老年原发性高血压患者动态血压参数与部分体液因素的相关性研究

目的观察老年原发性高血压患者动态血压参数与血浆肾素、血管紧张素Ⅱ及醛固酮的相关性及其临床意义。方法将162例患者分为A纽82例（〉60岁）,B组80例（〈60岁）,采用放射免疫法检测162例原发性高血压患者的血浆肾素、血管紧张素Ⅱ及醛固酮水平,同时测定24h动态血压,进行相关分析。结果（1）老年高血压具有是脉压增大,波动性大,晨峰高血压现象及并发症多的特点;（2）A组血浆肾素、血管紧张素Ⅱ及醛固酮水平明显高于B组;（3）血浆肾素、血管紧张素Ⅱ及醛固酮与老年高血压的特点,特别是脉压增大、波动性大、晨峰高血压现象有关。结论老年原发性高血压患者血浆肾素和血管紧张素Ⅱ浓度升高,提示血浆肾素、血管紧张素一醛固酮系统对老年原发性高血压心血管系统有影响,导致老年原发性高血压患者血压特征性的变化,血浆肾素、血管紧张素Ⅱ和醛固酮的测定可作为老年原发性高血压患者病情监测及治疗指标之一。     

恩格列净对2型糖尿病合并高血压患者血压变异性和左心室质量指数的影响

目的:探讨恩格列净对2型糖尿病（T2DM）合并高血压患者血压变异性（BPV）和左心室质量指数（LVMI）的影响。方法:采用前瞻性平行对照研究设计,选取2020年10月至2021年4月在安徽医科大学第二附属医院内分泌科住院的90例血糖控制欠佳的T2DM合并高血压患者作为研究对象,均为使用1种或以上降糖药物血糖仍未达标者。...     

慢性心衰患者心房颤动与血浆血管紧张素Ⅱ及醛固酮的关系

目的：观察老年慢性心力衰竭（CHF）合并心房颤动（Af）患者血浆肾素、血管紧张素Ⅱ（AngⅡ）以及醛固酮浓度的变化。方法：选择76例治疗后病情稳定的老年CHF患者,根据其是否合并Af分Af组（41例）和窦性心律组（35例）,分别检测两组患者血浆肾素、AngⅡ以及醛固酮的浓度。结果：合并Af的老年CHF患者的血浆AngⅡ以及醛固酮浓度较窦性心律患者明显增高（P〈0．05～〈0．01）。结论：老年慢性心力衰竭患者心房颤动的发生可能与血浆血管紧张素Ⅱ以及醛固酮水平的增高有一定关系。     

新诊断早发2型糖尿病患者发生糖尿病肾脏疾病的危险因素分析

目的 探讨新诊断早发T2DM患者发生DKD的危险因素。方法 选取2018年1月至2021年6月于我院内分泌代谢科住院治疗的新诊断早发T2DM患者500例。根据是否合并DKD分为单纯T2DM组（n=402）和DKD组（n=98）,Logistic回归分析DKD的危险因素。结果 DKD组合并高血压比例、FPG、FC-P、TG及TG-葡萄糖（TyG）指数高于T2DM组（P<0.05）。Spearman相关分析显示，DKD与高血压分级、FC-P、TG及TyG指数呈正相关（P<0.05）。Logistic回归分析显示，高血压2级、3级及TyG指数是新诊断早发T2DM患者发生DKD的危险因素。结论 高血压和TyG指数是新诊断早发T2DM患者DKD的危险因素。     

2型糖尿病合并高尿酸血症对高血压患病风险的影响临床研究

选取2017年8月到2018年9月110例高血压患者作为试验组,健康体检的110名为对照组,运用Logistic回归分析法进行单因素与多因素分析,观察T2DM合并高尿酸血症对高血压患病风险的影响。结果:经单因素Logistic回归分析后可知,T2DM合并高尿酸血症患者的高血压患病率为T2DM患者高血压患病率的2.276倍;经多因素Logistic回归分析后可知,T2DM合并高尿酸血症患者的高血压患病率为T2DM患者高血压患病率的2.749倍。结论:T2DM合并高尿酸血症会引发高血压疾病。     

糖尿病合并高血压的发病机理及其治疗

糖尿病(DM)合并高血压(HT)发病率高,本文就其发病机理的几方面:DM 肾病和 HT,DM 和原发性 HT,肾素-血管紧张素-醛固酮系统,钠和体液容量,血管反应及胰岛素和 HT 进行讨论,并介绍 DM 合并 HT 的治疗。     

