【摘要】：背景高血壓在慢性心血管疾病中較為普遍,長期血壓維持在較高水平極易引發(fā)動(dòng)脈硬化,進(jìn)而導(dǎo)致一系列由動(dòng)脈硬化病變而產(chǎn)生的心腦血管疾病。目前對于動(dòng)脈硬化的評估主要基于頸動(dòng)脈超聲、動(dòng)脈血管造影及無創(chuàng)外周動(dòng)脈硬化檢測等檢查,一旦出現(xiàn)陽性結(jié)果提示病理結(jié)局已經(jīng)形成。近些年,隨著對MAU進(jìn)一步深入研究發(fā)現(xiàn),多數(shù)高血壓患者可并發(fā)MAU,MAU出現(xiàn)提示高血壓已造成早期血管損傷,其在動(dòng)脈硬化的早期即可出現(xiàn)。對高血壓MAU水平與血管動(dòng)脈硬化指標(biāo)進(jìn)行比較分析,將有助于揭示MAU在早期預(yù)測動(dòng)脈硬化中的價(jià)值,具有重要的臨床意義。目的通過對原發(fā)性高血壓MAU與頸動(dòng)脈硬化評分進(jìn)行相關(guān)性分析,探究高血壓MAU與動(dòng)脈硬化之間的聯(lián)系,促使臨床醫(yī)生重視對高血壓MAU的檢測,早期采取有效防治措施,降低動(dòng)脈硬化性心腦血管疾病的致死、致殘風(fēng)險(xiǎn)。方法選取玉溪市人民醫(yī)院心內(nèi)科從20 16年2月到2016年10月住院經(jīng)明確診斷的原發(fā)性高血壓患者359例,除外繼發(fā)性高血壓,并排除患者存在同樣能夠?qū)е履虬椎鞍咨叩募膊?諸如:糖尿病、腎功能不全、感染性性疾病、免疫性疾病、腫瘤等。研究對象于入院次日清晨采集清潔中段尿送檢,行ACR測定;采集空腹靜脈血測定空腹Glu、TC、TG、HDL-C、LDL-C、Hcy、Cys-C、hs-CRP、CREA、UA 水平;擇期通過超聲檢測儀測定頸動(dòng)脈內(nèi)膜中層厚度,觀察是否有斑塊及斑塊的厚度、數(shù)目,斑塊是否導(dǎo)致管腔阻塞及阻塞的程度,計(jì)算Crouse總積分、等級評分。根據(jù)ACR值分為MAU陰性組266例(ACR30mg/g)和MAU陽性組73例(30mg/g≤ACR≤300mg/g),臨床蛋白尿組20例(ACR300mg/g,因樣本量偏少未納入研究)。分別對兩組研究對象進(jìn)行一般資料(性別、吸煙史、BMI、是否合并冠心病)、血生化指標(biāo)(Glu、TC、TG、HDL-C、LDL-C、Hcy、Cys-C、hs-CRP、CREA、UA)、ACR、Crouse 總積分、等級評分、近期3月發(fā)生心腦血管事件率進(jìn)行統(tǒng)計(jì)分析。結(jié)果1.所有入選研究對象均按要求完成一般資料收集及ACR水平、血生化指標(biāo)、頸動(dòng)脈硬化指標(biāo)測定。2.近期3月隨訪無失訪現(xiàn)象。3.①M(fèi)AUp陽性組73例,平均年齡(64.48±8.76)歲,其中含35名男性,38名女性,平均 BMI(25.09±3.75),57 例吸煙,合并冠心病 49 例;Glu(5.07±0.52)mmol/L、TC(4.08±0.75)mmol/L、TG(2.25±2.06)mmol/L、HDL-C(1.12±0.19)mmol/L、LDL-C(2.08 ±0.66)mmol/L、Cys-C(1.22 ± 0.29)mg/L、hs-CRP(2.67±3.09)mg/L、Hcy(16.36±8.22)μmol/L、CREA(81.67± 22.73)μmol/L、UA(352.49±82.88)μmol/L、ACR(76.84±57.69)、Crouse總積分(5.85± 1.11)、等級評分(4.27± 1.26)、斑塊數(shù)目(4.53±1.00)、近期3月發(fā)生心腦血管事件27例;②MAU陰性組266例,平均年齡(65.39±11.53)歲,其中含157名男性,109名女性,平均 BMI(24.49±3.46),73 例吸煙,合并冠心病 126 例;Glu(5.13±0.56)mmol/L、TC(4.29± 1.10)mmol/L、TG(2.02±1.80)mmol/L、HDL-C(1.22±0.04)mmol/L、LDL-C(2.38± 1.31)mmol/L、Cys-C(1.26±0.45)mg/L、hs-CRP(2.36±3.36)mg/L、Hcy(17.83 ± 10.69)μmol/L、CREA(85.78 ±21.82)μmol/L、UA(364.76±95.38)μmol/L、ACR(5.75±6.17)、Crouse 總積分(2.09± 1.40)、等級評分(2.16± 1.12)、斑塊數(shù)目(1.31±0.90)、近期3月發(fā)生心腦血管事件41例。4.兩組之間在年齡、性別、BMI、吸煙史、Glu、TC、TG、HDL-C、LDL-C、Cys-C、hs-CRP、Hcy、CREA、UA方面的比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05);ACR、Crouse總積分、等級評分、斑塊數(shù)目、合并冠心病、近期心腦血管事件的比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。5.分別以Crouse總積分、等級評分、斑塊數(shù)目為因變量,以ACR為自變量進(jìn)行單因素相關(guān)分析,ACR與Crouse總積分、等級評分、斑塊數(shù)目呈正相關(guān)(r=0.784、0.733、0.787),進(jìn)一步以ACR為自變量分別對其行回歸分析,線性回歸方程分別為y=2.058+0.040x,y=2.060+0.026x,y=1.332+0.032x。6.兩組內(nèi)分別以Crouse總積分、等級評分、斑塊數(shù)為因變量,以TC、TG、LDL-C、LDL-C為自變量行單因素相關(guān)性分析,血脂水平(TC、TG、LDL-C)與Crouse總積分、等級評分、斑塊數(shù)呈正相關(guān),HDL-C與Crouse總積分、等級評分、斑塊數(shù)呈負(fù)相關(guān)。7.據(jù)膽固醇水平分為高膽固醇血癥組(TC≥5.2mmmol/L)56人(發(fā)生近期血腦血管事件11人)和非高膽固醇血癥組(TC5.2mmmol/L)283人(發(fā)生近期心腦血管事件57人);兩組在發(fā)生近期血腦血管事件方面的比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。另外,據(jù)甘油三酯水平分為高甘油三酯血癥組(TG≥1.7mmmol/L)148人(發(fā)生近期血腦血管事件30人)和非高甘油三脂血癥組(TG1.7mmmol/L)191人(發(fā)生近期心腦血管事件38人);兩組在發(fā)生近期血腦血管事件方面的比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論原發(fā)性高血壓MAU與頸動(dòng)脈硬化、合并冠心病、發(fā)生近期心腦血管事件有關(guān),且MAU水平與頸動(dòng)脈硬化程度呈正相關(guān),提示高血壓患者M(jìn)AU在一定水平上能早期預(yù)測動(dòng)脈硬化、靶器官血管損害及近期心腦血管事件風(fēng)險(xiǎn),且血脂異常促成并加速了動(dòng)脈硬化的進(jìn)程,對高血壓患者早期進(jìn)行MAU及血脂水平檢測,盡早采取有效防治手段,將有助于降低高血壓并發(fā)心腦血管疾病的致死、致殘風(fēng)險(xiǎn)。
