原发性高血压患者糖代谢水平及尿微量白蛋白的影响因素分析

发布时间：2018-03-19 11:13

本文选题：原发性高血压　切入点：糖代谢异常　出处：《新疆医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:探讨新疆某三甲医院原发性高血压既往未明确诊断糖尿病的住院患者糖代谢分布情况及糖代谢正常的原发性高血压患者向糖代谢异常合并状态发展的影响因素;了解原发性高血压患者eGFR分布,分析影响尿微量白蛋白的相关因素。方法:收集新疆某三甲医院高血压科住院的原发性高血压既往未明确诊断糖尿病患者的临床资料,计算不同民族、性别在糖代谢正常组与新诊断糖代谢异常组(空腹血糖受损、糖耐量异常、糖尿病)的构成比分布情况。按照糖代谢水平分组,按民族(维吾尔、哈萨克、汉)分为亚组,比较各项生化指标在各组的差异,将糖代谢正常组与糖代谢异常组间有统计学差异的指标纳入Logistics回归方程计算,确定糖代谢正常的原发性高血压患者向糖代谢异常合并状态进展过程中的危险因素和保护因素。计算eGFR水平在不同特征原发性高血压患者中的分布,并按照血糖、eGFR分组比较各项临床指标的差异。按照糖代谢水平分组,分析尿微量白蛋白与临床指标间的相关性。结果:不同民族(汉、维吾尔、哈萨克)、性别(男、女)的糖代谢水平(正常血糖、糖代谢异常)差异均无统计学意义(P0.05)。按照空腹血糖水平计算糖代谢异常构成比为10.1%。总研究人群中年龄、SBPmax、BMI、LDL、HDL、载脂蛋白B、TC在糖代谢正常组与糖代谢异常组差异均有统计学意义(P0.05);糖代谢正常组中,BMI、肌酐在汉族与维吾尔族间比较差异有统计学意义(P0.05);糖代谢异常组中,SBP、SBPmax、BMI在汉族与维吾尔族间比较差异有统计学意义(P0.05)。Logistic回归分析结果显示:年龄(P0.05,OR=1.013)、BMI(P0.05,OR=1.041)、TC(P0.05,OR=1.337)、HDL(P0.05,OR=0.620)。在尿微量白蛋白正常的原发性高血压患者中47.2%出现肾小球滤过率的减低。正常血糖组eGFR正常组与eGFR异常组的年龄、SBP、载脂蛋白B、血钾水平、24小时尿钠水平差异有统计学意义(P0.05),糖代谢异常组为年龄、SBP、载脂蛋白B、TC水平差异有统计学意义(P0.05),尿微量白蛋白相关性分析表明不同的糖代谢状态尿微量白蛋白排出量的影响因素不同;糖代谢正常组:舒张压(r=-0.11,p0.005)、年龄(r=-0.1,p0.005)、24小时尿钾(r=-0.17,p0.001)、24小时尿钠(r=-0.18,p0.001);糖代谢异常组:载脂蛋白B(r=-0.098,p0.01)、空腹血糖(r=0.087,p0.05)、餐后2小时血糖(r=-0.185,p0.001)、血清胱抑素C(r=-0.098,p0.01)、24小时尿钾(r=-0.16,p0.01)、24小时尿钠(r=-0.104,p0.001)。结论:年龄、BMI、TC升高是原发性高血压糖代谢正常患者向糖代谢异常合并状态进展过程中的危险因素,高HDL为保护因素。原发性高血压患者在尿微量白蛋白尚在正常范围内的情况下也会出现肾小球滤过率的减低。糖代谢正常组尿微量白蛋白与舒张压呈正相关,与年龄呈负相关;糖代谢异常组尿微量白蛋白与载脂蛋白B、空腹血糖、餐后2小时血糖、血清胱抑素C呈正相关;原发性高血压患者尿微量白蛋白与24小时尿钾、24小时尿钠水平呈负相关。
[Abstract]:Objective: to investigate the distribution of glucose metabolism in patients with primary hypertension (EH) who had not been diagnosed with diabetes mellitus (DM) and the factors influencing the development of EH patients with abnormal glucose metabolism. To understand the distribution of eGFR in patients with essential hypertension, and to analyze the related factors affecting urinary microalbumin. Methods: the clinical data of patients with essential hypertension who were hospitalized in Department of Hypertension in a third Grade A Hospital in Xinjiang were collected. The composition and distribution of gender in normal glucose metabolism group and newly diagnosed abnormal glucose metabolism group (impaired fasting blood glucose, impaired glucose tolerance, diabetes mellitus) were calculated according to the level of glucose metabolism and ethnic groups (Uygur, Kazak). Han) was divided into subgroups. The differences of biochemical indexes in each group were compared. The indexes with statistical difference between normal glucose metabolism group and abnormal glucose metabolism group were included in the Logistics regression equation. To determine the risk factors and protective factors in the progression of patients with normal glucose metabolism from essential hypertension to abnormal glucose metabolism and to calculate the distribution of eGFR level in patients with different characteristics of essential hypertension. According to the level of glucose metabolism, the correlation between urinary albumin and clinical indexes was analyzed. Results: different nationalities (Han, Uygur, Kazak, male, male, male). Glucose metabolism level (normal blood sugar), There was no significant difference