發(fā)布時間：2018-03-19 11:13

  本文選題：原發(fā)性高血壓　切入點：糖代謝異常　出處：《新疆醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討新疆某三甲醫(yī)院原發(fā)性高血壓既往未明確診斷糖尿病的住院患者糖代謝分布情況及糖代謝正常的原發(fā)性高血壓患者向糖代謝異常合并狀態(tài)發(fā)展的影響因素;了解原發(fā)性高血壓患者eGFR分布,分析影響尿微量白蛋白的相關(guān)因素。方法:收集新疆某三甲醫(yī)院高血壓科住院的原發(fā)性高血壓既往未明確診斷糖尿病患者的臨床資料,計算不同民族、性別在糖代謝正常組與新診斷糖代謝異常組(空腹血糖受損、糖耐量異常、糖尿病)的構(gòu)成比分布情況。按照糖代謝水平分組,按民族(維吾爾、哈薩克、漢)分為亞組,比較各項生化指標(biāo)在各組的差異,將糖代謝正常組與糖代謝異常組間有統(tǒng)計學(xué)差異的指標(biāo)納入Logistics回歸方程計算,確定糖代謝正常的原發(fā)性高血壓患者向糖代謝異常合并狀態(tài)進展過程中的危險因素和保護因素。計算eGFR水平在不同特征原發(fā)性高血壓患者中的分布,并按照血糖、eGFR分組比較各項臨床指標(biāo)的差異。按照糖代謝水平分組,分析尿微量白蛋白與臨床指標(biāo)間的相關(guān)性。結(jié)果:不同民族(漢、維吾爾、哈薩克)、性別(男、女)的糖代謝水平(正常血糖、糖代謝異常)差異均無統(tǒng)計學(xué)意義(P0.05)。按照空腹血糖水平計算糖代謝異常構(gòu)成比為10.1%�？傃芯咳巳褐心挲g、SBPmax、BMI、LDL、HDL、載脂蛋白B、TC在糖代謝正常組與糖代謝異常組差異均有統(tǒng)計學(xué)意義(P0.05);糖代謝正常組中,BMI、肌酐在漢族與維吾爾族間比較差異有統(tǒng)計學(xué)意義(P0.05);糖代謝異常組中,SBP、SBPmax、BMI在漢族與維吾爾族間比較差異有統(tǒng)計學(xué)意義(P0.05)。Logistic回歸分析結(jié)果顯示:年齡(P0.05,OR=1.013)、BMI(P0.05,OR=1.041)、TC(P0.05,OR=1.337)、HDL(P0.05,OR=0.620)。在尿微量白蛋白正常的原發(fā)性高血壓患者中47.2%出現(xiàn)腎小球濾過率的減低。正常血糖組eGFR正常組與eGFR異常組的年齡、SBP、載脂蛋白B、血鉀水平、24小時尿鈉水平差異有統(tǒng)計學(xué)意義(P0.05),糖代謝異常組為年齡、SBP、載脂蛋白B、TC水平差異有統(tǒng)計學(xué)意義(P0.05),尿微量白蛋白相關(guān)性分析表明不同的糖代謝狀態(tài)尿微量白蛋白排出量的影響因素不同;糖代謝正常組:舒張壓(r=-0.11,p0.005)、年齡(r=-0.1,p0.005)、24小時尿鉀(r=-0.17,p0.001)、24小時尿鈉(r=-0.18,p0.001);糖代謝異常組:載脂蛋白B(r=-0.098,p0.01)、空腹血糖(r=0.087,p0.05)、餐后2小時血糖(r=-0.185,p0.001)、血清胱抑素C(r=-0.098,p0.01)、24小時尿鉀(r=-0.16,p0.01)、24小時尿鈉(r=-0.104,p0.001)。結(jié)論:年齡、BMI、TC升高是原發(fā)性高血壓糖代謝正�；颊呦蛱谴x異常合并狀態(tài)進展過程中的危險因素,高HDL為保護因素。原發(fā)性高血壓患者在尿微量白蛋白尚在正常范圍內(nèi)的情況下也會出現(xiàn)腎小球濾過率的減低。糖代謝正常組尿微量白蛋白與舒張壓呈正相關(guān),與年齡呈負(fù)相關(guān);糖代謝異常組尿微量白蛋白與載脂蛋白B、空腹血糖、餐后2小時血糖、血清胱抑素C呈正相關(guān);原發(fā)性高血壓患者尿微量白蛋白與24小時尿鉀、24小時尿鈉水平呈負(fù)相關(guān)。
[Abstract]:Objective: to investigate the distribution of glucose metabolism in patients with primary hypertension (EH) who had not been diagnosed with diabetes mellitus (DM) and the factors influencing the development of EH patients with abnormal glucose metabolism. To understand the distribution of eGFR in patients with essential hypertension, and to analyze the related factors affecting urinary microalbumin. Methods: the clinical data of patients with essential hypertension who were hospitalized in Department of Hypertension in a third Grade A Hospital in Xinjiang were collected. The composition and distribution of gender in normal glucose metabolism group and newly diagnosed abnormal glucose metabolism group (impaired fasting blood glucose, impaired glucose tolerance, diabetes mellitus) were calculated according to the level of glucose metabolism and ethnic groups (Uygur, Kazak). Han) was divided into subgroups. The differences of biochemical indexes in each group were compared. The indexes with statistical difference between normal glucose metabolism group and abnormal glucose metabolism group were included in the Logistics regression equation. To determine the risk factors and protective factors in the progression of patients with normal glucose metabolism from essential hypertension to abnormal glucose metabolism and to calculate the distribution of eGFR level in patients with different characteristics of essential hypertension. According to the level of glucose metabolism, the correlation between urinary albumin and clinical indexes was analyzed. Results: