【作者】 黄小云；

【导师】 韦建瑞；

【作者基本信息】 暨南大学 ， 内科学， 2008， 硕士

【摘要】 第一部分血管超负荷指数和原发性高血压合并代谢综合征患者靶器官损害相关性研究目的:观察新诊断的未治疗的高血压病患者合并代谢综合征组(MS+)与非合并代谢综合征组(MS-)的血管超负荷指数(VOI)及临床靶器官的损害情况,进一步研究血管超负荷指数是否和高血压合并代谢综合征的患者的靶器官损害相关。方法:研究对象为2006年3月至2008年1月份我院就诊的新诊断的高血压患者187例,其中合并代谢综合征组(MS+,n=79例)和非合并组(MS-,n=108例)。所有患者进行血压测量和心电图检查,计算出血管超负荷指数(VOI),测定血和尿生化指标,检查发现存在的靶器官损害指标,包括左室重量指数(LVMI)、颈动脉中层内膜厚度(CITM)、尿微量白蛋白(MUA)。结果:1.合并(MS+)组和非合并组(MS-)相比,年龄、性别、SBP、DBP无显著性差异。FBG、HDL-C、BMI、TG、VOI在两组间比较差异有统计学意义(P＜0.01)。2.MS(+)和MS(-)两组比较:LVH(53.24±10.4 vs 44.2±11.9,P＜0.001);CIMT(0.71±0.15 vs 0.65±0.15,P＜0.001);LogACR(0.31±0.07 vs 0.06±0.04,P＜0.001)差异有统计学意义。MS+组同时伴随着较高的VOI值(64.03±2.15vs 48.23±1.58,P＜0)。3.单变量相关分析发现,VOI和年龄(r=0.147;P≤0.033),SBP(r=0.154;P≤0.0181)、BMI(r=0.220;P≤0.0029)、TG(r=0.175;P≤0.089)正相关。而且和早期靶器官损害LVMI(r=0.125;P≤0.0360)、LogACR(r=0.257;P≤0.0012)、CIMT(r=0.199;P≤0.0142)正相关.4.多元线性回归分析发现,在调整了年龄、性别、吸烟及血糖的影响外,LVH、CIMT、MUA和VOI有独立的相关性(P＜0.001)。结论:1.和非合并代谢综合征的高血压组相比,合并代谢综合征组的VOI值明显升高,提示血流循环的负荷增加。2.高血压合并代谢综合征患者,在检测到心脏损害的同时,伴随着尿微量白蛋白和颈动脉中层内膜增厚、斑块增多,大部分患者可以发现至少一种靶器官损害。临床上对合并代谢综合征的高血压患者应进行亚临床疾病的早期检测和预防。3.血管超负荷指数和原发性高血压患者的靶器官损害相关,试验证实了VOI可以作为代谢综合征患者的心血管疾病危险因子,血管超负荷指数增加,心血管不利事件发生也增加。第二部分静息心率和原发性高血压合并代谢综合征患者靶器官损害相关性研究目的:研究静息心率增加是否与高血压合并代谢综合征患者的靶器官损害相关。方法:入选对象同第一部分,依据静息心率进行分组处理(A组＜60;B组60-80;C组≥80)次/分,每组又分为MS+和MS-亚组,其他检查同第一部分。结果:1.三组靶器官损害检出率:LVH(32%vs 43%vs 59%,P均＜0.01)、CIMT(5%v27%vs 56%,P均≤0.05)和MUA(21%vs 18%vs 19%,P均＜0.05)。随着静息心率的增加,靶器官损害的检出率增加,且有显著性差异。2.MS+和MS-亚组比较,LVH、CIMT、MUA的发生率MS+组比MS-组增高(40%vs 37%,29%vs 15%,29%vs9%,P均≤0.05)。3.超声心动图检测值LVMI(176.8±52.3 vs 210.9±57:182.2±49.8 vs 217.8±59;200.8±44.1 vs 218.4±52.3);LVH(39.9±9.8 vs 45.1±10.6;47.2±11.9 vs 53.4±13.4:51.4±12.5 vs 55.3±12.8);以及CIMT(0.54±0.08 vs 0.61±0.11:0.70±0.12 vs0.73±0.19;0.85±0.14 vs 0.92±0.17)值随着静息心率的增加而呈上升趋势。尽管ACR的趋势并不明显(2.97±0.35 vs 6.39±1.22;2.42±1.25 vs 5.52±3.10:4.44±1.87 vs 10.30±3.22)。所有亚组靶器官损害指标在合并MS+组的值高于MS-组,有显著性差异(P均≤0.05)。结论:1.静息心率增加仍然是高血压合并代谢综合征的患者靶器官损害的很强的预测因子,尽管是传统的心血管危险因子在临床上仍有意义。2.代谢综合征增加了高血压病患者的静息心率和靶器官损害,同时静息心率增加的患者合并代谢异常的组分增加,表明代谢综合征和静息心率二者对靶器官的损害可能存在协同作用。更多还原