2型糖尿病合并冠心病的危险因素的配对病例对照研究

与不合并冠心病的2型糖尿病（T2DM）患者（100例）相比,合并冠心病的T2DM患者（100例）糖尿病病程长、既往有高血压病史、血糖控制差、患糖尿病前摄入鱼或瘦肉较少。调查时BMI和LDL-C水平增高,增加T2DM合并冠心病的危险性。     

糖尿病伴高血压性肾损害的特征、识别及临床处理

流行病学资料显示1型糖尿病（T1DM）患者糖尿病肾病（DN）发生率达40％,而2型糖尿病（T2DM）患者,尿蛋白发生率可达20％。糖尿病（DM）合并高血压（HT）约占DM患者的30％-80％。已有HT后合并T2DM其并发DN风险明显升高;合并HT的DM患者随病程进展病人蛋白尿的发生率高于无HT的DM患者;T2DM患者血压升高与糖尿病肾损害进展相关;     

血浆肾素-血管紧张素系统与原发性高血压病的关系评价

目的探究肾素-血管紧张素系统与原发性高血压病的关系。方法选取自2015年以来我院收治的原发性高血压患者50例,其中高血压1级患者18例,2级患者17例,3级患者15例,同时随机选取50例正常健康体检者作为对照,采用放射免疫方法测定所有患者立位、卧位的血浆肾素活性、醛固酮浓度以及血管紧张素浓度,记录并作出比较。结果原发性高血压患者的立位、卧位血浆肾素活性均低于对照组,而立位、卧位的血浆醛固酮浓度以及血管紧张素浓度要高于对照组,并且随着病情的发展,这种差距逐渐增大,差异具有统计学意义(P0.05)。结论肾素-血管紧张素系统与原发性高血压有很密切的关系,其中的指标如血浆肾素活性、血管紧张素浓度、醛固酮浓度等可以作为原发性高血压并诊断、分型及分级的有效指标,同时血浆中的血管紧张素及醛固酮含量的降低也应该作为治疗原发性高血压的重要因素受到临床的重视。     

中青年原发性高血压患者肾素和醛固酮水平与短时血压变异性的相关性

目的 探讨中青年原发性高血压患者肾素和醛固酮水平与短时血压变异性的相关性。方法 回顾性分析2020年7月～2022年12月间就诊于甘肃省人民医院的65岁以下原发性高血压患者192例，检测肾功能、尿酸、血脂、空腹血糖、糖化血红蛋白（HbA1c）、立位血浆肾素浓度、醛固酮浓度水平，并行24 h动态血压监测。以醛固酮浓度/肾素浓度（ARR）的中位数（ARR=11.81）为分界线，分为高ARR组（>ARR中位数者）和低ARR组（相似文献   

QT interval in patients with primary aldosteronism and low-renin essential hypertension

INTRODUCTION: QT interval prolongation increases the risk of sudden death in several medical conditions. Patients with primary aldosteronism and salt-sensitive hypertension experience more cardiovascular events than those with normal-renin essential hypertension. QT interval prolongation might represent one of the risk factors for cardiovascular events in these patients. The aim of the present study was to evaluate the QT interval in patients with primary aldosteronism and low-renin essential hypertension (LREH). METHODS: Twenty-seven patients with primary aldosteronism, 17 patients with LREH, 117 patients with essential hypertension and 25 healthy individuals were studied. Plasma aldosterone, plasma renin activity, and aldosterone to plasma renin activity ratio (ARR) were determined. Corrected QT intervals (QTcs) were measured from a 12-lead electrocardiogram. RESULTS: The QTc was longer in primary aldosteronism (434 +/- 23 ms) and LREH (430 +/- 18 ms) compared with essential hypertension (419 +/- 22 ms) and healthy controls (412 +/- 19 ms) (P = 0.0004). The prevalence of QTc longer than 440 ms was higher in primary aldosteronism (48%) and LREH (23%) compared with essential hypertension (11%) and healthy controls (4%) (P < 0.0001). QTc correlated with plasma aldosterone (P = 0.01), ARR (P = 0.02), and diastolic blood pressure (P = 0.01). ARR (P = 0.01) and systolic blood pressure (P = 0.01) were identified as independent predictors of QTc. CONCLUSIONS: We postulate that the elevated aldosterone secretion contributes to the prolongation of the QT interval in patients with primary aldosteronism and LREH through both a depletion of intracellular potassium concentration and higher blood pressure values. QTc measurement might represent one simple, non-invasive and reproducible index to characterize the cardiovascular risk in patients with primary aldosteronism and LREH.     

