原发性高血压伴蛋白尿患者窦性心率震荡的观察及安体舒通对其干预产生的效应

The changes of heart rate turbulence in hypertensive patients with proteinuria and spironolactone therapy effect

目的观察原发性高血压伴蛋白尿患者的窦性心率震荡变化及安体舒通干预作用。方法原发性高血压患者75例，根据24h尿蛋白值分为〈150mg、150～299mg及≥300mg组。根据是否服用安体舒通。各组又分为基础治疗者和安体舒通治疗者，均行24h动态心电图监测，计算治疗前及治疗12周后各组的震荡初始（TO）和震荡斜率（TS）。结果≥300mg组T0、TS[（078±0．31）％、（7．55±131）ms]与〈150mg组[（025±0．31）％、（18．12±234）ms]、150～299mg组[（0.54±0．43）％、（1112±125）ms】比较，差异均有显著统计学意义（均P〈0．01）。150～299mg组、≥300mg组治疗后TO、TS与治疗前比较，差异均有统计学意义（均P〈0.01），且同组治疗后安体舒通治疗者与基础治疗者比较差异均有统计学意义（均P〈0．01）。〈150mg组治疗后TS较治疗前增大，差异均有统计学意义（均P〈0.01）。结论原发性高血压患者存在自主神经功能不全，尿蛋白阳性者损害更加明显，安体舒通可改善高血压伴蛋白尿患者的HRT现象。

Objective To investigate the changes of heart rate turbulence （HRT） in hypertensive patients with proteinuria （ UP）and spironolactone therapy effect. Methods 75 patients with hypertension were divided into 3 groups： 〈150mg group,150-299mg group, ≥ 300mg group according to the 24hour proteinria. They were further divided into subgroups with or without spironolactone therapy. Turbulence onset （TO） and turbulence slope （TS）were calculated based on 24h dynamic ECG recorded before and after 12 weeks of treatment. Results TO decreased and TS increased from ≥ 300mg group [（0.78 ±0.31 ）%, （7.55 ±1.31 ）ms] to 150-299m group [（0.54 ±0.43）%, （ 11.12 ± 1.25）ms] to 〈 150mg group[（ 0.25 ±0.31 ）%, （ 18.12 ± 2.34 ）ms],there was significantly different among each group （all P〈0.01 ）.TO and TS changed significantly after treatment and there was a significant difference of these changes between subgroups with and without spironolactone treatment in≥300mg and 150-299mg groups （all P〈0.01 ）. TS increased significantly after treatment in 〈 150mg group. Conclusion Autonomic nervous dysfunction may exist in hypertensive patients, especially those with proteinuria. Spironolactone may improve HRT in patients with hypertension and proteinuria.