45岁及以上高血压患者醛固酮与颈动脉粥样硬化关系研究

Association between plasma aldosterone concentration and carotid atherosclerosis in hypertensive patients aged 45 years old and over

目的探讨45岁以上高血压患者血清醛固酮浓度(PAC)与颈动脉粥样硬化(CA)的关系。方法连续入选新疆维吾尔自治区人民医院高血压中心住院的45岁以上高血压患者126例,根据颈动脉超声检查结果分为CA组(74例)和无CA组(52例)。测定患者常规及分别立、坐、卧2 h后的PAC。用简单相关分析两组双侧颈动脉内膜中层厚度(IMT)与常规及三体位的PAC相关性。采用Logistic回归分析CA与常规及三体位的PAC关系。结果 CA组的常规PAC(rs=0.361,P=0.003)与双侧颈内动脉IMT均值呈正相关;Logistic回归分析显示,校正了年龄、性别、高血压病程、吸烟、饮酒、血压升高程度、糖尿病及脂质代谢紊乱等相关混杂因素后,坐位PAC(OR=1.126,95%CI1.005～1.261,P=0.04)、常规PAC(OR=1.147,95%CI 1.008～1.304,P=0.037)与CA独立相关。结论坐位及常规PAC可能是CA形成的独立危险因素。

Objective To investigate the association of carotid atherosclerosis （CA） with plasma aldosterone concentration （PAC） in hypertensive patients aged 45 years old and over. Methods Carotid intima-media thickness （IMT） and carotid plaque were measured with B-mode ultrasonography and PACs in different position were tested in126 hypertensive patients over 45 years old. Patients were categorized into 2 groups according to the results of B-mode ultrasonography （74 with carotid plaque, 52 without）. Binary Logistic regression and Spearman rank correlations were used to evaluate the association of CA with PAC in upright posture, sitting posture and supine posture. Results There was exact linear relationship between routine PAC and the mean of bilateral internal carotid IMT （ r = 0. 361, P = 0. 003 ）. According to the Logistic regression analysis after adjusting confounders, PAC in sitting position （ OR = 1. 126, 95% CI 1.005-1.261, P =0.04） and routine PAC （OR = 1.147, 95% CI 1.008-1.304, P =0.037） were independently associated with CA. Conclusions PAC in sitting position and routine PAC are independent risk of CA in hypertensive patients over 45 years old.