A biallelic gene polymorphism of CYP11B2 predicts increased aldosterone to renin ratio in selected hypertensive patients

Altered control of aldosterone synthase (CYP11B2) gene expression may modulate aldosterone secretion, as suggested by a raised aldosterone to renin ratio (ARR) in some patients with essential hypertension. We compared the frequency of two linked CYP11B2 polymorphisms, one in the steroidogenic factor-1 (SF-1) binding site and the other an intronic conversion (Int2) in relation to ARR in 141 hypertensive patients. Patients were divided into groups with either normal or high supine ARR using a cut-off threshold of 145 pmol/liter per ng/liter. Supine ARR was normal in 104 patients and raised in 37 patients. The two polymorphisms were in strong linkage disequilibrium (chi(2) = 123.8; P < 0.0001). The SF-1 T and Int2 C alleles were more prevalent among patients with high ARR (46% and 43%, respectively) than with normal ARR (22% and 17%; P < 0.01 and P < 0.005, respectively). Odds ratios for raised ARR in subjects with a homozygous SF-1 T and Int2 C haplotype were 6.1 (95% confidence interval, 1.6-22.5; P < 0.005) when compared with the contrasting haplotype. Linear modeling of individual postural changes in renin and aldosterone showed a maximal achievable aldosterone increase of 110 pmol/liter with no mutated haplotype and 500 pmol/liter with two mutated haplotypes. These findings support the view of a molecular basis regulating aldosterone production.     

肥胖及超重2型糖尿病患者代谢手术后5年疗效随访研究

目的探讨肥胖及超重T2DM患者代谢手术后5年疗效。方法采用前瞻性病例自身前后对照法,对接受代谢手术满5年且随访资料完整的38例肥胖及超重T2DM患者进行疗效分析,观察术后代谢指标、DM缓解率和并发症变化。结果患者代谢手术后第1~5年,体重、BMI、WC、FPG、HbA1c、FIns、FC-P、胰岛素抵抗指数(HOMA-IR)、LDL-C较术前降低(P<0.05)。将14例T2DM患者分为术后5年完全缓解组(CR,缓解率为42.9%)和部分缓解及无效组(Con)。与Con组比较,CR组术前FIns(t=-2.33,P=0.038)、HOMA-IR(t=2.82,P=0.016)、FC-P(t=4.73,P=0.000)、BMI(t=3.07,P=0.01)较高,年龄低(t=-2.33,P=0.038),DM病程短(t=-4.04,P=0.002)。术后5年脂代谢异常、高血压病、阻塞性睡眠呼吸暂停综合征缓解率分别为55.2%、60.0%、64.3%。结论肥胖及超重T2DM患者实施代谢手术,可持续有效控制体重,改善各项代谢指标及减少多种并发症。T2DM长期缓解可能与术前胰岛功能、IR程度、DM病程、BMI和年龄相关。     

老年2型糖尿病病人血清尿酸/肌酐比值与胰岛素抵抗及胰岛B细胞功能的相关性

目的 探讨老年2型糖尿病(T2DM)病人血清尿酸/肌酐比值(SUA/SCr)与胰岛素抵抗及胰岛B细胞功能的相关性.方法 选择老年T2DM病人784例(男512例,女272例),均行75 g口服葡萄糖耐量试验(OGTT),并测定SUA、SCr、TG、TC、LDL-C、HDL-C、HbA1c、葡萄糖、胰岛素等指标水平,并计...     

CYP11B2 gene polymorphisms and hypertension in highlanders accustomed to high salt intake

