中国全科医学2017，Vol.20Issue(7)：817-822,6.DOI:10.3969/j.issn.1007-9572.2017.07.012
肾素、醛固酮协同作用对原发性高血压病合并阻塞性睡眠呼吸暂停低通气综合征患者左心结构和功能的影响研究
Synergic Effect of Renin and Aldosterone on the Left - sided Heart Structure and Function in Essential Hypertension with Obstructive Sleep Apnea-hypopnea Syndrome
摘要
Abstract
Objective To study the synergic effect of renin and aldosterone on the left - sided heart structure and function in essential hypertension with obstructive sleep apnea - hypopnea syndrome (OSAHS)patients. Methods We selected 277 inpatients who did not take any antihypertensive drugs affecting renin - angiotensin - aldosterone system (RAAS) 〔197 males and 80 females with an average of (44. 3 ± 7. 9)years old (ranged from 18 to 60)〕from 546 patients hospitalized in Department of Hypertension,the First Affiliated Hospital of Xinjiang Medical University and confirmedly diagnosed with essential hypertension and OSAHS from January 2011 to January 2016,and divided them into 4 groups based on the plasma renin activity (PRA)and plasma aldosterone concentration (PAC)levels:normal PRA and PAC (N group,n = 74),high PRA and normal PAC (HR group,n = 113),normal PRA and high PAC (HA group,n = 22),high PRA and high PAC (HRA group,n= 68). Echocardiogram was used to determine the parameters of left - sided heart structure and function,including left atrial diameter (LAD),left ventricular end diastolic diameter (LVEDD ),left ventricular end systolic diameter (LVESD ), interventricular septal thickness (IVST),left ventricular posterior wall thickness (LVPWT),and mitral ratio of peak early to late diastolic filling velocity (E/ A). Left ventricular ejection fraction (LVEF)and left ventricular mass index (LVMI)were calculated according to the formula. Radioimmunoassay method was adopted to measure the PRA and PAC levels. And the multivariate Logistic regression analysis was used to study the factors affecting left - sided heart structure and function. Results The contrast in general data between 4 groups:the differences in average 24 - hour diastolic blood pressure (24 hDBP)and apnea hypoventilation index (AHI) were statistically significant (P < 0. 05 ),while those in gender,age,duration of hypertension,BMI,average 24 - hour systolic blood pressure (24 hSBP),fasting plasma glucose (FPG),total cholesterol (TC),triacylglycerol (TG),low - density lipoprotein cholesterol (LDL-C),high - density lipoprotein cholesterol (HDL-C) were not (P > 0. 05). The contrast in echocardiographic indicators between 4 groups:the differences in LAD,LVEDD,IVST, LVPWT,LVMI,E/ A were statistically significant (P < 0. 05),whereas those in LVESD and LVEF were not (P > 0. 05). The multivariate Logistic regression analysis found that BMI 〔OR = 2. 756,95% CI (1. 604,4. 738),P < 0. 001〕,high PRA and high PAC 〔OR = 2. 377,95% CI (1. 038,5. 446),P = 0. 041〕were the influencing factors of LAD;factors exerting effect on LVMI were gender 〔OR = 0. 283,95% CI (0. 134,0. 601),P = 0. 001〕,BMI 〔OR = 2. 058,95% CI (1. 198, 3. 533),P = 0. 009〕,AHI 〔OR = 2. 776,95% CI (1. 364,5. 650),P = 0. 005〕,and high PRA and high PAC 〔OR= 3. 222,95% CI (1. 377,7. 537),P = 0. 007〕;E/ A was influenced significantly by age 〔OR = 2. 859,95% CI (1. 943, 4. 206),P < 0. 001〕. Conclusion The combination of renin and aldosterone determines impairment of left - sided heart structure and function in essential hypertension with OSAHS patients,especially the synergic effect of hyperreninemia and hyperaldosternism is obvious.关键词
高血压/睡眠呼吸暂停,阻塞性/肾素/醛固酮/左心结构/心室功能,左Key words
Hypertension/Sleep apnea/obstructive/Renin/Aldosterone/Left ventricular and atrial structure/Ventricular function/left分类
医药卫生引用本文复制引用
祖力米热·阿布力孜,孙晓靖,陈玉岚,张俊仕,珠勒皮亚·司马义,徐新娟,张向阳..肾素、醛固酮协同作用对原发性高血压病合并阻塞性睡眠呼吸暂停低通气综合征患者左心结构和功能的影响研究[J].中国全科医学,2017,20(7):817-822,6.基金项目
新疆维吾尔自治区自然科学基金资助项目(2015211C038) （2015211C038）
