[摘要]目的 探讨原发性高血压患者血脂综合指数与左心房大小的相关性。方法 选择2014年5月~2016年4月在我院接受治疗的原发性高血压患者200例,根据经胸超声心动图检查结果分为左心房增大组70例及左心房正常组130例。测量患者肾功能、血脂、血压、空腹血糖、血脂综合指数等指标并进行统计分析,采用Spearman进行相关性分析,多变量线性回归分析左心房增大的相关因素。结果 两组血脂综合指数差异有统计学意义(P http://
[关键字]原发性高血压;高血压;血脂综合指数;左心房;相关性
[中图分类号] R544 [文献标识码] A [文章编号] 1674-4721(2017)12(a)-0012-04
[Abstract]Objective To investigate the correlation between lipid comprehensive index and left atrial size in patients with essential hypertension.Methods From May 2014 to April 2016,200 patients with essential hypertention whose data were complete in our hospital were selected.According to the results of transthoracic echocardiography,the patients were divided into case atrial enlargement group(70 cases)and left atrial normal group(130 cases),The renal function, blood lipid,blood pressure, fasting blood glucose,blood lipid comprehensive index and other indicators were measured and statistically analyzed.Spearman was used for correlation analysis,and multivariate linear regression was used for the analysis of relevant factors of left atrial enlargement.Results In blood lipid comprehensive index between the two groups,the difference was statistically significant(P0.05),具有可比性。所有患者均签订知情同意书并经相关医学伦理委员会批准。 1.2 方法
1.2.1血液检测 入选患者空腹12 h后,抽取静脉血2~3 ml,由日式7170A全自动生化分析仪进行血脂、血糖、生化等化验分析,并计算血脂综合指数=总胆固醇×三酰甘油×低密度脂蛋白胆固醇/高密度脂蛋白胆固醇[7]。
1.2.2血压测量 高血压的测量和诊断标准按2010年中国高血压防治指南[8]:血压值持续或非同日3次以上超过标准血压诊断标准,即收缩压≥140mmHg(18.6 kPa)和(或)舒张压≥90 mmHg(12 kPa)者,或正在服用降压药物。
1.2.3 颈动脉的测量 采用美国产的GEVivid7彩色多普勒超声诊断仪, 探头频率2.5~3.5 MHz,由B超室专职医师操作,受检者在平静状态下取仰卧位及左侧卧位,取胸骨旁长轴、短轴切面以及心尖四腔切面记录患者的超声心动图图像,分别测量左心房内径,左心室舒张和收缩末期内径,室间隔厚度,左心室壁厚度,射血分数。其中定义左心房≥4 mm为左心房增大[9]。
1.3统计学方法
采用统计学软件SPSS 22.0分析数据,计量资料以均数±标准差(x±s)表示,采用t检验,计数资料以率表示,采用χ2检验,以P0.05),而血脂综合指数两组间差异有统计学意义(P [参考文献]
[1]Leung AA,Nerenberg K,Daskalopoulou SS,et al.Hypertension Canada′s 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement,Diagnosis,Assessment of Risk,Prevention,and Treatment of Hypertension[J].Can J Cardiol,2016,32(5):569-588.
[2]修订委员会中国高血压基层管理指南.中国高血压基层管理指南(2014年修订版)[J].中华健康管理学杂志,2015, 9(1):10-30.
[3]Daskalopoulou SS,Rabi DM,Zarnke KB,et al.The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis,assessment of risk,prevention,and treatment of hypertension[J].Can J Cardiol,2015,31(5):549-568.
[4]Hanif W, Alex L,Su Y,et al.Left atrial remodeling,hypertrophy,and fibrosis in mouse models of heart failure[J].Cardiovasc Pathol,2017,30:27-37.
[5]中??胆固醇教育计划委员会.高甘油三酯血症及其心血管风险管理专家共识[J].中华心血管病杂志,2017,45(2):108-115.
[6]Markman TM,Habibi M,Venketash BA,et al.Association of left atrial structure and function and incident cardiovascular disease in patients with diabetes mellitus: results from multi-ethnic study of atherosclerosis(MESA)[J].Eur Heart J Cardiovasc Imaging,2017,28(2):1-7.
[7]余亚仁,李文华,陈静,等. 胆红素血脂综合指数和纤维蛋白原水平与冠状动脉病变程度的相关性研究[J].中国循环杂志,2015,30(11):1039-1042.
[8]中华人民共和国卫生部疾病控制预防控制局.《中国高血压防治指南》2009年基层版[M].8版.北京:人民卫生出版社,2013:189.
[9]Douglas PS,Garcia MJ,Haines D E,et al.ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography.A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force,American Society of Echocardiography,American Heart Association,American Society of Nuclear Cardiology,Heart Failure Society of America,Heart Rhythm Society,Society for Cardiovascular Angiography and Interventions,Society of Critical Care Medicine,Society of Cardiovascular Computed Tomography,and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians[J].J Am Coll Cardiol,2011,57(9):1126-1166.
[10]Cuspidi C,Rescaldani M,Sala C.Prevalence of echocardiographic left-atrial enlargement in hypertension:a systematic review of recent clinical studies[J].Am J Hypertens,2013,26(4):456-464.
[11]Almodares Q,Wallentin GC,Thurin A,et al.Larger right atrium than left atrium is associated with all-cause mortality in elderly patients with heart failure[J].Echocardiography,2017,34(5):662-667.
[12]Thanigaimani S,Lau DH,Agbaedeng T,et al.Molecular mechanisms of atrial fibrosis:implications for the clinic[J].Expert Rev Cardiovasc Ther,2017,15(4):247-256. [13]Thomas L,Abhayaratna WP.Left atrial reverse remodeling:mechanisms,evaluation,and clinical significance[J].JACC Cardiovasc Imaging,2017,10(1):65-77.
[14]Bytyci I,Bajraktari G.Left atrial changes in early stages of heart failure with preserved ejection fraction[J].Echocardiography,2016,33(10):1479-1487.
[15]Wang Q,Yu Y,Zhang P,et al.The crucial role of activin A/ALK4 pathway in the pathogenesis of Ang-Ⅱ-inducedatrial fibrosis and vulnerability to atrial fibrillation[J].Basic Res Cardiol,2017,112(4):47-58.
[16]Kachur S,Lavie CJ,de Schutter A,et al.Obesity and cardiovascular diseases[J].Minerva Med,2017,108(3):212-228.
[17]Wang W,Zhu Y,Yi J,et al.Nkx2.5/CARP signaling pathway contributes to the regulation of ion channel remodeling induced by rapid pacing in rat atrial myocytes[J].Mol Med Rep,2016,14(4):3848-3854.
[18]Jalife J,Kaur K.Atrial remodeling,fibrosis and atrial fibrillation[J].Trends Cardiovasc Med,2015,25(6):475-484.
[19]Fu H,Li G,Liu C,et al.Probucol prevents atrial remodeling by inhibiting oxidative stress and TNF-alpha/NF-kappaB/TGF-beta signal transduction pathway in alloxan-induced diabetic rabbits[J].J Cardiovasc Electrophysiol,2015, 26(2):211-222.
[20]Kume O,Teshima Y,Abe I,et al.Role of atrial endothelial cells in the development of atrial fibrosis and fibrillation in response to pressure overload[J].Cardiovasc Pathol,2017, 27:18-25.
(收稿日期:2017-09-07 本文?辑:白 婧)