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目的通过对顽固性高血压患者加用螺内酯治疗,分析影响螺内酯疗效的因素。方法选择2013年6月~2016年6月本院收治的使用螺内酯治疗顽固性高血压的患者222例,按照螺内酯疗效分为无效组102例及有效组120例。收集入组患者年龄、性别、BMI、吸烟情况、肾小球率过滤、低密度脂蛋白、同型半胱氨酸、尿白蛋白肌酐比、左心室肥厚、缺血性心脏病、糖尿病、脑卒中及抑郁焦虑状态基线资料。比较两组间基线指标并进行Logistic多因素分析。结果无效组与有效组相比,患者的年龄越大、血清同型半胱氨酸越高,左心室肥厚、糖尿病及抑郁焦虑状态人数也升高,差异有统计学意义(P<0.05)。两组患者在性别、BMI、吸烟、肾小球率过滤、低密度脂蛋白、尿白蛋白肌酐比、缺血性心脏病、脑卒中几个因素比较,差异无统计学意义(P>0.05)。多元Logistc分析结果表明年龄(OR=3.831,95%Cl 1.852~9.27)、糖尿病(OR=3.259,95%Cl 1.477~7.189)、左心室肥厚(OR=3.434,95%Cl 1.665~7.081)、高同型半胱氨酸(OR=11.067,95%Cl 5.217~23.475)、抑郁焦虑状态(OR=4.194,95%Cl1.712~10.275)是螺内酯治疗顽固性高血压的影响因素。结论高龄、糖尿病、左心室肥厚、高同型半胱氨酸、抑郁焦虑状态显著影响了螺内酯治疗顽固性高血压的疗效,这些状态单独或并存时,螺内酯治疗顽固性高血压无效的风险增高。
Objective To analyze the factors affecting the efficacy of spironolactone by adding spironolactone to patients with refractory hypertension. Methods Totally 222 patients treated with spironolactone in our hospital from June 2013 to June 2016 were divided into the ineffective group (n = 102) and the effective group (n = 120) according to the efficacy of spironolactone. Age, gender, BMI, smoking status, glomerular filtration rate, low density lipoprotein, homocysteine, urinary albumin creatinine ratio, left ventricular hypertrophy, ischemic heart disease, diabetes mellitus and stroke And depression and anxiety status baseline data. Baseline indicators were compared between the two groups and Logistic multivariate analysis was performed. Results invalid group compared with the effective group, the patient’s age, serum homocysteine, left ventricular hypertrophy, diabetes and depression and anxiety state number also increased, the difference was statistically significant (P <0.05). There was no significant difference between the two groups in gender, BMI, smoking, glomerular filtration rate, low density lipoprotein, urinary albumin creatinine, ischemic heart disease and stroke. There was no significant difference between the two groups (P> 0.05) . Multivariate Logistc analysis showed that age (OR = 3.831, 95% CI 1.852-9.27), diabetes (OR = 3.259,95% Cl 1.477-7.189), left ventricular hypertrophy (OR = 3.434, 95% Cl 1.665-7.081) Homocysteine (OR = 11.067, 95% CI 5.217 ~ 23.475), depression and anxiety (OR = 4.194, 95% Cl1.712-10.275) were the influencing factors of spironolactone treatment of refractory hypertension. CONCLUSIONS Elderly patients with diabetes mellitus, left ventricular hypertrophy, hyperhomocysteine, depression and anxiety significantly affect the efficacy of spironolactone in treating refractory hypertension. When these conditions are taken alone or in combination, the risk of spironolactone in treating refractory hypertension is increased.