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首页> 中文期刊> 《中国全科医学》 >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

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

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目的 探讨肾素、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(OSAHS)患者左心结构和功能的影响.方法 从2011年1月—2016年1月在新疆医科大学第一附属医院高血压科住院确诊的原发性高血压病合并OSAHS患者546例中,选取未服用影响肾素-血管紧张素-醛固酮系统(RAAS)降压药物的患者277例,其中男197例,女80例;年龄18~60岁,平均年龄(44.3±7.9)岁.根据肾素、醛固酮水平分为正肾素正醛固酮组(N组,n=74)、高肾素正醛固酮组(HR组,n=113)、正肾素高醛固酮组(HA组,n=22)、高肾素高醛固酮组(HRA组,n=68).采用心脏超声心动图测定反映左心结构和功能的相关指标,包括左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左房室瓣血流频谱E峰和A峰最大流速比值(E/A),并根据公式计算左心室射血分数(LVEF)和左心室质量指数(LVMI).采用放射免疫法测定血浆肾素活性(PRA)、醛固酮水平(PAC).影响因素分析采用多因素Logistic回归分析.结果 4组性别、年龄、高血压病程、BMI、24 h平均收缩压(24 hSBP)、空腹血糖(FPG)、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)间差异无统计学意义(P>0.05),而24 h平均舒张压(24 hDBP)、睡眠呼吸暂停低通气指数(AHI)间差异有统计学意义(P<0.05).4组LAD、LVEDD、IVST、LVPWT、LVMI、E/A间差异有统计学意义(P<0.05),而LVESD、LVEF间差异无统计学意义(P>0.05).BMI〔OR=2.756,95%CI(1.604,4.738),P<0.001〕、高肾素高醛固酮 〔OR=2.377,95%CI(1.038,5.446),P=0.041〕是LAD的影响因素;性别 〔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〕、高肾素高醛固酮 〔OR=3.222,95%CI(1.377,7.537),P=0.007〕是LVMI的影响因素;年龄 〔OR=2.859,95%CI(1.943,4.206),P<0.001〕是E/A的影响因素.结论 肾素、醛固酮组合对原发性高血压病合并OSAHS患者左心结构和功能改变有协同作用,其中高肾素高醛固酮组合影响最明显.%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.

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