原发性高血压患者血清B型利钠肽水平与亚临床靶器官损害密切相关

B-type natriuretic peptides and subclinical target organ damage in essential hypertensive patients

目的探讨原发性高血压(EH)患者血清B型利钠肽(BNP)水平与左室肥厚(LVH)、颈动脉壁增厚(IMT>0.9mm)、冠状动脉钙化(CS)及尿白蛋白/肌酐的关系。方法原发性高血压患者317例根据血清B型利钠肽(BNP)水平将所有患者分为3组:低BNP组(BNP<600ng/L)102例;中BNP组(BNP600～883.5ng/L)116例;高BNP组(BNP>883.5ng/L)99例。分别测量血压、左室重量指数(LVMI)、颈动脉内膜中层厚度(IMT)、冠状动脉钙化积分(CS)及尿白蛋白/肌酐,对比分析各组上述指标变化和两组间的差异。结果①EH患者在三个不同分层切点血清B型利钠肽水平上LVMI、IMT、CS及尿白蛋白/肌酐的差异比较显著;而且随着BNP水平增加,左心室质量指数(LVMI)[(91.09±18.71)比(102.8±23.12)比(123.9±26.47)g/m2]、颈动脉内膜中层厚度(IMT)[(0.84±0.28)比(0.95±0.32)比(1.16±0.37)mm]、冠状动脉钙化积分(CS)及尿白蛋白/肌酐均明显增加。②直线相关分析显示,LVMI、IMT、CS及尿白蛋白/肌酐与LgBNP均呈显著正相关(r分别为0.45、0.43、0.39及0.41,均P<0.01)。多元Logistic回归结果提示年龄、收缩压、BNP、空腹血糖、尿白蛋白/肌酐、低密度脂蛋白胆固醇(LDL-C)及BMI与原发性高血压患者亚临床靶器官损害密切相关。结论 EH患者血清B型利钠肽水平与亚临床靶器官损害密切相关。

Objective To investigate the relationship between B-type natriuretic peptides（BNP） and subclinical target organ damage in essential hypertensive（EH） patients.Methods A total of 317 EH patients were divided into 3 groups according to BNP levels,namely normal（BNP600 ng/L） group（n=102）,moderate（600-883.5 ng/L） group（n=116）,and elevated BNP（883.5 ng/L） group（n=99）.The blood pressure,left ventricularmass index（LVMI）,the intima media thickness（IMT） of the common carotid artery,the plaque size in the coronary artery（CS） and microalbuminuria levels were analyzed in these patients.Results The EH patients with moderate and elevated BNP showed significantly higher LVMI,IMT,CS and microalbuminuria levels than those with normal BNP level（LVMI：102.8？？3.12 and 123.9？？6.47 vs 91.09？？8.71 g/m2;IMT：0.95？？.32 and 1.16？？.37 vs 0.84？？.28 mm;microalbuminuria：31.36？？0.55 and 36.73？？2.07 vs 23.21？？8.68,P0.01）.After adjustment,BNP was positively correlated to LVMI,IMT,CS and microalbuminuria level（r=0.45,0.43,0.39 and 0.41,respectively,P0.01）.Multivariate logistic regression analysis showed that age,systolic blood pressure,BNP,FPG,and microalbuminuria,LDL-C,and BMI were all related to the occurrence of subclinical target organ damages.Conclusion BNP is positively correlated to subclinical target organs damages in EH patients.