【Abstract】 Part one:The Relationship of the blood vascular overload index(VOI) with target organ damage(TOD) in the essential hypertensives with metabolic syndrome.Objective:The study was aimed to measure the blood vascular overload index(VOI) in hypertensives with MS and without MS,to search for subclinical target organ damage,We sought to evaluate whether VOI was associated with TOD in the essential hypertensives with MS。Methods:The study population was recruited from untreated hypertensive individuals who attended the Clinic of our Department during the period of 2006 Mar to 2008 Jan。All patients had undergone BP measurement and ECG,to calculate the blood vascular overload index(VOI),physical examination and routine biochemical analyses of blood and urineo All patients underwent extensive investigations searching for subclinical target organ damage(TOD),Including LVMI、CTIM and MUA。Result:1 Compared without MS-,age、gender、SBP、DBP was no significantly different;FBG、HDC-L、BMI、TG、VOI was significantly higher in the MS+ group(P≤0.001)。2.Hypertensive patients with the metabolic syndrome had a greater LVH(53.2±10.4 vs 44.2±11.9,P＜0.001);CIMT(0.71±0.15 vs 0.65±0.15,P＜0.001); LogACR(0.31±0.47 vs 0.06±0.54,P＜0.001)。and a greater VOI(64.03±2.15 vs 48.23±1.58,P≤0.001).3.Nivariate regression analysis show that VOI had significantly positive correlations with age(r=0.147;P≤0.033),SBP(r=0.154;P≤0.0181)、BMI(r=0.220;P≤0.0029)、TG(r=0.175;P≤0.089),and had significantly positive correlation with clinic TOD:LVMI(r=0.125;P≤0.0360), LogACR(r=0.257;P≤0.0012);CIMT(r=0.199;P≤0.0142)4.Multiple linear regression analysis show VOI was found to be independently associated with LVH、IMT(P≤0.002) and MUA(P≤0.01)、after adjusting for age、gender、and FBG。Conclusions:1.Hypertensives with the metabolic syndrome had a greater VOI。It confirms that alterations in vascular structure and function as assessed by LVMI、CTIM and MUA were more frequent in patients with MS than in those without MS。2.The more pronounced cardiac involvement of hypertensives with MS was paralleled by an increased prevalence of microalbuminuria and carotid artery wall thickening or plaques,hypertensives with MS should underwent extensive investigations searching for subclinical organ damage(TOD)。3.Blood vascular overload index(VOI) is associated with organ damage in primary hypertension.With MS.The study strengthen the role of this index as a marker of risk and help to explain the high cardiovascular mortality reported in patients with high blood vessel overload index。 Part two:The Relationship of resting heart rate(RHR) with target organ damage (TOD) in the essential hypertensives with MSObjective:We sought to evaluate whether increasing resting heart rate has a greater impact on target organ damage in the essential hypertensives with MS。Methods:The subjects was the same as the former:A total of 187 hypertensive patients underwent ECG to measure resting heart rate,categorized in three groups(group A≤60;group B:60-80;group C:≥80)beat/min,according to resting heart rate。Result:1 Prevalence of LVH(32%vs 43%vs 59%,P≤0.01 for all)、CIMT(5%vs 27%vs 56%,P≤0.05 for all) and MUA(21%vs 18%vs 19%,P≤0.05 for all) was significantly different in three groups.2 Prevalence rates of LVH,carotid plaques,and microalbuminuria were significantly higher in patients with MS than without MS((40%vs 37%,29%vs 15%,29%vs 9%,P＜0.05 for all)。3 Echocardiography values LVMI(176.8±52.3 vs210.9±57;182.2±49.8vs 217.8±59;200.8±44.1 vs 218.4±52.3);LVH(39.9±9.8 vs 45.1±10.6;47.2±11.9 vs 53.4±13.4;51.4±12.5 vs 55.3±12.8);CIMT(0.54±0.08 vs 0.61±0.11;0.70±0.12 vs 0.73±0.19;0.85±0.14 vs 0.92±0.17) showed a progressive increase from the Low-HR group to higher-HR group o Although,without showing an RHR-related increase for the prevalence of ACR(2.97±0.35 vs 6.39±1.22;2.42±1.25 vs 5.52±3.10;4.44+1.87 vs 10.30±3.22)。In all groups values were markedly altered in patients with MS as compared to those without MS,the difference being statistically significant(P＜0.05)。 Conclusions1.In conclusion,Resting heart rate is still strongly predictors of clinical target organ damage in essential hypertension with metabolic syndrome and that it maintains its role regardless of it is classic cardiovascular risk factor。2.Metabolism syndrome increases resting heart rate and the target organ damage in hypertension patient,simultaneously increasing resting heart rate followed by increased metabolic anomalies,indicated that metabolism syndrome and increasing resting heart rate have possibly the synergism to the target organ damage in hypertension patients。更多还原