高血压患者PWV与早期肾功能损害及左室肥厚的相关性分析

【摘要】目的 探讨原发性高血压患者脉搏波传导速度与早期肾功能损害及左室肥厚之间的关系。方法 选取年龄60~90岁的原发性高血压患者427例，测定其臂踝脉搏波传导速度（baPWV），根据baPWV四分位数将人群分成4组。测定其各项生化指标，计算肾小球滤过率（eGFR）；心脏多普勒超声检查计算左室心肌质量指数（LVMI）以评价左室肥厚的程度。结果 4组间年龄、踝臂指数(ABI)、收缩压、平均动脉压、脉压、空腹血糖、LVMI及eGFR差异有统计学意义（P＜0.05）；偏相关分析发现，控制年龄及血糖后，baPWV与收缩压、平均动脉压、脉压、LVMI呈正相关（r 分别为0.295、0.187、0.292和0.159，P＜0.01），baPWV与eGFR呈负相关（r=-0.314，P＜0.01）。多元线性回归显示，调整其他心血管危险因素后，年龄、baPWV和舒张压仍是eGFR的影响因素（t分别为8.251、6.834、2.142，P＜0.05），收缩压和ABI是LVMI的影响因素（t分别为4.557和3.016，P＜0.05），尚不能认定baPWV是LVMI的影响因素(t=1.722，P=0.086)。结论 baPWV对预测心血管危险因素及高血压导致肾功能损害的早期筛查和预防有重要作用。

Relationship among Brachial-Ankle Pulse Wave Velocity,Early Renal Dysfunction and Left Ventricular Hypertrophy in Patients with Hypertension

Abstract] Objective To study the relationships among brachial-ankle pulse wave velocity (baPWV) , early renal function and left ventricular hypertrophy (LVH) in patients with essential hypertension. Methods Four hundred and twen? ty-seven patients aged60-90years were selected from the patients with essential hypertension. The patients were divided in? to four groups by quartile of the baPWV. Biochemical index were recorded. The eGFR were calculated using Cockcroft Gault formulation. Ultrasonic cardiogram(UCG) were employed to calculate the left ventriclar mass index (LVMI).Results There were significant differences in the age, ankle brachial index(ABI), systolic blood pressure(SBP), mean arterial pressure (MAP),pulse pressure(PP), fasting blood glucose(FBG), LVMI and eGFR among the four groups. Given the age and FBG , baPWV was positively correlated with SBP (r=0.295, P＜0.01), MAP(r=0.187, P＜0.01), PP(r=0.292, P＜0.01), LVMI(r= 0.159,P＜0.01), but negatively related to eGFR (r=-0.314, P＜0.01). Multiple linear regression analysis indicated that pressure(DBP) still were still independent risk factors of eGFR, after adjusting for other cardiovascular risk factors, age, baP? WV and diastolic blood (t=8.251，6.834，2.142，P＜0.05). Systolic blood pressure(SBP) and ankle brachial index(ABI) were independent risk factors of LVMI ( t=4.557,3.016，P＜0.05), but the baPWV was not an assured independent risk factor of LVMI(t=1.722, P=0.086). Conclusion baPWV played an important role in evaluating the cardiovascular risk factors and early renal dysfunction caused by hypertension.