[Abstract]:Background Hypertension is common in chronic cardiovascular diseases. Long-term maintenance of high blood pressure can easily lead to atherosclerosis, which leads to a series of cardiovascular and cerebrovascular diseases. In recent years, with the further study of MAU, most patients with hypertension can be complicated with MAU. MAU indicates that hypertension has caused early vascular injury, which can occur in the early stage of atherosclerosis. Objective To explore the relationship between hypertensive MAU and atherosclerosis by analyzing the correlation between MAU and carotid atherosclerosis score in essential hypertension, so as to urge clinicians to pay attention to the detection of hypertensive MAU and take effective measures in the early stage. Methods From February 2016 to October 2016, 359 patients with essential hypertension were admitted to the Department of Cardiology of Yuxi People's Hospital. Except for secondary hypertension, the patients were excluded from having diseases that could also lead to elevated urinary albumin. For example, diabetes mellitus, renal insufficiency, infectious diseases, immune diseases, tumors and so on. The subjects were collected in the morning of admission clean middle urine for examination, ACR measurement; Fasting venous blood was collected to determine fasting Glu, TC, TG, HDL-C, LDL-C, Hcy, Cys-C, hs-CRP, CREA, UA levels; Choosing ultrasonic detector to determine the carotid intima-media thickness, and so on. The total Crouse score and grade score were calculated. According to ACR value, 266 cases were classified as MAU negative group (ACR30mg/g) and 73 cases were classified as MAU positive group (30mg/g < ACR < 300mg/g). 20 cases were classified as clinical proteinuria group (ACR300mg/g, not included in the study because of the small sample size). General data (gender, smoking history, BMI, whether coronary heart disease was associated), blood biochemical indicators (Glu, TC, TG, HDL-C, LDL-C, Hcy, Cys-C, hs-CRP, CREA, UA), ACR, Crouse total score, ranking score, the incidence of cardiovascular and cerebrovascular events in recent March were statistically analyzed. Results 1. All the selected subjects completed general information as required. Data were collected and ACR levels, blood biochemical indices and carotid atherosclerosis indices were measured. 2. There was no missing follow-up in recent 3 months. 3. 