【作者】 王磊；

【导师】 李南方；

【作者基本信息】 新疆医科大学 ， 内科学， 2008， 硕士

【摘要】 目的了解住院的难以控制的高血压患者病因分布、合并的代谢紊乱及其靶器官损害的状况;并观察代谢紊乱、靶器官损害在原发性高血压和继发性高血压中分布的差异。方法回顾性分析了1997～2005年间在高血压专科住院的628例难以控制的高血压患者的病历资料,观察其病因分布、合并的代谢紊乱及其靶器官损害的状况;并观察代谢紊乱和靶器官损害在原发性高血压和继发性高血压中分布的差异。采用SPSS13.0软件行统计学分析。结果1.在628例难以控制的高血压患者中原发性高血压占80.10%,继发性高血压占18.95%,病因待定者占0.95%。2.在119例难以控制的继发性高血压患者中,肾血管性高血压所占比例最高(33.61%),接下来为睡眠呼吸暂停综合征(23.53%),肾实质性高血压(15.97%),原发性醛固酮增多症(13.45%)。3.在628例难以控制的高血压患者中,合并脂代谢紊乱占66.24%,合并糖代谢紊乱占43.78%;与继发性高血压比较,在难以控制的原发性高血压中糖尿病的患病率(P<0.001)和体重指数的水平(P<0.05)更高。4.在628例难以控制的高血压患者中,合并脑卒中、冠心病、慢性心功能不全、慢性肾功能不全分别为39.97%、31.85%、16.57%、29.62%;与继发性高血压比较,在难以控制的原发性高血压中合并脑卒中(P<0.05)、冠心病(P<0.001)的比例较高;慢性肾功能不全(P<0.001)多见于难以控制的继发性高血压患者。5.与原发性高血压比较,难以控制的继发性高血压患者的年龄较轻,血压水平更高。结论难以控制的住院高血压患者中原发性高血压占多数,肾性高血压、睡眠呼吸暂停综合征是继发性高血压中血压难以控制的主要原因;难以控制的高血压患者多合并糖脂代谢紊乱,心、脑、肾靶器官损害严重,有效的控制血压并纠正代谢紊乱对降低靶器官损害有重要的意义。更多还原

【Abstract】 Objective To analyze the etiology, metabolic disorders and target organ damage of in-patients hypertensives whose blood pressure were difficult to control and to observe differences of metabolic disorders and target organ damage between essential hypertension(EH) and secondary hypertension(SH) in order to provide basis of correct diagnosis and therapy of these hyperensives. Methods Retrospective study was performed based on etiology, metabolic disorders and target organ damage of 628 in-patients hypertensives whose blood pressure were difficult to control in department of hypertension, People’s Hospital of Xinjiang Uighur Autonomous Region, from September 1997 to December 2005. Comparison of metabolic disorders and target organ damage between EH and SH were performed. The datum were analyzed by using SPSS 13.0 software package. Results 1.Of 628 in-patients hypertensives whose blood pressure were difficult to control, there were 80.10% of EH, 18.95% of SH and 0.95% of indefinite diagnosis. 2.119 SH comprised 33.61% of renovascular hypertension, 15.97% of renal hypertension , 23.53 % of obstructive sleep apnea syndrome, 13.45% of primary aldosteronism, 5.04% of pheochromocytoma. 3. Of 628 in-patients hypertensives whose blood pressure were difficult to control, there were 66.24% of dyslipidemia, 43.78% of abnormality of glucose metabolism. Prevalence of diabetes mellitus (P<0.001)and level of body mass index(P<0.05) in essential hypertension were higher than those in secondary hypertension. 4. Of 628 in-patients hypertensives whose blood pressure were difficult to control, prevalence of stroke, coronary heart disease, chronic heart failure, chronic renal inadequacy were 39.97%, 31.85%, 16.57%, 29.62%, respectively. Prevalence of stroke, coronary heart disease and age in EH were higher than those in SH. Prevalence of chronic renal inadequacy and levels of blood pressure in SH were higher than those in EH. Conclusion EH was main composition in in-patients hypertensives whose blood pressure were difficult to control, renal and renovascular hypertension and obstructive sleep apnea syndrome were major cause of blood pressure difficult to control. Most hypertensives whose blood pressure was difficult to control complicated with metabolic disorders, there were severe target organ damage in those hypertensives. It play an important role on protection of target organ damage to make blood pressure control and rectify metabolic disorders.更多还原