引用本文:陈素芬,赵玉兰,黄亚萍,赵映璇.糖耐量异常对高血压患者尿白蛋白肌酐比与左室质量指数的影响[J].中国临床新医学,2019,12(4):418-422.
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糖耐量异常对高血压患者尿白蛋白肌酐比与左室质量指数的影响
陈素芬,赵玉兰,黄亚萍,赵映璇
450000 河南,郑州大学第二附属医院心内科
摘要:
[摘要] 目的 探讨糖耐量异常对高血压患者尿白蛋白肌酐比(ACR)与左室质量指数(LVMI)的影响。方法 回顾性分析2016-12~2018-02门诊及住院的2级及以上原发性高血压患者184例,高血压病程在10年以内。所有入选者均行简化糖耐量试验,并记录每位患者空腹血糖(FPG)、OGTT餐后2 h血糖(2h PG),根据《全国临床检验操作规程》中关于OGTT试验FPG、2 h PG异常诊断标准,将所有入选患者分成两组。对照组即血糖正常(NGT)组91例,糖耐量异常(IGT)组93例。同时记录184例患者的身高、体重、体重指数(BMI)、性别、年龄、高血压病程、血压、血脂、肌酐等一般临床资料。所有入选者已行ACR检测及心脏彩色多普勒超声检查,记录室间隔厚度(IVST)、左室后壁厚度(PWT)、左室射血分数(LVEF)及左室舒张末内径(LVIDd),研究糖耐量异常对高血压患者ACR与LVMI的影响。结果 两组研究对象的一般资料高血压病程、年龄、性别、BMI、舒张压、HDL-C、LDL-C、甘油三酯(TG)及FPG等差异无统计学意义(P>0.05)。IGT组收缩压、TC、肌酐、室间隔厚度较NGT组高,射血分数较NGT组低,差异有统计学意义(P<0.05)。IGT组ACR、LVMI平均值及MAU阳性率、左室肥厚检出率较NGT组高,差异均有统计学意义(P<0.01)。2h PG水平与ACR呈正相关(r=0.67,P<0.01),与LVMI亦呈正相关(r=0.45,P<0.01)。Logistic回归分析得出2h PG(OR=1.449,95%CI:1.006~2.089)、室间隔厚度(OR=2.317,95%CI:1.539~3.490)为左室肥厚的危险因素(P<0.05)。结论 高血压合并糖耐量异常阶段已出现微量白蛋白尿及左室肥厚等靶器官损害现象。
关键词:  简化糖耐量试验  尿白蛋白肌酐比  左室质量指数
DOI:10.3969/j.issn.1674-3806.2019.04.16
分类号:R 544.1
基金项目:
Effects of impaired glucose tolerance on urinary albumin to creatinine ratio and left ventricular mass index in hypertensive patients
CHEN Su-fen, ZHAO Yu-lan, HUANG Ya-ping
Department of Cardiology, the Second Affiliated Hospital of Zhengzhou University, Henan 450000, China
Abstract:
[Abstract] Objective To investigate the effects of impaired glucose tolerance on urinary albumin to creatinine ratio(ACR) and left ventricular mass index(LVMI) in hypertensive patients. Methods A retrospective analysis of 184 patients with grade 2 or above of essential hypertension from December 2016 to February 2018 was performed. The duration of hypertension was less than 10 years. All the selected subjects underwent simplified glucose tolerance test, and fasting blood glucose(FPG) and OGTT 2-hour blood glucose(2h PG) were recorded in each patient. The patients who were diagnosed with fasting blood glucose and 2-hour blood glucose abnormality in the OGTT test according to the criteria of National Clinical Laboratory Procedures were divided into two groups: the control group [with normal blood glucose(NGT), n=91] and the impaired glucose tolerance(IGT) group(n=93). The general clinical data such as height, weight, body mass index(BMI), gender, age, course of hypertension, blood pressure, blood lipids, and creatinine were recorded. ACR and cardiac color Doppler ultrasonography were performed on all the patients. Interventricular septal thickness(IVST), left ventricular posterior wall thickness(PWT), left ventricular ejection fraction(LVEF) and left ventricular internal diameter at end-disatole(LVIDd) were recorded. The effects of impaired glucose tolerance on ACR and LVMI were studied. Results There were no significant differences in the course of hypertension, age, gender, BMI, diastolic blood pressure, HDL-C, LDL-C, triglyceride(TG) and FPG between the two groups(P>0.05). The systolic blood pressure, ACR, TC, creatinine and ventricular septal thickness in the IGT group were significantly higher than those in the NGT group(P<0.05). The ejection fraction of the IGT group was significantly lower than that of the NGT group(P<0.05). The mean rates of ACR and LVMI, and the MAU positive rate and left ventricular hypertrophy in the IGT group were significantly higher than those in the NGT group(P<0.01). The 2h PG level was positively correlated with ACR(r=0.67, P<0.01) and positively correlated with LVMI(r=0.45, P<0.01). Logistic regression analysis showed that 2h PG(OR=1.449, 95% CI: 1.006~2.089) and ventricular septal thickness(OR=2.317, 95% CI: 1.539~3.490) were the risk factors of left ventricular hypertrophy(P<0.05). Conclusion The target organ damages such as microalbuminuria and left ventricular hypertrophy have been observed in the stage of hypertension complicated with impaired glucose tolerance.
Key words:  Simplified glucose tolerance test  Urinary albumin to creatinine ratio(ACR)  Left ventricular mass index(LVMI)