6.06mmol/L, HDL-C (1.12 (+ 0.19) mmol/L, HDL-C (1.12 (+ 0.19) mmol/L, LDL-C (2.08 (+ 0.66) mmol/L, Cys-C (1.22 (+ 0.29) mg/L, hs-CRP (2.67 (2.67 (+ 3.09) mg/L), hs-CRP (2.67 (2.67 (2.67 (+ 3.09) mg/L), Hcy (16.36 (+ 16.36 [8.22.22.22.22) mmol/L, CREA (81.67 (+ 81.67 [22.73 [22.73 (+ 352 85 + 1.11, grade score (4.27 + 1.26), number of plaques (4.53 + 1.00), recent occurrence in March 27 cases of cardiovascular and cerebrovascular events; 2 266 cases in MAU negative group, with an average age of (65.39 + 11.53) years, including 157 maleand 109 females, 157 males and 109 females, with an average BMI (24.49 + 3.46), 73 smok, and 126 patients with coronary heart disease; Glu (5.13 + 0.56) mmol / L, Glu (5.13 + 0.56) mmol / L, TC (4.29 + 1.10) mmol / L, TG (2.02 + 1.80) mmol / L, HDL-C (1.22 + 0.04) mmol / L, L-C (1.22 [0.04) mmol / L, L-L (2.22 [(2.04) L-L (L, Cys-C(1.26+0) 45 mg/L, hs-CRP (2.36 (+ 3.36) mg/L, hs-CRP (2.36 (+ 3.36) mg/L, Hcy (17.83 (+ 10.69) micromol/L, CREA (85.78 (+ 21.82) micromol/L, UA (364.76 (+ 95.38) micromol/L, ACR (5.75 (+ 6.17), ACR (5.75 (+) 17), Crouse total score (2.09 (+ 1.40), grade score (2.16 (+ 1.12), number of PLA (1.31 (+ 0.31 (+ 0.90), 41 recent cardiovascular and cerebrovascular events (4.4.4.4.4) between the two groups in March, u, TC There were no significant differences in TG, HDL-C, LDL-C, Cys-C, hs-CRP, Hcy, CREA, UA (P 0.05); ACR, Crouse total score, grade score, plaque number, coronary heart disease, and recent cardiovascular and cerebrovascular events (P 0.05). Univariate correlation analysis showed that ACR was positively correlated with the total score of Rouse, grade score and the number of plaques (r = 0.784, 0.733, 0.787). Further regression analysis was performed with ACR as independent variables. The linear regression equations were y = 2.058 + 0.040x, y = 2.060 + 0.026x, y = 1.332 + 0.032x.6. Crouse total score, grade score, plaque number were used in the two groups respectively. TC, TG, LDL-C and LDL-C were used as independent variables for univariate correlation analysis. The total score of serum lipid (TC, TG, LDL-C) was positively correlated with the total score of Rouse, grade score and plaque number. HDL-C was negatively correlated with the total score of Rouse, grade score and plaque number. There was no significant difference between the two groups (P 0.05). In addition, 148 patients were divided into hypertriglyceridemia group (TG < 1.7 mmmol/L) and non-hypercholesterolemia group (TC5.2 mmmol/L) according to the level of triglyceride (TG < 1.7 mmmol/L). There was no significant difference between the two groups in the occurrence of recent cardiovascular and cerebrovascular events (P 0.05). Conclusion MAU in essential hypertension is associated with carotid atherosclerosis, coronary heart disease and recent cardiovascular and cerebrovascular events. Positive correlation was found between MAU and carotid atherosclerosis, suggesting that MAU can predict early atherosclerosis, target organ vascular damage and the risk of recent cardiovascular and cerebrovascular events, and abnormal blood lipid contributes to and accelerates the process of atherosclerosis. Early detection of MAU and blood lipid levels in patients with hypertension, and effective prevention and treatment as soon as possible. It will help reduce the risk of death and disability of hypertension complicated with cardiovascular and cerebrovascular diseases.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R544.11

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