原发性高血压患者轻中度肾功能受损与左心室舒张功能障碍相关

Association between mild-to-moderate renal dysfunction and left ventricular diastolic dysfunction in patients with essential hypertension

目的评估原发性高血压患者早期肾功能受损对左心室舒张功能的影响。方法选取2011年1月至2013年1月上海交通大学医学院附属瑞金医院高血压科住院的原发性高血压患者187例,年龄（54.9±13.9）岁,行99锝m-二乙三胺五乙酸（99 Tcm-DTPA）肾动态显像测定肾小球滤过率（GFR）,行心脏组织多普勒超声计算二尖瓣舒张早期血流峰速/二尖瓣环舒张早期运动速度（E/Ea）评估左心室舒张功能。按GFR水平将高血压患者分为肾功能正常组（GFR≥90mL/min,n=59）,轻度肾功能受损组（GFR 60-〈90mL/min,n=95）和中度肾功能受损组（GFR 30-〈60mL/min,n=33）,比较3组间左心室舒张功能的差异,采用多元回归分析肾功能损伤程度对左心室舒张功能障碍的影响。结果中度肾功能受损患者E/Ea大于轻度、正常肾功能受损患者（14.9±3.6比12.4±3.5,11.4±2.6,均P〈0.01）。校正年龄、性别、体质量指数（BMI）、高血压病程、血压、血糖、血脂等传统危险因素后,多元线性回归分析显示,GFR减小是E/Ea增大的独立危险因素（β=-0.26,P〈0.01）,多元Logistic回归分析显示,中度肾功能受损合并左心室舒张功能障碍的风险是肾功能正常组的8.84倍（OR8.84,95%CI 1.93-40.48）。结论原发性高血压患者中轻中度肾功能受损与左心室舒张功能障碍密切相关。

Objective To evaluate the association between mild-to-moderate renal dysfunction and left ventricular diastolic dysfunction in patients with essential hypertension. Methods A total of 187 inpatients with essential hypertension at the average age of 154.9 ±13.9） in Department of Hypertension Rui Jin Hospital Shanghai Jiao Tong University School of Medicine were enrolled from January, 2011 to January, 2013. The renal function was estimated by glomerular filtration rate （GFR） with 99Tcm-DTPA. Left ventricular diastolic function was estimated by the ratio of early diastolic velocities （E） from transmitral inflow tO early diastolic velocities （Ea） of tissue Doppler at mitral annulus （septal corner） ; E/Ea〉15 was defined as left ventricular diastolic dysfunction. The subjects were classi- fied into 3 groups： normal renal function with GFR≥90 mL/min （n= 59）, mild renal dysfunction with GFR 60-〈90 mL/min（n=95） and moderate renal dysfunction with GFR 30-〈60 mL/min（n=33）. Left ventricular diastolic function was compared among the three groups, and multivariate regression analysis was used to estimate the relation between renal function and left ventricular diastolic function. Results E/Ea was lower in GFR 60- 〈90 mL/mingroup（12.4±3.5） than in GFR 30-〈60 mL/min group（14.9±3.6）, but higher than in GFR ≥90 mL/min group（11.4±2.6） （P〈0.01）. After adjusted for potential confounding factors （age, gender, body mass index, course of hypertension, blood pressure, blood glucose,blood lipid）, GFR was significantly negative correlated with E/Ea in multivariate linear regression analysis （β=-0.26, P〈0.01）. Multivariate logistic regression analysis showed that participants in moderate renal dysfunction group were more likely to have left ventricular diastolic dysfunction compared with those in normal renal function group with an adjusted odds ratio of 8.84 （95% CI 1.93-40.48）. Conclusions Mild-to-moderate renal dysfunction is closely associated with left ventricular diastolic dysfunction in essential hypertension.