原发性高血压患者合并低水平白蛋白尿与左室不良构型及舒张功能的关系

目的 探讨原发性高血压患者合并低水平白蛋白尿(晨尿白蛋白10～30mg/L)与左室构型及舒张功能的关系.方法 301例未经系统治疗的原发性高血压患者按晨尿白蛋白水平分为三组:正常组107例(晨尿白蛋白＜10 mg/L),低水平白蛋白尿组127例(晨尿白蛋白10～30 mg/L),微量白蛋白尿组67例(晨尿白蛋白＞30 mg/L).分别测量各组患者的血压、身高、体重,检测血肌酐(SCr)、血尿素氮(BUN)、尿酸(UA)、空腹血糖(FBG)、口服葡萄糖耐量试验2 h血糖(2hPG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C),并进行心脏超声检查,测量左室舒张末期内径(LVEDD)、左室后壁厚度(LVPWT)、室间隔厚度(IVST).多普勒超声心动图测定二尖瓣舒张早期血流速度峰值(E)、舒张晚期血流速度峰值(A),计算E/A,并测定E峰减速时间(DT)和左室等容舒张时间(IVRT),评估左室舒张功能.根据公式计算左室质量指数(LVMI)、相对室壁厚度(RWT),比较各组LVMI、RWT、左室构型及左室舒张功能.结果 尿白蛋白水平与LVMI呈显著正相关(r=0.43,P＜0.01).低水平白蛋白尿组与正常组比较,IVST、LVPWT、RWT、LVMI均显著升高(P＜0.01),左室正常构型比例降低(P＜0.01),向心性重构、向心性肥厚发生率升高(P＜0.05),A升高(P＜0.05),E/A显著降低(P＜0.01).301例患者左室舒张功能不全发生率为28.6%(86/301),正常组、低水平白蛋白尿组、微量白蛋白尿组左室舒张功能不全发生率分别为12.1%(13/107)、33.9%(43/127)及44.8%(30/67),微量白蛋白尿组、低水平白蛋白尿组左室舒张功能不全发生率均显著高于正常组(P＜0.01).结论 合并低水平白蛋白尿的原发性高血压患者左室不良构型及左室舒张功能不全发生率升高.

Abstract：

Objective To investigate the relationship between low-grade albuminuria and unfavourable cardiac geometric adaptations and left ventricular diastolic dysfunction in non-treated essential hypertensive(EH ) patients. Methods Three hundred and one patients of EH were divided into three groups acording to morning urine albumin concentration ( MU AC ): normoalbuminuria (NAU) group ( 107 cases,MUAC ＜ 10 mg/L) ;low-gradealbuminuria (LGAU) group ( 127 cases, MUAC 10-30 mg/L); microalbuminuria (MAU) group (67 cases, MUAC ＞ 30 mg/L). The blood pressure,body height and weight was measured for all the patients. The serum creatinine (SCr),blood urea nitrogen (BUN), uric acid (UA),fasting plasma glucose (FBG), plasma glucose 2 hours after oral glucose load (2hPG), total cholesterol (TC), triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) were detected by automatic biochemical analyzer.Echocardiogram exarmination was performed to detect left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic posterior wall thickness (LVPWT) and interventricular septum thickness at end-diastole (IVST). Color Doppler ultrasound was used to measure indicators of left ventricular diastolic function, including peak E velocity of mitral diastolic flow (E) and peak A velocity of mitral diastolic flow ( A ), calculated E/A, measured the deceleration time of peak E ( DT ), and isovolumic relaxation time (IV RT ).Left ventricular mass index (LVMI) and relative wall thickness(RWT) were calculated by formula, and LVMI,RWT,left ventricular configuration diastolic dysfunction was compared. Results The level of MUAC had positive relationship with LVMI (r = 0.43 ,P ＜ 0.01 ). Compared with that in NAU group, IVST, LVPWT,RWT, LVMI increased (P ＜ 0.01 ), the ratio of left ventricular normal configuration decreased (P ＜ 0.01 ), the incidence of concentric reconstitution, concentric hypertrophy increased (P ＜ 0.05 ), A increased (P ＜ 0.05 ),and E/A decreased (P ＜ 0.01 ) in LGAU group. The total incidence of left ventricular diastolic dysfunction was 28.6%(86/301 ),12.1%(13/107),33.9%(43/127) and 44.8%(30/67)in NAU group,LGAU group and MAU group. The incidencerates of left ventricular diastolic dysfunction in LGAU group and MAU group were higher than that in NAU group (P ＜ 0.01 ). Conclusion LGAU is positively related to incidence of unfavourable cardiac geometric adaptations and left ventricular diastolic dysfunction in EH patients.     

