青年高血压病发病特点及预后分析研究

发布时间：2019-03-26 11:43

【摘要】：目的:回顾性分析山西医科大学第一医院心内科青年高血压病患者住院诊治情况,并随访其院外治疗依从情况,研究青年高血压病的发病特点及治疗与预后的关系,初步阐明综合危险控制(包含药物治疗)对靶器官保护的重要性,以期为临床工作提供一定的帮助。方法:选取在山大一院心内科2005年1月至2015年12月约11年间住院,诊断为青年高血压病的患者,共计病例314例。根据患者首诊时的血压水平分为1级青年高血压组、2级青年高血压组、3级青年高血压组三个组别,通过对各组患者住院期间资料及相关随访资料的统计分析,研究青年高血压病的发病特点及该病治疗与预后的关系。结果:本研究共入选314例患者,男性213例(67.8%),女性101例(32.2%),平均年龄为38.59±4.14(29-44)岁。1级高血压共60(19.11%)例,2级高血压共109(34.71%)例,3级高血压共145(46.18%)例。男性青年高血压病患者约是女性的2倍,3级高血压患者居多(约占50%);近70%的患者有高血压病家族史;就生活方式而言,各级青年高血压病患者都有不同程度的BMI超标,有吸烟、饮酒等不良生活习惯,且随血压等级升高,吸烟、饮酒、有家族史者所占比例随之增大;青年高血压患者均存在血脂、血糖、尿酸等代谢异常,但不同血压级别之间无差异;伴随疾病方面,3级高血压患者约20%的患者有冠心病和缺血性脑卒中,约8%的患者伴有心力衰竭、出血性脑卒中或慢性肾脏病。此外,在治疗方面,约20%的患者为单药治疗,发现其中约40%患者选用CCB,其次为ACEI;约70%的患者需联合2种或3种药物治疗,回顾发现,在2、3级青年高血压患者中,采用ACEI/ARB+β受体阻滞剂+CCB联合降压者居多,多数治疗以β受体阻滞剂为基础联合用药。经积极干预治疗后,绝大多数青年高血压患者血压控制于135/85 mm Hg左右,总胆固醇控制于4.5mmol/L左右,甘油三酯小于1.8mmol/L,低密度脂蛋白均小于2.6mmol/L,高密度脂蛋白均大于1.09mmol/L。在生活方式方面,BMI无明显变化(干预前后:24.33±2.42 VS 23.88±1.89),吸烟以及饮酒者减少(治疗前后:67.52%VS 59.24%;63.69%VS 51.27%)。药物治疗方面,全部研究对象坚持单药治疗总人数显著增加(18.15%VS 28.34%),其中坚持单药治疗者,1级高血压患者最显著(23.33%VS76.67%),2级和3级患者无显著变化(28.44%VS 28.44%,8.28%VS 8.28%);联合用药总人数无显著变化(67.20%VS 67.20%),联合用药者均为2级或3级高血压患者。靶器官受损方面,左心室肥厚(25.80%VS 28.03%)、颈动脉硬化(8.60%VS10.83%)、冠心病(15.61%VS 18.15%)略增加,心力衰竭(5.10%VS 6.05%),缺血性脑卒中(14.01%VS 15.29%)、出血性脑卒中(5.10%VS 6.05%)、慢性肾脏病(4.78%VS 5.41%)人数均稍增加。结论:(1)青年高血压发病多有家族史,男性居多,肥胖体型及生活习惯不良者更易发病,同时伴有代谢异常;(2)青年高血压病患者的治疗应重视综合危险因素控制,尤其应注意改善不良生活习惯,选用最佳个体化治疗方案,以期最大保护其靶器官。
[Abstract]:Objective: to analyze retrospectively the diagnosis and treatment of young hypertensive patients in the Department of Cardiology, first Hospital of Shanxi Medical University, and to investigate the relationship between the treatment and prognosis of the young hypertensive patients by following up the out-of-hospital treatment in order to study the incidence characteristics and the relationship between treatment and prognosis of young hypertension. The importance of comprehensive risk control (including drug therapy) for target organ protection was preliminarily elucidated in order to provide some help for clinical work. Methods: from January 2005 to December 2015, 314 patients were diagnosed as young hypertensive patients, who were hospitalized in the Department of Cardiology of the first Hospital of Shanshan University from January 2005 to December 2015. According to the blood pressure level at the first visit, the patients were divided into three groups: grade 1 youth hypertension group, grade 2 youth hypertension group and grade 3 young hypertension group. The data of hospitalization period and related follow-up data of each group were statistically analyzed. To study the characteristics of hypertension in young people and the relationship between the treatment and prognosis. Results: a total of 314 patients (male 213 (67.8%), female 101 (32.2%) were enrolled in this study. The mean age was 38.59 卤4.14 (29 / 44) years old. There were 60 (19.11%) patients with grade 1 hypertension. There were 109 (34.71%) cases of grade 2 hypertension and 145 (46.18%) cases of grade 3 hypertension. The number of young men with hypertension was about twice as high as that of women, and the majority of grade 3 hypertension patients (about 50%), nearly 70% of them had family history of hypertension. As far