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目的:探讨原发性高血压患者血醛固酮水平与靶器官损害间的关系。方法:根据无药物影响定义(入院前停用醛固酮受体拮抗剂至少6周,停用β受体阻滞剂及利尿剂至少4周,停用血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂类药物至少2周),排除降压药物对血醛固酮检查结果造成的影响。选取2008年至2012年在我院住院的原发性高血压患者共664例,为无药物影响组;同时选取年龄、性别匹配的664例原发性高血压患者作为开放用药组。对患者进行常规生化检查、24 h时动态血压监测及心脏超声检查。结果:①简单相关分析发现,2组患者的血醛固酮水平与年龄、24 h尿钠钾比值及血钾呈负相关。②多元线性相关回归分析发现,在无药物影响组,矫正年龄、性别后,血醛固酮与尿白蛋白/尿肌酐比值(logACR)(β=0.228,P<0.001)、肾脏病膳食改良试验(β=-0.110,P=0.003)、左心室质量指数(β=0.092,P=0.032)相关,进一步矫正血钠、血钾、24 h尿钠、尿钾后,这种相关性仍存在,而在开放用药组这种相关性消失。③多元回归分析发现,在无药物影响组,矫正了相关混杂因素后,ln醛固酮与蛋白尿、肾小球滤过率下降、左心室肥厚独立相关,分别为ln醛固酮与蛋白尿(OR=2.954,95%CI:1.551～5.628,P=0.001),ln醛固酮与肾功能下降(OR=1.800,95%CI:1.174～2.761,P=0.007),ln醛固酮与左心室肥厚(OR=2.235,95%CI:1.737～2.749,P=0.006),而在开放用药组,该相关性消失。结论:血醛固酮水平与高血压患者的靶器官损害相关,但必须排除降压药物对血醛固酮检测结果造成的影响。
Objective: To investigate the relationship between serum aldosterone level and target organ damage in patients with essential hypertension. METHODS: Based on the definition of no drug effect (discontinuation of aldosterone receptor antagonist for at least 6 weeks before admission, discontinuation of beta blockers and diuretics for at least 4 weeks, discontinuation of angiotensin converting enzyme inhibitors or angiotensin II Receptor antagonist drugs for at least 2 weeks), excluding antihypertensive drugs on serum aldosterone test results. A total of 664 essential hypertension patients hospitalized in our hospital from 2008 to 2012 were selected as drug-free group. 664 patients with essential hypertension who were age-matched and sex-matched were selected as open-drug group. Patients routine biochemical tests, 24 h ambulatory blood pressure monitoring and echocardiography. Results: ①Correlation analysis showed that serum aldosterone levels in two groups were negatively correlated with age, 24-hour urinary sodium-potassium ratio and serum potassium. ② Multiple linear regression analysis showed that the ratio of serum aldosterone to urinary albumin / urinary creatinine (logACR) (β = 0.228, P <0.001), the diet modification test of renal disease (β = -0.110, P = 0.003), left ventricular mass index (β = 0.092, P = 0.032). Correlation still existed after further correction of serum sodium, serum potassium, 24 h urine sodium and urine potassium, Open relevance group disappeared. ③ Multiple regression analysis showed that ln aldosterone and albuminuria, glomerular filtration rate decreased and left ventricular hypertrophy were independent correlated in lumbar interventricular septum and non-drug-affected group, respectively, with ln aldosterone and proteinuria (OR = 2.954 (OR = 1.800, 95% CI: 1.174-2.761, P = 0.007), ln aldosterone and left ventricular hypertrophy (OR = 2.235, 95% CI: 1.551-5.628, P = 0.001) % CI: 1.737 ~ 2.749, P = 0.006), while in the open drug group, the correlation disappeared. Conclusion: The level of serum aldosterone is related to the target organ damage in hypertensive patients. However, the effect of antihypertensive drugs on the test of serum aldosteron must be excluded.