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目的:探讨原发性高血压患者高密度脂蛋白胆固醇(HDL-C)水平与靶器官损伤之间的关联性。方法:选取406例初诊为Ⅰ级原发性高血压患者,根据患者入院HDL-C水平分为HDL-C正常组和HDL-C减低组,每12个月对患者随诊1次,随诊时间共3年。主要观察指标包括:心率、收缩压、舒张压、颈动脉内膜中膜厚度(IMT)、心绞痛、心肌梗死、心律失常、心功能不全、脑血管意外、无症状心肌缺血、尿微量白蛋白、肾小球滤过率(GFR)和肾血流量。结果:与HDL-C正常组相比,随访结束时HDL-C减低组患者尿微量白蛋白发生率显著增高(10.00%︰4.20%,P<0.05),随访至12、24和36个月时GFR、肾血流量显著降低(P<0.05),随访至36个月时,IMT显著增加(P<0.05),随访结束时无症状心肌缺血发生率亦显著增高(35.00%︰25.17%,P<0.05)。HDL-C水平与肾血流量、GFR呈正相关(r=0.261、0.309,P<0.05),与IMT呈负相关(r=-0.146,P<0.05)。结论:HDL-C降低与Ⅰ级原发性高血压患者肾功能、心肌缺血和IMT明显相关。
Objective: To investigate the association between high-density lipoprotein cholesterol (HDL-C) levels and target organ damage in patients with essential hypertension. Methods: A total of 406 patients with newly diagnosed primary hypertension were divided into HDL-C normal group and HDL-C reduction group according to HDL-C admission level. Patients were followed up every 12 months and followed up A total of 3 years. MAIN OUTCOME MEASURES: Heart rate, systolic blood pressure, diastolic blood pressure, carotid IMT, angina pectoris, myocardial infarction, arrhythmia, cardiac insufficiency, cerebrovascular accident, asymptomatic myocardial ischemia, urinary microalbumin , Glomerular filtration rate (GFR) and renal blood flow. Results: Compared with HDL-C normal group, the incidence of urinary albumin in HDL-C decreased group was significantly higher than that in HDL-C normal group (10.00%: 4.20%, P <0.05), followed up to 12, 24 and 36 months (P <0.05). IMT was significantly increased at follow-up to 36 months (P <0.05). The incidence of asymptomatic myocardial ischemia was also significantly increased at the end of follow-up (35.00%: 25.17%, P <0.05). HDL-C levels were positively correlated with renal blood flow and GFR (r = 0.261,0.309, P <0.05), but negatively correlated with IMT (r = -0.146, P <0.05). Conclusion: The decrease of HDL-C is associated with renal function, myocardial ischemia and IMT in patients with grade I essential hypertension.