难治性高血压肾功能损害与左心室肥厚的关系

目的研究难治性高血压(RH)患者肾功能损害与左心室肥厚(LVH)的关系,并探讨影响RH患者LVH的相关危险因素。方法回顾性分析2007-10-2010-07北京安贞医院高血压科住院患者215例(RH患者120例,非RH患者95例)的临床资料,通过"肾脏病膳食改良试验(MDRD)"公式评估肾功能;进行24h动态血压监测;行超声心动图检查,计算左心室质量指数(LVMI),LVMI>125(男性),>110g/m2(女性)作为LVH的诊断。结果与非RH患者比较,RH患者估算的肾小球滤过率(eGFR)(72.3±22.1)比(83.1±19.5)mL/(min·1.73m2)]较低,eGFR<60mL/(min·1.73m2)检出率(29.2%比10.5%)、LVH检出率(32.5%比16.8%)、继发性高血压检出率(31.7%比5.3%)、左心室质量指数(108.0±27.1)比(95.3±22.9)g/m2]较高(均P<0.01)。经Logistic回归分析,LVH的影响因素为eGFR<60mL/(min·1.73m2)OR4.5(95%CI1.82～11.07),P=0.001]和合并高胆固醇血症OR3.6(95%CI1.36～9.58),P=0.010]。结论 RH患者有明显的肾功能损害和LVH,不同肾功能水平对LVH影响不同,eGFR<60mL/(min·1.73m2)是LVH的危险因素。

Relationship of renal function impairment and left ventricular hypertrophy in refractory hypertension

Objective To study the relationship between renal function impairment and left ventricular hypertrophy (LVH) in patients with refractory hypertension (RH), and to investigate the relative risk factors of LVH in RH patients. Methods The data of 215 patients (120 cases of RH and 95 cases of none RH) who hospitalized in Bejing Anzhen Hospital were retrospectivly analysed from October 2007 to July 2010. The renal function was evaluated by modification of diet in renal disease (MDRD) formula, and 24-hour ambulatory blood pressure were monitored. Echocardiography measurement were performed, and left ventricular mass index (LVMI) were calculatled. LVH were definited when LVMI>125 g/m2 in male or LVMI>110 g/m2 in female. Results Compared with that in none RH group, estimated glomerular filtration rate (eGFR) in RH group was lower (72.3±22.1) vs (83.1±19.5) mL/(min·1.73 m2), P<0.01], while the detectable rates of eGFR<60 mL/(min·1.73 m2), LVH, secondary hypertension, and left ventricular mass index in RH group were higher respectively 29.2% vs 10.5%, 32.5% vs 16.8%, 31.7% vs 5.3%, (108.0±27.1) vs (95.3±22.9) g/m2]. These differences had statistic significance (all P<0.01). The logistic regression analysis showed that OR value of eGFR<60 mL/(min·1.73 m2) and concomitant hypercholesteremia were respectively 4.5 (95% CI 1.82-11.07, P=0.001) and 3.6 (95% CI 1.36-9.58, P=0.010). Conclusion Renal function impairment and LVH are evident in RH patients. Different levels of renal function had different impacts on LVH. eGFR<60 mL/(min·1.73 m2) is an risk factor of LVH.