肾素、醛固酮协同作用对原发性高血压病合并阻塞性睡眠呼吸暂停低通气综合征患者左心结构和功能的影响研究

发布时间：2018-12-14 05:48

【摘要】：目的探讨肾素、醛固酮协同作用对原发性高血压病合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者左心结构和功能的影响。方法从2011年1月—2016年1月在新疆医科大学第一附属医院高血压科住院确诊的原发性高血压病合并OSAHS患者546例中,选取未服用影响肾素-血管紧张素-醛固酮系统(RAAS)降压药物的患者277例,其中男197例,女80例;年龄18~60岁,平均年龄(44.3±7.9)岁。根据肾素、醛固酮水平分为正肾素正醛固酮组(N组,n=74)、高肾素正醛固酮组(HR组,n=113)、正肾素高醛固酮组(HA组,n=22)、高肾素高醛固酮组(HRA组,n=68)。采用心脏超声心动图测定反映左心结构和功能的相关指标,包括左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左房室瓣血流频谱E峰和A峰最大流速比值(E/A),并根据公式计算左心室射血分数(LVEF)和左心室质量指数(LVMI)。采用放射免疫法测定血浆肾素活性(PRA)、醛固酮水平(PAC)。影响因素分析采用多因素Logistic回归分析。结果 4组性别、年龄、高血压病程、BMI、24 h平均收缩压(24 h SBP)、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)间差异无统计学意义(P0.05),而24 h平均舒张压(24 h DBP)、睡眠呼吸暂停低通气指数(AHI)间差异有统计学意义(P0.05)。4组LAD、LVEDD、IVST、LVPWT、LVMI、E/A间差异有统计学意义(P0.05),而LVESD、LVEF间差异无统计学意义(P0.05)。BMI〔OR=2.756,95%CI(1.604,4.738),P0.001〕、高肾素高醛固酮〔OR=2.377,95%CI(1.038,5.446),P=0.041〕是LAD的影响因素;性别〔OR=0.283,95%CI(0.134,0.601),P=0.001〕、BMI〔OR=2.058,95%CI(1.198,3.533),P=0.009〕、AHI〔OR=2.776,95%CI(1.364,5.650),P=0.005〕、高肾素高醛固酮〔OR=3.222,95%CI(1.377,7.537),P=0.007〕是LVMI的影响因素;年龄〔OR=2.859,95%CI(1.943,4.206),P0.001〕是E/A的影响因素。结论肾素、醛固酮组合对原发性高血压病合并OSAHS患者左心结构和功能改变有协同作用,其中高肾素高醛固酮组合影响最明显。
[Abstract]:Objective to investigate the effects of renin and aldosterone on left ventricular structure and function in patients with essential hypertension complicated with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods from January 2011 to January 2016, 546 patients with essential hypertension complicated with OSAHS were hospitalized in the Department of Hypertension, first affiliated Hospital of Xinjiang Medical University. 277 patients (197 males and 80 females) who did not take (RAAS) antihypertensive drugs affecting renin-angiotensin-aldosterone system were selected. The average age was (44.3 卤7.9) years. According to the levels of renin and aldosterone, they were divided into three groups: positive renin positive aldosterone group (n = 74), high renin positive aldosterone group (HR, n = 113), positive renin high aldosterone group (HA, n = 22) and high renin high aldosterone group (HRA, n = 68). Left ventricular structure and function were measured by echocardiography, including left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), interventricular septal thickness (IVST),). Left ventricular posterior wall thickness (LVPWT), left atrioventricular valve flow spectrum E / A ratio (E / A). According to the formula, the left ventricular ejection fraction (LVEF) and left ventricular mass index (LVMI).) were calculated. Determination of plasma renin activity (PRA), aldosterone level (PAC). By radioimmunoassay The influencing factors were analyzed by multivariate Logistic regression analysis. Results Sex, age, duration of hypertension, BMI,24 h mean systolic blood pressure (24 h SBP), fasting blood glucose, (FPG), total cholesterol, (TC), triglyceride, (TG), low density lipoprotein cholesterol (LDL-C), There was no significant difference in high density lipoprotein cholesterol (HDL-C) among the four groups (P0.05), but the 24 h mean diastolic blood pressure (24 h DBP), sleep apnea hypopnea index (AHI) was significantly different among the 4 groups (P0.05). The difference of LVEDD,IVST,LVPWT,LVMI,E/A was statistically significant (P0.05), but there was no significant difference between LVESD,LVEF (P0.05). BMI (OR=2.756,95%CI (1.604 卤4.738), P0.001). High renin and aldosterone (OR=2.377,95%CI (1.038, 5.446), P0. 041) were the influencing factors of LAD. Sex (OR=0.283,95%CI (0.134 / 0.601), Pn0. 001), BMI (OR=2.058,95%CI (1. 198 / 3.533), P0. 009), AHI (OR=2.776,95%CI (1. 364 / 5.650), P0. 005), High renin and aldosterone (OR=3.222,95%CI (1.377-7.537), P0. 007) were the influencing factors of LVMI. Age (OR=2.859,95%CI (1.943 卤4.206), P0.001) was a factor of EPA. Conclusion the combination of renin and aldosterone has synergistic effect on the changes of left ventricular structure and function in patients with essential hypertension complicated with OSAHS, among which the combination of high renin and aldosterone is the most obvious.
【作者单位】：新疆医科大学第一附属医院高血压科;新疆医科大学第二附属医院重症医学科;
【基金】：新疆维吾尔自治区自然科学基金资助项目(2015211C038)
【分类号】：R544.11;R766

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