different nationalities (Han, Uygur, Kazak, male, male, male). Glucose metabolism level (normal blood sugar), There was no significant difference in abnormal glucose metabolism (P 0.05). According to the fasting blood glucose level, the composition ratio of abnormal glucose metabolism was calculated as 10.1. There were statistical differences in HDLand Apolipoprotein BTC between normal glucose metabolism group and abnormal glucose metabolism group in the general study population. There were significant differences in BMIand creatinine between Han and Uygur nationality in normal glucose metabolism group (P 0.05) and significant difference in BMI between Han and Uygur nationality in abnormal glucose metabolism group (P 0.05). Logistic regression analysis showed that there was significant difference between Han and Uygur nationality. : the age of P0.05 ORA 1.013 BMIP0.05 ORP 1.041TCU 1.337HDLP0.05OR0.200.The glomerular filtration rate decreased in 47.2% patients with essential hypertension with normal urinary microalbumin. The age of eGFR normal group and abnormal eGFR group were found in normal glucose group, apolipoprotein B group, serum potassium level and 24 hour urinary sodium level of patients with normal blood glucose and abnormal eGFR. The results showed that there was no significant difference between normal blood glucose group and abnormal eGFR group in the age of SBP, apolipoprotein B, serum potassium level and 24 hours urinary sodium level in 47.2% patients with hypertension with normal urinary microalbumins. The difference was statistically significant (P 0.05). The age group of abnormal glucose metabolism was SBP and the level of apolipoprotein BU TC was significantly different (P 0.05). The correlation analysis of urinary microalbumin showed that the factors affecting the excretion of urinary microalbumin were different among different glucose metabolism states. Normal glucose metabolism group: diastolic blood pressure r-0.11p 0.005U, age: r-0.1g p0.005U 24 h urinary potassium r-0.17p0.001U 24 h urinary sodium r-0.18p 0.001g; abnormal glucose metabolism group: apolipoprotein Br-0.098p 0.01U, fasting blood glucose r0.087p 0.05a, 2 h postprandial blood glucose r-0.185p0.001, serum cystatin Crr-0.098p0.01a 24 h urinary potassium r-0.16p1a 24 h r-0.104p 0.001p = 0.104p0. 001p = 0.104p0. 001p = 0.104p0. 001p = 0.104p0. 001p = = ='= = =. Elevated BMITC is a risk factor in the progression from abnormal glucose metabolism to abnormal glucose metabolism in patients with essential hypertension. High HDL was the protective factor. In patients with essential hypertension, the glomerular filtration rate was decreased under the condition that the urinary microalbumin was still within the normal range. In the normal glucose metabolism group, urinary microalbumin was positively correlated with diastolic blood pressure, and negatively correlated with age. There was a positive correlation between urinary microalbumin and apolipoprotein B, fasting blood glucose, 2 hours postprandial blood glucose, and serum cystatin C in patients with abnormal glucose metabolism, and a negative correlation between urinary microalbumin and 24 hour urinary potassium and 24 hour urinary sodium in patients with essential hypertension.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R544.11

