P<0.05 ) , and body mass index( BMI) and waist circumference ( WC ) were independent risk factors of left ventricular hypertrophy ( LVH, P<0.05 ) . Conclusion Simple hypertension, hypertension complicating metabolic disorder and metabolic hypertension all can induce target organ damage to some extent, and the target organ damage induced by metabolic hypertension is the most severe. BMI and WC are independent risk factors of target organ damage.