血清维生素D与原发性高血压靶器官损害的相关研究

发布时间：2018-01-25 05:37

本文关键词： 维生素D 高血压左室肥厚动脉粥样硬化　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:通过比较不同危险分层的EH患者血清Vit D水平变化,明确血清Vit D与EH发病与不同终末靶器官损害的临床意义。方法:入选符合诊断标准的118例EH患者,按照EH危险分层标准分为23例低危组,25例中危组,32组高危组,38例极高危组。对照组选自健康体检者。采集所有入选对象空腹血,离心血清后应用化学发光法测定每组患者Vit D水平,比较各组间差异,并分析维生素D水平与IMT、LVMI和Gensini积分的相关性。结果:①原发性高血压患者的血清维生素D水平均低于正常对照组[(27.88±5.34)ng/m L,(23.05±6.74)ng/m L,(19.31±8.08)ng/m L,(17.36±2.66)ng/m L vs(30.08±4.77)ng/m L,(P0.05)],且高血压极高危组、高血压高危组的血清维生素D水平明显降低(P0.05)。②不同颈动脉斑块等级患者血清维生素D水平存在差异:随着斑块等级的增加,血清维生素D水平逐渐降低(P0.05)③对行冠脉造影的患者行Gensini评分。得分介于10~72分,以20分和40分为界分为3个组。血清维生素D水平在Gensini积分40分亚组均低于10~20分亚组和20~40分亚组[(11.06±3.97)ng/m L,vs(17.13±0.36)ng/m L,(15.13±1.05)ng/m L,(P0.05)],但在Gensini积分位于10~20和20~40分两亚组间无统计学差异(P0.05)。单支、双支、三支血管病变的组间血清维生素D水平差异无显著性(P0.05),但是三支血管病变者血清维生素D水平较低。④血清维生素D与颈动脉内-中膜厚度、左室质量指数、Gensini积分存在负相关(偏回归系数b值分别为-4.849、-0.061、-0.034,P0.10)。结论:①原发性高血压患者血清维生素D水平降低,且与高血压的危险程度呈负相关,随着高血压危险程度的加深,维生素D水平降低更显著。②维生素D水平与颈动脉内膜-中层厚度呈负相关,且随着颈动脉斑块等级的变化而变化,可以作为颈动脉粥样硬化的早期指标。③维生素D与冠脉狭窄程度量化指标Gensini评分之间的负性相关性,提示维生素D水平降低参与冠脉病变的进展。④维生素D与左室质量指数之间呈负相关,表明维生素D缺乏在高血压致心室重塑方面发挥一定作用。⑤维生素D缺乏可以作为高血压终末靶器官损害的重要的预警信号,明确高血压患者靶器官损害与慢性炎症的关系,提升临床医生和高危人群对高血压预防和治疗的认识,减少高血压致残率。
[Abstract]:Objective: to compare the changes of serum Vit D levels in EH patients with different risk stratification. Methods: 118 EH patients who met the diagnostic criteria were selected and divided into 23 low risk groups according to the risk stratification criteria of EH. 25 cases of middle risk group, 32 groups of high risk group, 38 cases of extremely high risk group. The control group was selected from the healthy people, and all the subjects were collected fasting blood. After centrifugation, the levels of Vit D in each group were measured by chemiluminescence method, the differences between each group were compared, and the levels of vitamin D and IMT were analyzed. Results the serum vitamin D levels in patients with essential hypertension were lower than those in normal controls. [(2) 27.88 卤5.34 ng / mL (23.05 卤6.74 ng / mL) 19.31 卤8.08 ng / mL. Vs(30.08 卤4.77 ng / mL (P0.05), and high risk group of hypertension. The serum vitamin D level of hypertension high risk group was significantly lower than that of the patients with different carotid plaque grade: with the increase of plaque grade, the serum vitamin D level was significantly lower in patients with different carotid plaque grades. The level of serum vitamin D decreased gradually (P 0.05) and the Gensini score of the patients undergoing coronary angiography was between 1072 and 1072. The serum vitamin D levels in the Gensini score 40 subgroup were lower than those in the 10 ~ 20 subgroup and 20 ~ 40 subgroup. [11.06 卤3.97 ng / m / m / ng / m / ng / m / g / m / L = 17.13 卤0.36 ng / m / g / m / L = 15.13 卤1.05ng / m / m / g / m ~ (0.05)]. However, there was no statistical difference between the two subgroups in Gensini score between 10 ~ 20 and 20 ~ 40 years (P < 0.05). There was no significant difference in serum vitamin D levels among the three vessel disease groups, but the serum vitamin D levels in the three vessel disease groups were lower than that in the three vessel lesions groups. The levels of serum vitamin D and carotid intima-media thickness were lower than those in the three vessel lesions groups. There was a negative correlation between Gensini integral and left ventricular mass index (partial regression coefficient b was -4.849 ~ 0.061 ~ 0.034). Conclusion the serum vitamin D level in patients with essential hypertension decreased, and was negatively correlated with the risk of hypertension, with the deepening of the risk degree of hypertension. The decrease of vitamin D level was more significant. 2. Vitamin D level was negatively correlated with carotid intima-media thickness, and changed with the change of carotid plaque grade. It can be used as an early indicator of carotid atherosclerosis. 3. 3 vitamin D and coronary stenosis quantitative index Gensini score of negative correlation. It is suggested that the decrease of vitamin D level is negatively correlated with left ventricular mass index (LVMI) in the progression of coronary artery disease. It is suggested that vitamin D deficiency plays a role in ventricular remodeling induced by hypertension. Vitamin D deficiency can be used as an important warning signal for the target organ damage of hypertension. To clarify the relationship between target organ damage and chronic inflammation in patients with hypertension, to improve the understanding of the prevention and treatment of hypertension among clinicians and high risk groups, and to reduce the rate of hypertension disability.
【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

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