【相似文獻】

相關(guān)期刊論文 前10條

1 徐艷麗;;引起糖代謝紊亂的常見藥物[J];沈陽藥科大學(xué)學(xué)報;2009年S1期

2 何冬梅;鄭萬芳;許寶珠;;體檢中心糖代謝異�？腿说慕】倒芾韀J];醫(yī)療裝備;2012年01期

3 張力心;;淺談鋅對糖代謝的影響[J];中國中醫(yī)藥現(xiàn)代遠(yuǎn)程教育;2012年23期

4 張煥文;;講授生化“糖代謝”的體會[J];廣州中醫(yī)學(xué)院學(xué)報;1985年02期

5 王曉梅,李秉儒,穆長征;伴有糖代謝紊亂的老年急性心肌梗塞的臨床特征[J];錦州醫(yī)學(xué)院學(xué)報;2000年03期

6 夏娣文,張蓉,張茂祥;單純皰疹病毒性腦炎伴糖代謝異常1例報告[J];華中醫(yī)學(xué)雜志;2001年01期

7 李珍珠,張迎春;從糖代謝談素質(zhì)教育[J];衛(wèi)生職業(yè)教育;2003年12期

8 邵虹,李蜀光,邱曉敏,陳雪梅,張耿新,潘鑒枝;廣東佛山普君社區(qū)老年人糖代謝異常初步調(diào)查[J];社區(qū)醫(yī)學(xué)雜志;2004年05期

9 賀衛(wèi)平;糖尿病健康教育對2型糖尿病患者糖代謝的干預(yù)[J];基層醫(yī)學(xué)論壇;2004年11期

10 吳乃君;南國珍;蘇勝偶;;2型糖尿病患者糖代謝紊亂與血清胰島素樣生長因子1、胰島素樣生長因子結(jié)合蛋白3的相關(guān)性研究[J];臨床薈萃;2006年14期

相關(guān)會議論文 前10條

1 王新國;王紅梅;李南方;張德蓮;常桂娟;王新玲;祖菲亞;周克明;王國亮;;原發(fā)性醛固酮增多癥患者糖代謝紊亂情況的分析[A];第十三次全國心血管病學(xué)術(shù)會議論文集[C];2011年

2 李勇;;慢性乙型病毒性肝病繼發(fā)糖代謝紊亂相關(guān)因素初探[A];第二十二屆全國中西醫(yī)結(jié)合消化系統(tǒng)疾病學(xué)術(shù)會議暨消化疾病診治進展學(xué)習(xí)班論文匯編[C];2010年

3 張子韜;陳小燕;黃華興;蘇淑貞;謝福武;曾彥茹;丘麗冰;;糖代謝異�；颊咦≡核劳鎏攸c分析[A];2006年中華醫(yī)學(xué)會糖尿病分會第十次全國糖尿病學(xué)術(shù)會議論文集[C];2006年

4 殷應(yīng)傳;余本富;梅周;何巧娟;周曉惠;何凡;何z，

本文編號：1634014