生物学标记物在原发性高血压合并房颤患者中的临床研究

发布时间：2018-05-15 22:18

  本文选题：原发性高血压 + 心房颤动　； 参考：《兰州大学》2015年硕士论文

【摘要】：目的探讨原发性高血压合并心房颤动患者与非心房颤动患者生物学标记物的差异以及临床意义。方法本研究为病例对照研究,按照病例和对照进行1：1匹配。纳入符合原发性高血压入排标准的患者120例(均为兰州大学第二医院心血管内科住院患者),按照是否合并心房颤动分为两组：合并心房颤动为病例组共63例(至少在入院前48小时内发生过心房颤动)；不合并心房颤动为对照组共57例。统计病例组和对照组的基线资料(年龄,性别,体重指数,血压分级,心功能分级,是否合并糖尿病及冠心病)和临床资料(常规生化指标,心电图,超声心动图)；比较两组的生物学标记物(C反应蛋白,白介素-6,同型半胱氨酸,肾素-血管紧张素-醛固酮系统,可溶性血栓调节蛋白,血管性血友病因子,血管细胞黏附因子-1)的差异。采用SPSS 19.0统计软件进行数据的统计学分析。结果两组患者的基线资料：年龄,性别,体重指数,血压分级,心功能分级,是否合并糖尿病,是否合并冠心病等均无统计学差异(P=0.061,P=0.141,P=0.275, P=0.152, P=0.263, P=0.342, P=0.074)。两组间的常规生化指标：肾功能指标(尿素,肌酐,尿酸)无统计学差异(P=0.102,P=0.391,P=0.256)；电解质(钾,镁)无统计学差异(P=0.340,P=0.178)；血脂(总胆固醇,甘油三酯,低密度脂蛋白胆固醇,高密度脂蛋白胆固醇),并计算血浆致动脉硬化指数(甘油三脂和高密度脂蛋白胆固醇比值的对数转换值),均无统计学差异(P=0.124,P=0.177, P=0.513, P=0.224, P=0.432)。应用心电图Cornell方法计算是否存在左心室肥厚,两组间无统计学差异(P=0.209)。采用超声心动图测量左心室收缩及舒张末期内径,两组间无统计学差异(P=0.339,P=0.886),两组间左心房前后径和左心室射血分数有统计学差异(P=0.008,P=0.043)。两组间C反应蛋白,白介素-6,同型半胱氨酸无统计学差异(P=0.053,P=0.214,P=0.421)；血管紧张素Ⅰ、醛固酮、肾素活性无统计学差异(P=0.367,P=0.233,P=0.485),血管紧张素Ⅱ有统计学差异(P=0.026)；可溶性血栓调节蛋白有统计学差异(P=0.002),血管性血友病因子和血管细胞黏附因子-1两组间无统计学差异(P=0.645,P=0.944)。结论与单纯高血压患者相比,高血压合并心房颤动患者在基线资料和生化指标无明显差异,但血管紧张素Ⅱ水平以及可溶性血栓调节蛋白水平在高血压合并心房颤动患者组明显升高,且有统计学差异。提示在心房颤动的发病过程中血管紧张素Ⅱ和可溶性血栓调节蛋白可能起到一定作用。
[Abstract]:Objective to investigate the difference and clinical significance of biological markers in patients with essential hypertension complicated with atrial fibrillation (EH) and non-atrial fibrillation (non-atrial fibrillation). Methods this study is a case-control study, according to the case and control 1:1 matching. A total of 120 patients (all hospitalized in the Department of Cardiovascular Medicine, second Hospital of Lanzhou University) who met the admission criteria for essential hypertension were divided into two groups according to whether they were complicated with atrial fibrillation: 63 patients with atrial fibrillation. Atrial fibrillation occurred less than 48 hours before admission, and no atrial fibrillation was associated with atrial fibrillation in 57 patients in the control group. Baseline data (age, sex, body mass index, blood pressure grading, cardiac function grading, diabetes mellitus and coronary heart disease) and clinical data (routine biochemical indicators, electrocardiogram) were recorded in the case group and control group. Echocardiography, comparison of biological markers such as C-reactive protein, interleukin-6, homocysteine, renin-angiotensin-aldosterone system, soluble thrombomodulin, von Willebrand factor, The difference of vascular cell adhesion factor-1. The data were analyzed by SPSS 19.0 software. Results there were no significant differences in baseline data between the two groups: age, sex, body mass index, blood pressure grade, cardiac function grade, diabetes mellitus, coronary heart disease, etc. There was no significant difference between the two groups (P = 0.061, P = 0.141 or P = 0.275, P = 0.152, P = 0.263, P = 0.342, P = 0.074, P = 0.074). There was no significant difference in renal function (urea, creatinine, uric acid) between the two groups. There was no significant difference between the two groups in renal function (urea, creatinine, uric acid); electrolytes (potassium, magnesium) were not significantly different; serum lipids (total cholesterol, triglyceride, low density lipoprotein cholesterol, low density lipoprotein cholesterol, There was no significant difference in plasma arteriosclerosis index (TG / HDL-C) between high density lipoprotein cholesterol (HDL-C) and high density lipoprotein cholesterol (HDL-C). There was no significant difference in plasma arteriosclerosis index (P = 0.124, P = 0.173, P = 0.513, P = 0.224, P = 0.432, P = 0.432). The left ventricular hypertrophy (LVH) was calculated by electrocardiogram (Cornell) method. There was no statistical difference between the two groups (P < 0. 209). Left ventricular systolic and end-diastolic diameters were measured by echocardiography. There was no significant difference between the two groups (P < 0.01). The left atrial anterior and posterior diameter and left ventricular ejection fraction (LVEF) were significantly different between the two groups. There was no significant difference in C-reactive protein, interleukin-6 and homocysteine between the two groups. There was no significant difference in renin activity between the two groups (P < 0. 367). There was no significant difference in the activity of renin between two groups (P = 0. 363), there was a significant difference in angiotensin 鈪，

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