新疆某三甲医院汉、维吾尔、哈萨克族原发性高血压患者并发左心室肥厚的危险因素研究

The difference of risk factors on essential hypertension patients with left ventricular hypertrophy-ethnic difference among Han,Uyghur and Kazakh subjects in 3A grade hospital of Xinjiang

目的探讨新疆汉、维吾尔、哈萨克族原发性高血压患者并发左心室肥厚(LVH)的危险因素及可能存在的民族差异。方法选择2013年1月-2015年1月新疆医科大学第一附属医院高血压科收治的确诊原发性高血压患者1 579例,以族别分为汉、维吾尔、哈萨克族3组,再以有无LVH分为2个亚组,比较各组原发性高血压患者相关血液指标及动态血压参数的差异。结果(1)汉族LVH组血清胱抑素C(CysC)、同型半胱氨酸(Hey)水平高于非LVH组,而叶酸水平低于非LVH组,差异有统计学意义(P<0.05);维吾尔族LVH组CysC、纤维蛋白原(Fib)、Hcy水平高于非LVH组,差异有统计学意义(P<0.05);哈萨克族LVH组CysC、Fib、Hcy水平高于非LVH组,差异有统计学意义(P<0.05);维吾尔族LVH组叶酸、维生素D(VitD)水平低于汉族LVH组患者,差异有统计学意义(P<0.05);哈萨克族LVH组叶酸水平低于汉族LVH组患者,差异有统计学意义(P<0.05)。(2)汉族LVH组24 h收缩压(SBP)、24 h舒张压(DBP)、24 h脉压(PP)、白天收缩压(dSBP)、白天舒张压(dDBP)、白天脉压(dPP)、夜间收缩压(nSBP)、夜间舒张压(nDBP)、夜间脉压(nPP)高于汉族非LVH组,差异有统计学意义(P<0.05);维吾尔族LVH组24 h SBP、24 h PP、dSBP、dPP、nSBP、nDBP、nPP高于维吾尔族非LVH组,差异有统计学意义(P<0.05);哈萨克族LVH组24 h SBP、24 h PP、dPP、nSBP、nDBP、nPP高于哈萨克族非LVH组,差异有统计学意义(P<0.05)。维吾尔族LVH组24 h DBP、dDBP、nDBP低于汉族LVH组,差异有统计学意义(P<0.05)。(3)多因素分析结果表明维吾尔族、哈萨克族、24 h DBP、24 h PP、CysC、Fib是LVH的危险因素,而女性为保护性因素。结论新疆原发性高血压患者并发LVH存在民族及性别差异,LVH的发生与多种因素有关,应从多方而对这些因素进行干预。

Objective To study the risk factors and the differences in-patients who have essential hypertension with left ventricular hypertrophy from Han,Uygur and Kazakh ethnic groups in Xinjiang province.Methods Patients from the First Hospital of Xinjiang Medical University with essential hypertension during January 2013 to January 2015 were randomized into three groups into three groups according to ethnic differences,and then every group was divided into two subgroups.Compared the difference of blood parameters and ambulatory blood pressure parameters in different groups.Results In Han left ventricular hypertrophy group,serum cystatin C and homocysteine were higer than norrleft ventricular hypertrophy group,while folic acid was lower than norrleft ventricular hypertrophy group（P〈0.05）.In Uygur left ventricular hypertrophy group,serum cystatin C,fibrinogen and homocysteine were higher than norrleft ventricular hypertrophy group（P0.05）.In Kazakh left ventricular hypertrophy group,serum cystatin C,fibrinogen and homocysteine were higher than norrleft ventricular hypertrophy group（P〈0.05）.Comparaed with Han left ventricular hypertrophy group,Uygur had a lower level of folic acid and Vitamin D（P0.05）,Kazakh had a lower level of folic acid（P〈0.05）.In Han left ventricular hypertrophy group,24 hours systolic blood pressure（24 h SBP）,24 hours diastolic blood pressure（24 h DBP）,24 hours pulse Pressure（24 h PP）,day systolic blood pressure（dSBP）,day diastolic blood pressure（dDBP）,day pulse Pressure（dPP）,night systolic blood pressure（nSBP）,night diastolic blood pressure（dDBP）,night pulse Pressure（nPP）were higher than non—-left ventricular hypertrophy group（P0.05）.In Uygur left ventricular hypertrophy group,24 h SBP,24 h DBP,24 h PP,dSBP,dPP,nSBP,nDBP,nPP were higher than norrleft ventricular hypertrophy group（P0.05）.In Kazakh left ventricular hypertrophy group,24 h SBP,24 h PP,dPP,nSBP,nDBP,nPP were higher than norrleft ventricular hypertrophy group（P〈0.05）.Comparaed with Han left ventricular hypertrophy group,Uygur had the lower 24 h DBP,dDBP,dDBP level.Logistic regression showed that 24-hour systolic blood pressure,24-hours pulse pressure,serum cystatin C and fibrinogenof Uygurand Kazakh were the significantly independent determinants for left ventricular hypertrophy,while the females seemed a protective factor.Conclusion The prevalence of left ventricular hypertrophy is different among ethnics and different between males and females.These results implied that a comprehensive intervention should be taken in the prevention of left ventricular hypertrophy.