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目的观察原发性高血压(EH)合并靶器官损害病人血清肾上腺髓质素(ADM)水平,探讨ADM能否成为反映高血压靶器官损害的生物标志物。方法选取2010-07-12福建医科大学附属第一医院心内科EH住院病人202例,其中合并心脑肾等靶器官损害和临床疾患的EH患者131例(靶器官损害组),单纯高血压患者71例(单纯高血压组),100例门诊正常体检者设定为对照组,其中正常血压组50例,正常高值组50例。对住院病人采集病史,收集相关实验室检查结果及心脏彩色多普勒超声(彩超)检查+左心功能测定、双侧颈动脉彩超、冠脉造影等检查,并采用ELISA法定量测定血清中ADM含量。结果靶器官损害组患者血清ADM水平明显高于单纯高血压组、正常高值组和正常血压组[(63·89±14·1)>(45·07±7·53)>(27·68±5·66)>(19·85±3·22)ng/L,均P<0·01]。靶器官损害组ADM与相关参数进行相关性分析显示,ADM与肾小球滤过率、左心室射血分数呈负相关(r=-0·677,P<0·01;r=-0·217,P<0·05),与B型利钠肽、高敏c反应蛋白(hsCRP)、血肌酐、尿酸、尿微量白蛋白、尿白蛋白肌酐比和室间隔厚度呈正相关。logistic回归分析提示ADM与高血压靶器官损害具有相关性(OR1·229,95%CI1·149~1·315,P<0·01),ADM与hsCRP具有明显相关性(OR7·226,95%CI5·701~9·158,P<0·01)。结论血清ADM的水平与高血压心肾功能损害的严重程度呈正相关,可以作为预测EH病情严重程度生物学标志之一。
Objective To investigate the level of serum adrenomedullin (ADM) in patients with essential hypertension (EH) complicated with target organ damage and to explore whether ADM can become a biomarker of target organ damage in hypertension. Methods Totally 202 inpatients with EH in the Department of Cardiology of the First Affiliated Hospital of Fujian Medical University from July 2010 to July 2010 were enrolled in this study. Among them, 131 cases of EH patients (target organ damage group) complicated with target organ damage such as cardiovascular and cerebrovascular diseases and clinical diseases, 71 cases (simple hypertension group) and 100 normal outpatients were set as control group, including 50 cases in normal blood pressure group and 50 cases in normal high value group. Collecting the patient’s history, collecting the relevant laboratory test results and heart color Doppler ultrasound (color Doppler ultrasonography) + left ventricular function test, bilateral carotid ultrasound, coronary angiography and other tests, and ELISA quantitative determination of serum ADM content. Results The level of serum ADM in patients with target organ damage was significantly higher than that in patients with hypertension alone, normal high value group and normal blood pressure group (63.89 ± 14.1)> (45.07 ± 7.33)> (27.68 ± 5 · 66)> (19.85 ± 3.22) ng / L, all P <0.01. Correlation analysis showed that there was a negative correlation between ADM and glomerular filtration rate and left ventricular ejection fraction (r = -0.677, P <0.01; r = -0 · 217, P <0.05), which was positively correlated with B-type natriuretic peptide, hsCRP, creatinine, uric acid, urine microalbuminuria, creatinine ratio of urine albumin and thickness of interventricular septum. Logistic regression analysis showed that there was a correlation between ADM and target organ damage in hypertension (OR1.29, 95% CI 1.14-1.315, P <0.01), and hsCRP was associated with ADM (OR 7.26, 95% CI5 · 701-9 · 158, P <0.01). Conclusions Serum ADM levels are positively correlated with the severity of cardiac and renal dysfunction in hypertensive patients and may be used as one of the biomarkers for predicting the severity of EH.