BACKGROUND: High salt intake is the main determinant of hypertension. The alleles, which once had adaptive value in the salt-poor environment, by promoting salt retention, now induce hypertension. It would be interesting to determine whether the variant alleles of the aldosterone synthase gene (CYP11B2), if related to exaggerated expression/altered activity, are associated with hypertension when combined with a salt-rich diet. OBJECTIVE: To investigate the -344T/C, K173R and intron-2 conversion polymorphisms of CYP11B2 for an association with hypertension in highlanders accustomed to a high salt intake. DESIGN AND METHODS: Three CYP11B2 polymorphisms were compared with respect to frequencies and clinical characteristics in 190 normotensive highlanders (NHLs) and 100 hypertensive highlanders (HHLs). One-way ANOVA, chi2 test and logistic regression analysis were carried out to investigate the association of these polymorphisms with hypertension. RESULTS: The HHLs had significantly higher systolic blood pressure (SBP), diastolic blood pressure (DBP) (P < 0.0001), body mass index (BMI) (P = 0.0002), plasma aldosterone levels (P = 0.03) and aldosterone to plasma renin ratio (ARR) (P < 0.0001) and lower plasma renin activity (PRA) (P = 0.007). The -344T/C and K173R polymorphisms were in complete linkage disequilibrium with each other and the intron-2 conversion allele was in absolute association with the T allele. The TC/CC genotypes correlated with higher BMI when compared with TT genotype in the NHLs and the HHLs (P = 0.002 and 0.004, respectively). The intron-2 conversion heterozygotes/homozygotes correlated with higher SBP in the HHLs (P = 0.03) and significantly higher ARR when compared to IwIw (P = 0.02). Genotype combinations between the -344T/C and intron-2 conversion polymorphisms revealed that combinations with TC or CC genotypes inclined towards higher BMI in both the groups (P < 0.05). CONCLUSIONS: Our findings showed a correlation of C allele with high BMI, suggesting that -344T/C polymorphism is in linkage disequilibrium with a functional polymorphism on the adjacent 11-beta hydroxylase gene. The correlation of the intron-2 conversion allele with high SBP and ARR associates it with hypertension. The intron-2 conversion could be a functional variant, since it has been suggested to lead to overexpression of the gene; however, the presence of another functional variant in linkage disequilibrium within the gene cannot be ruled out.     

应用受试者工作特征曲线分析糖化血红蛋白对于2型糖尿病的诊断价值

目的 探讨HbA1c对于T2DM的诊断价值. 方法 选取T2DM患者230例,IGR患者130例和糖耐量正常（NGT）者102名,行75 gOGTT,同时测定FPG、2 hPG、HbA1c等临床指标. 结果 T2DM组FPG、2 hPG高于IGR、NGT组,IGR组FPG与NGT组比较差异无统计学意义.IGR组2hPG高于NGT组.T2DM组HbA1c高于IGR、NGT组（P＜0.01）,IGR组与NGT组比较差异无统计学意义.Pearson相关性分析显示,HbA1c与FPG、2hPG呈正相关（r=0.698、0.652,P=0.000）.受试者工作特征（ROC）曲线显示,HbA1c≥6.4％为诊断切点的曲线下面积0.922（95％CI：0.899～0.946）,HbA1c≥6.4％时与FPG及与2 hPG诊断T2DM的曲线下面积比较差异无统计学意义（P＞0.05）. 结论 HbA1c可作为T2DM诊断标准之一,HbA1c≥6.4％为最佳诊断切点.     

糖化血红蛋白与血浆致动脉粥样硬化指数对中老年2型糖尿病发生风险的联合预测价值

目的:探讨糖化血红蛋白（HbA 1c）和血浆致动脉粥样硬化指数（AIP）对中老年2型糖尿病（T2DM）发生风险的联合预测价值。 方法:本研究依托中国T2DM患者肿瘤发生风险的流行病学研究（REACTION）,对2011至2014年在大连社区40周岁及以上人群中开展的流行病学调查资料进行回顾性分析,...     

Aldosterone to renin ratio as a determinant of exercise blood pressure response in hypertensive patients

Aldosterone to renin ratio (ARR) is a marker of inappropriate aldosterone activity in hypertension. Since aldosterone may adversely affect vascular compliance, we hypothesised that the ARR would relate to exercise blood pressure (BP) responses in hypertension. Blood sampling was done in untreated hypertensives for plasma renin activity (PRA, ng/mL/hr) and plasma aldosterone (PA, pmol/L). ARR was derived by dividing the PA value by the PRA value, and this index was normalised by natural logarithm (lnARR) for further analyses. Each patient underwent 24-h ambulatory BP (ABP), and a 3-min submaximal exercise test using the Dundee Step Test. The Spearman rank correlation coefficients between lnARR and office BP (OBP), ABP and exercise BPs and BP changes estimated during exercise were assessed. A total of 119 (66 males) hypertensive subjects aged 48 (s.d. 12) years were studied. The respective OBP, ABP, exercise BP and the change in exercise BP were 167(23)/105(11), 140(15)/87(10), 189(26)/107(12) and 25(15)/2(9) mmHg. lnARR was significantly correlated with exercise systolic BP (r = 0.24, P < 0.001), exercise diastolic bp (r = 0.23, P < 0.05), systolic abp (r = 0.22, P < 0.05) and systolic obp (r = 0.19, P < 0.05). in a multiple regressional analysis controlling for age and sex and all other bp measurements to assess the relative strengths of correlation between all the bp indices with lnarr, only exercise systolic bp (P = 0.012) and the change in systolic BP during exercise (negatively, P = 0.013) emerged as significant independent predictors of lnARR. In conclusion, there was an independent and significant correlation between ARR and exercise systolic BP.     