in abnormal glucose metabolism (P 0.05). According to the fasting blood glucose level, the composition ratio of abnormal glucose metabolism was calculated as 10.1. There were statistical differences in HDLand Apolipoprotein BTC between normal glucose metabolism group and abnormal glucose metabolism group in the general study population. There were significant differences in BMIand creatinine between Han and Uygur nationality in normal glucose metabolism group (P 0.05) and significant difference in BMI between Han and Uygur nationality in abnormal glucose metabolism group (P 0.05). Logistic regression analysis showed that there was significant difference between Han and Uygur nationality. : the age of P0.05 ORA 1.013 BMIP0.05 ORP 1.041TCU 1.337HDLP0.05OR0.200.The glomerular filtration rate decreased in 47.2% patients with essential hypertension with normal urinary microalbumin. The age of eGFR normal group and abnormal eGFR group were found in normal glucose group, apolipoprotein B group, serum potassium level and 24 hour urinary sodium level of patients with normal blood glucose and abnormal eGFR. The results showed that there was no significant difference between normal blood glucose group and abnormal eGFR group in the age of SBP, apolipoprotein B, serum potassium level and 24 hours urinary sodium level in 47.2% patients with hypertension with normal urinary microalbumins. The difference was statistically significant (P 0.05). The age group of abnormal glucose metabolism was SBP and the level of apolipoprotein BU TC was significantly different (P 0.05). The correlation analysis of urinary microalbumin showed that the factors affecting the excretion of urinary microalbumin were different among different glucose metabolism states. Normal glucose metabolism group: diastolic blood pressure r-0.11p 0.005U, age: r-0.1g p0.005U 24 h urinary potassium r-0.17p0.001U 24 h urinary sodium r-0.18p 0.001g; abnormal glucose metabolism group: apolipoprotein Br-0.098p 0.01U, fasting blood glucose r0.087p 0.05a, 2 h postprandial blood glucose r-0.185p0.001, serum cystatin Crr-0.098p0.01a 24 h urinary potassium r-0.16p1a 24 h r-0.104p 0.001p = 0.104p0. 001p = 0.104p0. 001p = 0.104p0. 001p = 0.104p0. 001p = = ='= = =. Elevated BMITC is a risk factor in the progression from abnormal glucose metabolism to abnormal glucose metabolism in patients with essential hypertension. High HDL was the protective factor. In patients with essential hypertension, the glomerular filtration rate was decreased under the condition that the urinary microalbumin was still within the normal range. In the normal glucose metabolism group, urinary microalbumin was positively correlated with diastolic blood pressure, and negatively correlated with age. There was a positive correlation between urinary microalbumin and apolipoprotein B, fasting blood glucose, 2 hours postprandial blood glucose, and serum cystatin C in patients with abnormal glucose metabolism, and a negative correlation between urinary microalbumin and 24 hour urinary potassium and 24 hour urinary sodium in patients with essential hypertension.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R544.11

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