390例老年人动态心电图分析

[目的]通过24 h动态心电图(DCG)分析老年人昼夜窦房结功能和各种心律失常的发生以及ST-T改变情况.[方法]390例老年组和456例中年组的临床资料和DCG检查结果进行对比分析.[结果]老年组390例除白天最慢心率外,其余各项心率均低于中年组(P＜0.05);各种类型的心律失常,ST-T改变,心率变异性降低总发生率均明显高于中年组,组间比较差异有显著性意义(P＜0.05).[结论]老年人窦房结功能减退与各种心律失常增加有明显随年龄增长而增加的特点,老年组无症状心肌缺血明显高于中年组.DCG对老年人窦房结功能评价,心律失常和无症状心肌缺血的检出及危险评估有重要的临床意义.     

T波电交替伴QT延长合并恶性室性心律失常一例

患者女,65岁。患高血压病30多年,蛋白尿10余年,1年前发现已有慢性肾功能不全,2个月前开始血液透析。近半个月来,3次于血液透析后刚回到家中发生晕厥。入院当日上午,医院内卧位透析1 h后,无任何预兆再发意识丧失,心音消失,呼吸停止,经心外按压20-30 s后心跳、呼吸恢复,意识转清,血压130／80 mm Hg(1 mm Hg=0.133 kPa)。当即心电图示窦性心律,心率60次／min,TU融合,QT或称QU明显延长达0.60 s(图1)。血电解质检查为轻度低钾     

培哚普利和氨氯地平对老年单纯收缩期高血压患者收缩压与脉压的影响

目的　对比观察培哚普利和氨氯地平对老年单纯收缩期高血压(ISH)患者收缩压与脉压的影响。方法　将96例ISH患者随机分成两组:A组(46例)服用培哚普利4mg ,每天1次晨服;B组(5 0例)服用氨氯地平5mg,每天1次晨服。第4周根据血压情况调整剂量至培哚普利8mg/d ,氨氯地平10mg/d ,第8周仍不达标者开始加用双氢克尿噻(DCT) 2 5mg,每日1次。观察服药前、服药后4周、8周、12周收缩压与脉压水平及主要不良反应。结果　服药12周后培哚普利组有效率达81.4 % ,不良反应为干咳,发生率为7.5 % ;氨氯地平组有效率达83.5 % ,主要不良反应为头昏、头痛、面部潮红及轻微踝部水肿,发生率为8.1%。结论　培哚普利与氨氯地平均能有效降低ISH患者收缩压与脉压水平,疗效相似,副作用少,耐受性好,可以作为老年ISH患者的一线用药长期服用。     

大连市房颤住院患者诊治状况调查分析

[目的]了解大连地区心房纤颤（房颤）住院患者年龄、病因、房颤类型、脑卒中等流行病学特征及不同类型房颤的治疗现状。[方法]对2003～2004年大连市6家综合医院诊断的房颤患者的住院病历进行回顾性分析。[结果]（1）共964例,房颤病因主要为高血压44．6％,冠心病30．4％。心力衰竭22．3％。（3）房颤类型中阵发性房颤28．6％,持续性房颤14．1％,持久性房颤57．2％。阵发性房颤复律及维持窦律治疗占56％,发作时治疗药物多为西地兰、胺碘酮,其次为普罗帕酮、β阻滞剂。慢性房颤78％采用心室率控制治疗,常用药物为地高辛、β阻滞剂,其次为钙拮抗剂及胺碘酮。（4）本组脑卒中患病率为9．4％,各种类型房颤之间比较无明显差异。（5）本组患者69．7％接受抗血小板治疗,长期华法林抗凝治疗者仅占4％,抗凝治疗严重不足。[结论]大连地区心房纤颤住院患者年龄、病因、房颤类型、脑卒中等流行病学特征与国内其他地区相似,阵发性房颤以节律控制为主,慢性房颤绝大多数采用心室率控制治疗。抗凝治疗严重不足。     