血尿酸和细胞间黏附分子1对2型糖尿病颈动脉内膜中层厚度的影响

目的探讨2型糖尿病合并颈动脉粥样硬化(CA)患者血尿酸、细胞间黏附分子1(ICAM-1)与颈动脉内膜中层厚度(IMT)的关系。方法选择2型糖尿病患者80例,根据诊断分为糖尿病合并颈动脉粥样硬化组(CA组)40例和单纯糖尿病组(对照组)40例,检测分析2组患者血尿酸、ICAM-1、收缩压、舒张压、空腹血糖、空腹胰岛素、糖化血红蛋白、餐后2 h血糖、餐后2 h胰岛素、HDL-C、LDL-C、TC、TG等糖、脂代谢指标及颈动脉IMT的水平差异。同时计算体重指数、胰岛素抵抗指数(HOMA-IR)。结果 CA组颈动脉IMT、血尿酸、ICAM-1、收缩压、体重指数、TG、TC、LDL-C、糖化血红蛋白、空腹血糖、餐后2 h血糖、空腹胰岛素、餐后2 h胰岛素、HOMA-IR均明显高于对照组(P<0.05,P<0.01)。血尿酸、ICAM-1与颈动脉IMT密切相关(P<0.01),作为CA的主要独立影响因素最先进入多元逐步回归方程。结论 2型糖尿病合并CA患者较无CA的糖尿病患者存在更明显的代谢紊乱、胰岛素抵抗、血管内皮功能障碍及炎性反应,早期联合检测血尿酸、ICAM-1有助于对糖尿病人群发生血管病变进行预测。     

2型糖尿病并发非酒精性脂肪肝患者的临床特征及影响因素分析

目的分析并发非酒精性脂肪肝(NAFLD)的2型糖尿病(T2DM)患者的临床特征,探讨T2DM患者发生NAFLD的影响因素。方法选取T2DM患者167例,收集患者性别、年龄、糖尿病病程、身高、体质量等一般资料,采集空腹血糖(FPG)、TG、TC、LDL-C、HDL-C、糖化血红蛋白(HbA1c)、ALT、AST、空腹胰岛素、空腹-C肽(FCP)等实验室检查指标。于空腹状态下行腹部肝脏多普勒超声检查,根据检查结果诊断是否存在NAFLD。比较有、无并发NAFLD的T2DM患者的一般资料、实验室检查指标;比较不同HbA1c、TG、TC、BMI水平分层的T2DM患者的NAFLD发生率;分析T2DM患者并发NAFLD的相关危险因素。结果根据B超检查结果,分为单纯T2DM患者86例、T2DM并发NAFLD患者81例。T2DM并发NAFLD患者的HbA1c、TG、TC、BMI、ALT、FCP均高于单纯T2DM患者,糖尿病病程小于单纯T2DM患者(P均<0.05)。HbA1c>8.9%、TG>1.7 mmol/L、BMI>23.43 kg/m²的T2DM患者并发NAFLD的发生率较高(P均<0.05)。以是否并发NAFLD为因变量,临床指标为自变量进行logistic回归分析示,FCP(OR=0.737,P=0.009)、BMI(OR=0.786,P=0.003)、HbA1c(OR=0.996,P<0.001)是导致T2DM患者并发NAFLD的独立危险因素。结论血糖控制不佳、血脂水平较高、病程短的T2DM患者更易出现NAFLD。FCP、BMI、HbA1c是导致T2DM患者发生NAFLD的独立危险因素。建议对BMI超过23.43 kg/m²、高脂血症的T2DM人群进行肝脏彩超筛查,及时预防NAFLD发生。