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目的研究难治性高血压(RH)患者肾功能损害与左心室肥厚(LVH)的关系,并探讨影响RH患者LVH的相关危险因素。方法回顾性分析2007-10-2010-07北京安贞医院高血压科住院患者215例(RH患者120例,非RH患者95例)的临床资料,通过“肾脏病膳食改良试验(MDRD)”公式评估肾功能;进行24h动态血压监测;行超声心动图检查,计算左心室质量指数(LVMI),LVMI>125(男性),>110g/m2(女性)作为LVH的诊断。结果与非RH患者比较,RH患者估算的肾小球滤过率(eGFR)[(72.3±22.1)比(83.1±19.5)mL/(min·1.73m2)]较低,eGFR<60mL/(min·1.73m2)检出率(29.2%比10.5%)、LVH检出率(32.5%比16.8%)、继发性高血压检出率(31.7%比5.3%)、左心室质量指数[(108.0±27.1)比(95.3±22.9)g/m2]较高(均P<0.01)。经Logistic回归分析,LVH的影响因素为eGFR<60mL/(min·1.73m2)[OR4.5(95%CI1.82～11.07),P=0.001]和合并高胆固醇血症[OR3.6(95%CI1.36～9.58),P=0.010]。结论 RH患者有明显的肾功能损害和LVH,不同肾功能水平对LVH影响不同,eGFR<60mL/(min·1.73m2)是LVH的危险因素。
Objective To study the relationship between renal dysfunction and left ventricular hypertrophy (LVH) in patients with refractory hypertension (RH) and to explore the related risk factors affecting LVH in patients with RH. Methods The clinical data of 215 inpatients with hypertension in Beijing Anzhen Hospital from October 2007 to July 2007 were retrospectively analyzed. The data of 120 patients with RH and 95 patients with non-RH were retrospectively analyzed. The results of the "Renal Disease Diet Improvement Test (MDRD) LVH> 125 (male),> 110 g / m2 (female) as a diagnosis of LVH. Echocardiography was performed to assess the renal function; 24-hour ambulatory blood pressure monitoring was performed; echocardiographic examination was performed to assess left ventricular mass index (LVMI) Results The glomerular filtration rate (eGFR) [(72.3 ± 22.1) vs (83.1 ± 19.5) mL / (min · 1.73m2)] was lower in patients with RH and the eGFR was less than 60 mL / (min · The rate of detection of secondary hypertension (31.7% vs 5.3%), the rate of left ventricular mass index [(108.0% ± 27.1) (95.3 ± 22.9) g / m2] (all P <0.01). Logistic regression analysis showed that the influencing factors of LVH were eGFR <60mL / (min · 1.73m2) [OR4.5 (95% CI 1.82 ~ 11.07, P = 0.001] and combined hypercholesterolemia [OR3.6 % CI 1.36 ~ 9.58), P = 0.010]. Conclusion The patients with RH have obvious renal dysfunction and LVH. Different levels of renal function have different effects on LVH. The eGFR <60mL / (min · 1.73m2) is a risk factor for LVH.