高血压病患者粥样硬化性肾动脉狭窄与左心室肥厚的关系

The relationship between atherosclerotic renal artery stenosis and left ventricular hypertrophy in patients with primary hypertension

目的探讨原发性高血压患者粥样硬化性肾动脉狭窄(RAS)与左心室肥厚(LVH)的关系。方法回顾性分析我院因怀疑冠状动脉粥样硬化性心脏病(冠心病)行冠状动脉和肾动脉造影的原发性高血压患者476例,根据肾动脉造影有无RAS将患者分为RAS组和对照组。分别以左心室质量指数(LVMI)标准和左心室壁厚度(IVSd)标准比较2组LVH的发生率,并比较2组LVMI和室间隔厚度(IVSd)的差异。结果106例(22.3%)患者存在单侧或双侧RAS。RAS组的LVMI和IVSd均显著高于对照组(P<0.05),且无论以LVMI还是IVSd作为LVH标准,RAS组LVH发生率均明显高于对照组(P<0.05)。多因素Logistic回归分析表明,RAS和高血压发病时间(年)、脉压水平以及是否服用血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)都是LVH的独立预测因子(P<0.05)。结论高血压病患者伴发RAS能够进一步促进LVH的发生。

Objective To investigate the relationship between atheroselerotie renal artery stenosis and left ventricular hypertrophy （LVH） in patients with primary hypertension, Methods The data in 476 patients with primary hypertension undergoing coronary and renal angiography were retrospectively analyzed. The patients were divided into two groups according to whether they had atherosclerotic renal artery stenosis （RAS） or not. The incidence of LVH was identified either by left ventricular mass index （LVMI） criteria or by ventricular wall thickness （IVSd） criteria, and the differences between LVMI and intraventricular septum （IVSd） thickness were compared. Results Among these patients, 106 patients （22.3%） had unilateral or bilateral RAS. Both the LVMI and IVSd in RAS group were significantly higher than those in control group （P 〈0. 05 ） . The incidence of LVH in RAS group was significantly higher than that in control group both by LVMI criteria and by IVSd criteria （P 〈 0. 05 ） . Multivariate Logistic analysis showed that the presence of RAS, time of hypertension onset（ year）, pulse pressure at admission and treatment of ACE-I or ARB were all the independent predictive factors for LVH （P 〈 0. 05） . Conclusion The patients with primary hypertension complicated by ARAS are more apt to develop LVH.