高血压前期合并肥胖患者左心室结构及功能变化与高敏C反应蛋白的相关性研究

发布时间：2018-01-02 20:01

本文关键词：高血压前期合并肥胖患者左心室结构及功能变化与高敏C反应蛋白的相关性研究　出处：《山西医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:通过观测高血压前期合并肥胖患者左心室结构与功能、高敏C反应蛋白水平变化趋势,探讨高血压前期、肥胖患者左心室结构及功能变化机制,并研究其与高敏C反应蛋白的关系。方法:选取我院2013年6月至2014年12月住院部及体检中心35-68岁人群,按分组标准分为4组,包括高血压前期组(PG)81例,肥胖组(OG)75例,高血压前期合并肥胖组(POG)60例,同时选择45例同时期在我院体检中心进行健康体检且结果正常的人群作为正常对照组(NG)。所选研究对象均记录年龄、性别、吸烟、饮酒史等基本资料,计算体重指数(BMI),隔夜空腹12小时后于次日清晨测量身高体重、血压水平;检测包括胆固醇(TC),甘油三酯(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)及空腹血糖(FPG)在内的常规生化指标;采用乳胶免疫增强比浊法测量高敏C反应蛋白浓度(hs-CRP)。超声心动图测定左室舒张末期内径(LVIDd)、左室收缩末期内径(LVIDs)、室间隔厚度(IVST)、舒张末期室间隔厚度(IVSd)、收缩末期室间隔厚度(IVSs)、左室后壁厚度(LVPWT)、左室舒张末期后壁厚度(PWTd)、左室收缩末期后壁厚度(PWTs)、舒张早期血流峰值流速(E)、舒张晚期血流峰值流速(A),并计算出左室质量指数(LVMI)、室壁中层缩短率(m FS)及舒张早期与舒张晚期充盈速度比值(E/A)。结果:1.POG组LVMI(53.68±10.29g/m2.7)显著高于PG组(41.53±9.64g/m2.7)、OG组(39.98±8.92g/m2.7)和NG组(28.46±5.73g/m2.7),且差异均有统计学意义(P0.05);PG组及OG组LVMI均高于对照组,差异均有统计学意义(P0.05)。2.POG组m FS(11.73±3.74%)显著低于PG组(15.81±4.96%)、OG组(15.16±4.23%)和NG组(19.47±4.94%),且差异均有统计学意义(P0.05);PG组、OG组均显著低于NG组,差异均有统计学意义(P0.05)。E/A值在四组间比较差异均无统计学意义(P0.05)。3.POG组患者hs-CRP(9.6±0.7mg/L)显著高于PG组(6.9±0.5mg/L)、OG组(6.2±0.4mg/L)和NG组(4.1±0.3mg/L),且差异均有统计学意义(P0.05);PG、OG组hs-CRP浓度高于NG组,差异均有统计学意义(P0.05)。4.析因分析示高血压前期和肥胖在LVMI、m FS、hs-CRP中均有交互作用。5.LVMI与m FS呈显著负相关(r=-0.783,P0.05),与hs-CRP浓度呈显著正相关(r=0.694,P0.05),与收缩压水平呈正相关(r=0.951,P0.05),与舒张压水平呈正相关(r=0.763,P0.05);m FS与收缩压水平呈负相关(r=-0.695,P0.05),与舒张压水平呈负相关(r=-0.894,P0.05)。6.回归分析示BMI、SBP、DBP、hs-CRP为影响LVMI的主要因素;BMI、SBP、DBP、hs-CRP为影响m FS的主要因素;仅有收缩压为影响E/A比值的主要因素。结论:高血压前期、肥胖是心血管疾病的危险因素;高血压前期及肥胖的交互作用可加重心功能损伤。hs-CRP参与了高血压前期、肥胖患者的心脏靶器官损害。
[Abstract]:Objective: to investigate the mechanism of left ventricular structure and function in prehypertensive and obese patients by observing the changes of left ventricular structure and function and the change trend of Gao Min C-reactive protein level. Methods: from June 2013 to December 2014, the patients aged 35 to 68 years old in our hospital and the physical examination center were divided into 4 groups according to the standard of grouping. There were 81 cases of prostaglandin in prehypertension group, 75 cases of OGN in obese group and 60 cases of POGN in prehypertension combined with obesity group. At the same time, 45 healthy people were selected as the normal control group. All the subjects were recorded the basic data of age, sex, smoking, drinking history and so on. Body mass index (BMI) was calculated. Height, weight and blood pressure were measured early the next morning after fasting for 12 hours. The routine biochemical parameters including TC, TGG, LDL-C, HDL-C and FPG were detected. The concentration of high sensitive C-reactive protein was measured by emulsion immunoenhancement turbidimetry. The left ventricular end-diastolic diameter (LVIDdN) and left ventricular end-systolic diameter (LVIDs) were measured by echocardiography. Interventricular septal thickness (IVSTT), end-diastolic septal thickness (IVSdT), end-systolic septal thickness (LVSsT), left ventricular posterior wall thickness (LVPWT). Left ventricular end diastolic posterior wall thickness, left ventricular end systolic posterior wall thickness, early diastolic peak flow velocity and late diastolic peak flow velocity. Left ventricular mass index (LVMI) was calculated. The ratio of early diastolic to late diastolic filling velocity was E / A. Results 1. LVMI(53.68 卤10.29 g / m ~ (2.7) in POG group). It was significantly higher than that in PG group (41.53 卤9.64g / m2.7). 39.98 卤8.92 g / m ~ (2.7) in group OG and 28.46 卤5.73 g / m ~ (2.7) in group NG, and the difference was statistically significant (P < 0.05). The LVMI of PG group and OG group were higher than that of control group. The difference was statistically significant. The m FS(11.73 卤3.74 in POG group was significantly lower than that in PG group (15.81 卤4.96). In group OG (15.16 卤4.23) and group NG (19.47 卤4.94), the difference was statistically significant (P 0.05). Group PG and group OG were significantly lower than those in group NG. All the differences were statistically significant. There was no significant difference between the four groups in the value of P0.05U. EPA. 3. The hs-CRP of POG group was higher than that of the control group (P < 0.05). 9.6 卤0.7 mg / L) was significantly higher than that in PG group (6.9 卤0.5 mg / L). OG group (6.2 卤0.4 mg / L) and NG group (4.1 卤0.3 mg / L), and the difference was statistically significant (P 0.05). The concentration of hs-CRP in PGN OG group was higher than that in NG group, and the difference was statistically significant (P 0.05). 4. Factorial analysis showed that prehypertension and obesity were in LVMIM FS. There was significant negative correlation between LVMI and MFS in hs-CRP (P 0.05). There was a significant positive correlation with the concentration of hs-CRP, 0.694m P0.05A, and a positive correlation with systolic blood pressure (SBP). There was a positive correlation between diastolic blood pressure and diastolic blood pressure. MFS was negatively correlated with systolic blood pressure (SBP) and diastolic blood pressure (P < 0.05) and diastolic blood pressure (DBP), respectively. Regression analysis showed that BMI was a negative correlation with systolic blood pressure (SBP) level and diastolic blood pressure (DBP) level. DBP hs-CRP was the main factor affecting LVMI. BMIS SBPU DBP hs-CRP was the main factor affecting mFS. Only systolic blood pressure (SBP) was the main factor affecting E / A ratio. Conclusion: before hypertension, obesity is a risk factor of cardiovascular disease. The interaction of prehypertension and obesity can aggravate the damage of cardiac function. Hs-CRP is involved in the heart target organ damage of obese patients.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R544.1;R589.2

【参考文献】