摘要
目的比较原发性醛固酮增多症（PA）和原发性高血压（EH）患者内皮损伤标志物的水平，探讨其对早期靶器官损害的预测价值。方法选择因“高血压查因”住院确诊的资料完整的36例PA患者与同期确诊的年龄、性别、高血压水平及其病程等相匹配的39例EH患者为研究对象，观察两组患者内皮损伤标志物包括血浆血管性假血友病因子（vWF）、可溶性细胞间黏附分子-1（slCAM-1）和氧化型低密度脂蛋白（OX—LDL），以左心室质量指数（LVMI）、24h尿蛋白及尿白蛋白排泄率（UAER）评估早期靶器官损害。结果（1）PA组内皮损伤标志物血浆vwF、slCAM-1和OX．LDL水平均较EH组高（均P〈0．01），且具有更高的24h尿蛋白、UAER（均P〈0．01）和LVMI（P〈0．05）。（2）相关性分析显示血浆醛固酮水平（PAC）与vwF、slCAM-1和OX—-LDL水平均呈正相关（均P〈0．05）。LVMI与PAC、OX-LDL、vwF和人院收缩压均呈正相关（均P〈0．05），与入院时血K＋呈负相关（P〈0．05）；UAER与PAC、经自然对数转换的血浆醛固酮／肾素比值（1nARR）、vWF和sICAM-1均呈正相关（均P〈0．05），与入院时血K＋呈负相关（P〈0．05）。（3）多元线性回归分析在调整了混杂因素后提示血浆vWF、sICAM-1和PAC对微量自蛋白尿有独立的预测价值；vWF、OX—LDL、PAC和人院收缩压对左心室肥厚有独立的预测价值。结论PA患者较EH患者具有更明显的内皮功能障碍及早期靶器官损害，PAC和多种内皮损伤标志物是早期靶器官损害独立的预测因子。
Objective To compaze plasma concentrations of biomarkers of endothelial dysfunction between patients with primary aldosteronism （PA） and essential hypertension （EH）, and to determine whether elevated levels of these biomarkers could predict development of early organ damage. Methods Thirty-six PA patients and 39 EH patients matched for age, sex, blood pressure and duration of hypertension were included in this study. Plasma levels of biomarkers reflecting endothelial dysfunction （yon Willebrand factor, vWF; soluble intercellular adhesion molecule 1, sICAM-1; and oxidized low density lipoprotein, ox-LDL） were detected and compared between PA and EH patients. Left ventricular mass index （LVMI） determined by echocardiography, 24-hour urinary protein quantitative determination and urinary albumin excretion rate （UAER） were analyzed to evaluate early organ damage. Left ventricular hypertrophy was defined as LVMI 〉 125 g/m2 in men and 〉 120 g/m2 in women, and UAER between 20 μg/min and 200 μg/min was defined as microalbuminuria. Results vWF [（122.3 ±53.8）% vs. （113. 1 ±68.3）%], sICAM-I [（401.0±74.1） μg/Lvs. （300.9±87.0） μg/L-1, ox-LDL[ （13.6±10.0） U/Lvs.（8.1± 5.9） U/L 1, LVMI [ （ 124. 7 ± 33.6） g/m2 vs. （ 109. 1 ± 25.7 ） g/m2 ] , 24-hour urinary protein quantitation 24hUPQ, （0.17±0.10） gvs. （ 0.09 ±0.04 ） g] and UAER [（25.9±7.7 ） μg/min vs. （ 9.7± 5.9） μg/min] were significantly higher in PA group than in EH group （all P 〈 0. 05 ）, Elevated plasma vWF, sICAM-1 levels and plasma aldosterone concentration independently predicted microalbuminuria. Whereas, elevated plasma vWF and ox-LDL levels, plasma aldosterone concentration and systolic blood pressure independently predicted left ventricular hypertrophy. Conclusion Patients with PA have severer endothelial dysfunction reflected by multiple biomarkers and earlier organ damage than patients with EH, and plasma aldosterone concentration and multiple endothelial dysfunction biom
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2012年第8期640-644,共5页
Chinese Journal of Cardiology
基金
广东省科技计划项目（20078031508005,20088050100010）
关键词
醛固酮增多症
高血压
生物因子
白蛋白尿
Hyperaldosteronism
Hhypertension
Biological factors
Albuminuria