华法林过量抗凝治疗四例

作在近几年的临床工作中，先后遇到几例因服用华法林过量而误诊，险些当作外科病手术，现报告如下，引以为戒。     

培哚普利和氨氯地平对老年单纯收缩期高血压患者收缩压与脉压的影响

目的对比观察培哚普利和氨氯地平对老年单纯收缩期高血压(ISH)患者收缩压与脉压的影响。方法将96例ISH患者随机分成两组：A组(46例)服用培哚普利4mg，每天1次晨服；B组(50例)服用氨氯地平5nag，每天1次晨服。第4周根据血压情况调整剂量至培哚普利8mg/d，氨氯地平10mg/d，第8周仍不达标者开始加用双氢克尿噻(DCT)25mg，每日1次。观察服药前、服药后4周、8周、12周收缩压与脉压水平及主要不良反应。结果服药12周后培哚普利组有效率达81．4％，不良反应为干咳，发生率为7.5％；氨氯地平组有效率达83.5％，主要不良反应为头昏、头痛、面部潮红及轻微踝部水肿，发生率为8.1％。结论培哚普利与氨氯地平均能有效降低ISH患者收缩压与脉压水平，疗效相似，副作用少，耐受性好，可以作为老年ISH患者的一线用药长期服用。     

高血压前期靶器官损害探讨

目的 探讨高血压前期人群靶器官损害情况.方法 选择健康体检人群中278例高血压前期者(高血压前期组)和136例血压正常者(血压正常组)作为研究对象,分别测量血压、身高、体重、腰围及生化指标[包括血肌酐(SCr)、血尿素氮(BUN)、尿酸(UA)、空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及晨尿白蛋白].进行心脏扇扫、颈部血管超声检查,测量左室舒张末期内径(LVEDd),左室后壁厚度(LVPWT),室间隔厚度(IVST).颈动脉内膜-中层厚度(IMT)、斑块指数(PI),统计斑块发生率,根据公式计算左室心肌质量指数(LVMI)、相对室壁厚度(RWT)、肾小球滤过率(GFR)、体质指数(BMI),并进行比较.结果 高血压前期组合并≥1个、≥12个及≥3个危险因素的比例分别为71.9%(200/278)、40.6%(113/278)、13.7%(38/278),而血压正常组分别为30.1%(41/136)、13.2%(18/136)、5.9%(8/136),两组比较差异均有统计学意义(P＜0.05).与血压正常组比较,高血压前期组年龄、收缩压、舒张压、FBG、腰围、BMI、晨尿白蛋白、TG、TC、UA、LDL-C、IVST、LVPWT、RWT、LVMI、IMT、PI升高,左室向心性重构率、向心性肥厚率、离心性肥厚率及颈动脉斑块发生率升高,左室正常构型率及GFR下降(P＜0.01或＜0.05).结论 高血压前期人群与血压正常人群相比伴随心血管危险因素增多,靶器官损害发生率明显增加.

Abstract：

Objective To investigate the incidence of target organ damage in prehypertensive. Methods Two hundred and seventy-eight prehypertensive cases (prehypertensive group) and 136 normotensive cases(normotensive group) were involved in this study. The blood pressure,body height,weight and waist circumference were measured. Serum creatinine (SCr), urea nitrogen (BUN),uric acid(UA), fasting blood glucose (FBG), total cholesterol (TC), triglyceride(TG),low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and morning urine albumin concentration were detected by automatic biochemical analyzer. Left ventricular end-diastolic dimension (LVEDd), left ventricular posterior wall thickness (LVPWT), interventricular septal thickness (IVST), intima-media thickness (IMT) and plaque index (PI) were examined by ultrasonography. The incidence rates of plaque, left ventricular mass index (LVMI), relative wall thickness (RWT), glomerular filtration rate (GFR) and body mass index (BMI) were calculated. Results The proportion of ≥ 1, ≥2 and ≥3 kinds of risk factors was 71.9% (200/278),40.6%(113/278) and 13.7%(38/278) in prehypertensive group and 30.1%(41/136), 13.2% (18/136) and 5.9%(8/136) in normotensive group, and there was significant difference between the two groups (P＜0.05). Compared with normotensive group, the age,systolic pressure, diastolic pressure, FBG, waist, BMI, morning urine albumin, TG,TC,UA,LDL-C,IVST,LVPWT,RWT,LVMI,IMT,PI were higher, meanwhile the incidence rate of concentric reconstruction of left ventricular, concentric hypertrophy, eccentric hypertrophy and carotid plaque was higher, and the incidence rate of left ventricular normal configuration and GFR was lower (P＜0.01 or ＜0.05). Conclusion People with prehypertensive may accompany with many kinds of cardiovascular risk factors, and the incidence rate of target organ damage is significantly increased.