原发性高血压患者尿微量白蛋白与左心室损害及血管内皮功能的相关性研究

发布时间：2018-01-15 12:35

本文关键词：原发性高血压患者尿微量白蛋白与左心室损害及血管内皮功能的相关性研究　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨原发性高血压患者尿微量白蛋白与左心室损害及血管内皮功能的相关性。方法:随机选择2012年10月-2013年10月来我院行高血压治疗的门诊就诊的患者60例,作为观察组。观察组进一步分为尿微量白蛋白(MAU)阳性组和MAU阴性组,另选择同期来我院行健康体检者20例,作为对照组。对三组入选后一天内行24h尿微量白蛋白(MAU)、内皮依赖性血流介导的血管舒张功能的检测(EDF)、左心室、颈动脉内膜中层厚度(c-IMT)超声检查。结果:1三组肱动脉内皮依赖性舒张功能(EDF)的比较:MAU阳性组、MAU阴性组、对照组肱动脉静息状态直径分别为(3.98±0.62)mm、(4.12±0.50)mm,(4.13±0.63)mm、MAU阳性组、MAU阴性组、对照组肱动脉反应性充血直径分别为(4.29±0.76)mm、(4.47±0.64)mm、(4.56±0.75)mm,MAU阳性组的血流介导的血管扩张反应(FMD)明显低于对照组(7.29±3.12%vs 10.13±3.07%),P0.05,而MAU阴性组和正常对照组之间并未见到统计学差异,P0.05,NS组间无明显差异。2三组颈动脉内膜中层厚度(c-IMT)的比较:MAU阳性、MAU阴性组、正常对照组颈动脉内膜中层厚度分别为(0.85±0.15mm)、(0.78±0.15mm)、(0.75±0.17mm),对照组和MAU阳性组之间比较,P0.05,MAU阴性组和MAU阳性组之间比较,P0.05。3三组左心室质量(LVM)和左心室质量指数(LVMI)的比较:结果显示MAU阳性组明显高于正常对照组LVM(166.99±17.71 vs143.70±16.57、LVMI 103.91±12.92 vs 84.13±11.27),P0.05;MAU阳性组也高于MAU阴性组,LVM(166.99±17.71 vs 149.24±15.74、LVMI103.91±12.92 vs 87.15±11.19),P0.05;而MAU阴性组和正常对照组之间,无统计学差异。结论:1 FMD和尿微量白蛋白之间存在线性相关,且随着尿微量白蛋白的增加,FMD呈下降趋势。2 c-IMT和尿微量白蛋白之间存在线性相关,且随着尿微量白蛋白的增加,c-IMT的厚度相应增加。3左心室质量指数(LVMI)和尿微量白蛋白之间存在线性相关,且随着尿微量白蛋白的增加,左心室质量指数也相应增加。4尿微量白蛋白可作为预测心脏、血管内皮受损的指标,作为可靠的临床检验指标对高血压早期肾损害严重程度进行预测,对微量白蛋白尿的早期检测及尽早采取相关干预措施,以延缓肾脏病变进展速度以及心脑血管性疾病的发生发展。
[Abstract]:Objective: to investigate the relationship between urinary microalbumin and left ventricular damage and vascular endothelial function in patients with essential hypertension. From October 2012 to October 2013, 60 outpatients who were treated with hypertension in our hospital were randomly selected. As the observation group, the observation group was further divided into positive group and MAU negative group, and 20 cases were selected for health examination in the same period. As the control group, the three groups were treated with 24 h urinary microalbuminuria (MAU), endothelium-dependent blood flow mediated vasodilation (EDF) and left ventricle (LV). Results the comparison of endothelium-dependent diastolic function (EDF) of brachial artery in three groups was made. In the control group, the diameter of brachial artery in resting state was 3.98 卤0.62mg, 4.12 卤0.50m / mm and 4.13 卤0.63m / mm respectively. The reactive hyperemia diameter of brachial artery in MAU negative group and control group was 4.29 卤0.76 mm and 4.47 卤0.64 mm respectively, and the diameter of brachial artery reactive hyperemia in control group was 4.56 卤0.75 mm. The FMD-mediated vasodilation response in MAU positive group was significantly lower than that in control group (7.29 卤3.12 vs 10.13 卤3.07) (P0.05). However, there was no statistical difference between the MAU negative group and the normal control group. 2 there was no significant difference between the three groups in carotid intima-media thickness (c-IMT). The intima-media thickness of carotid artery in MAU negative group and normal control group was 0.85 卤0.15mm and 0.78 卤0.15mm respectively (0.75 卤0.17mm). The comparison between the control group and the MAU positive group was compared between the P0.05-MAU negative group and the MAU positive group. Comparison of left ventricular mass (LVM) and left ventricular mass index (LVMI) in the three groups: the results showed that the MAU positive group was significantly higher than that of the normal control group (. 166.99 卤17.71 vs143.70 卤16.57. LVMI 103.91 卤12.92 vs 84.13 卤11.27P0.05; MAU positive group was also higher than MAU negative group 166.99 卤17.71 vs 149.24 卤15.74. LVMI103.91 卤12.92 vs 87.15 卤11.19 P 0.05; There was no significant difference between the MAU negative group and the normal control group. Conclusion there is a linear correlation between urinary microalbumin and urine microalbumin with the increase of urinary microalbumin.Conclusion there is a linear correlation between the MAU negative group and the normal control group. There was a linear correlation between FMD and urinary microalbumin in decreasing trend, and with the increase of urinary microalbumin. There was a linear correlation between the thickness of c-IMT and urinary microalbumin. 3. There was a linear correlation between left ventricular mass index (LVMII) and urinary microalbumin, and with the increase of urinary microalbumin. The left ventricular mass index (LVMI) was also increased accordingly. Urinary microalbuminuria could be used as a predictor of heart and vascular endothelial damage and as a reliable clinical test index to predict the severity of early renal damage in hypertensive patients. Early detection of microalbuminuria and early intervention measures were taken to delay the progression of renal disease and the occurrence and development of cardiovascular and cerebrovascular diseases.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.11

【参考文献】