as life style is concerned, young hypertensive patients at all levels have different degrees of BMI exceeding the standard, smoking, drinking and other bad living habits, and with the rise of blood pressure grade, smoking, drinking, the proportion of people with family history will increase; There were abnormal metabolism of blood lipid, blood sugar and uric acid in young patients with hypertension, but there was no difference among different blood pressure levels. In terms of disease, about 20% of patients with grade 3 hypertension had coronary heart disease and ischemic stroke, and about 8% had heart failure, hemorrhagic stroke or chronic kidney disease. In addition, in terms of treatment, about 20% of the patients were treated with single drug, and about 40% of the patients were found to use CCB, followed by ACEI;. About 70% of the patients needed two or three kinds of drug therapy. It was found that ACEI/ARB 尾 receptor blocker CCB combined with hypotension was most commonly used in young hypertensive patients of grade 2 and grade 3, and most of the treatments were based on 尾 receptor blocker. After active intervention, the blood pressure, total cholesterol, triglyceride, low density lipoprotein and low density lipoprotein in most young hypertensive patients were about 135 ~ 85 mm Hg, about 4.5mmol/L, 1.8 mmol / L and 2.6 mmol / L, respectively, and the total cholesterol was less than 1.8 mmol / L, and the low density lipoprotein (LDL) was less than 2.6 mmol / L. The high density lipoprotein (HDL) was more than 1.09mmol / L. In terms of life style, there was no significant change in BMI (before and after intervention: 24.33 卤2.42 VS 23.88 卤1.89), while smoking and drinking decreased (before and after treatment: 67.52%VS 59.24% vs 63.69% vs 51.27%). In terms of drug therapy, the total number of participants who insisted on single-drug therapy increased significantly (18.15%VS 28.34%), among them, the first-grade hypertension patients (23.33% vs 76.67%) were the most significant among those who insisted on single-drug therapy. There was no significant change in grade 2 and grade 3 patients (28.44%VS 28.44%, 8.28% vs 8.28%). There was no significant change in the total number of patients taking combined drugs (67.20%VS 67.20%). All the patients with combined drugs were grade 2 or grade 3 hypertension. In target organ damage, left ventricular hypertrophy (25.80%VS 28.03%), carotid atherosclerosis (8.60% vs 10.83%), coronary heart disease (15.61%VS 18.15%) and heart failure (5.10%VS 6.05%) increased slightly. Ischemic stroke (14.01%VS 15.29%), hemorrhagic stroke (5.10%VS 6.05%) and chronic kidney disease (4.78%VS 5.41%) increased slightly. Conclusion: (1) the incidence of hypertension in young people has family history, male is the majority, obese body type and poor living habits are more likely to develop, at the same time accompanied by metabolic abnormalities; (2) the treatment of young patients with hypertension should pay attention to the control of comprehensive risk factors, especially to the improvement of bad living habits, and the best individualized treatment scheme should be chosen in order to protect the target organs.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

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