高血压病患者主动脉脉压与肾小球滤过率的相关研究

The relationship between aortic pulse pressure and estimated glomerular filtration rate in hypertensive patients

目的探讨原发性高血压患者主动脉脉压与肾小球滤过率(GFR)的相关性。方法初发未经治疗的高血压病患者300例,在冠脉造影前应用造影导管和压力传感系统直接测量主动脉根部的收缩压和舒张压并计算主动脉脉压,收集患者的临床和实验室检查资料。公式计算患者的估算GFR(eGFR),按照数值分布的三分位点将患者分为3组。结果随着分组eGFR的降低,患者的年龄、高血压病史、A/E比值和主动脉脉压、血清尿酸、肌酐、左室心肌质量指数等均呈明显增高趋势(P<0.05,P<0.01)。多元线性相关和回归分析显示,eGFR与患者年龄、高血压病史、主动脉脉压、左室心肌质量指数、A/E比值、空腹血糖、血清尿酸、总胆固醇和低密度脂蛋白胆固醇呈显著负相关(r=-0.496、-0.236、-0.219、-0.218、-0.184、-0.163、-0.207、-0.177、-0.153,P<0.05,P<0.01),而与体表面积和主动脉舒张压呈显著正相关(r=0.256,0.133,P<0.05,P<0.01)。结论高血压病患者主动脉脉压与eGFR呈显著负相关,是eGFR的独立影响因素。

Objective To explore the relationship between aortic pulse pressure（PP） and estimated glomerular illtration rate（eGFR） in patients with essential hypertension. Melhods A total of 300 untreated primary hypertensive patients were consecutively recruited for first diagnostic coronary angiogram. The following data were collected： invasive intra-aortic systolic and diastolic blood pressure, aortic PP, clinical materials and laboratory characteristics. The eGFR was calculated with formula, and divided the patients inlo 3 groups according to value distribution. Results With the decline of eGFR in different group,the patients＇ age, history of hypertension, ME ratio,aortic PP, blood uric acid, creatinine, and left ventricular mass index were increased progressively（ P 〈 0.05 or P 〈 0.01）. Multivariable linear correlation and regression displayed that the eGFR was significantly negatively correlated with age, history of hypertension, aortic PP, left ventricular mass index, A/E ratio, fasting blood glucose, serum uric acid, total cholesterol and low density lipoprotein cholesterol （ r = - 0. 496, - 0.236, - 0.219, - 0.218, - 0.184, - 0. 163, - 0.207, - 0.177, - 0. 153, P 〈 0.05 or P 〈 0.01,respectively）, while the eGFR was positively correlated with body surface area and aortic diastolic pressure （ r = 0.256,0.133, P 〈 0.05 or P 〈 0.01, respectively）. Conclusion It provided that aortic PP was significantly negatively correlated with eGFR in hypertensive patients, also it was an independent factor to affect eGFR.