新疆汉、维吾尔、哈萨克族原发性高血压患者发生左心室重构及相关影响因素的差异性

The influential factors of left ventricular remodeling in essential hypertension patients-ethnic difference between Han,Uygur and Kazakh subjects in Xinjiang

目的了解新疆汉族、维吾尔族、哈萨克族原发性高血压患者发生左心室重构（LR）的相关影响因素及可能存在的民族差异。方法连续收集2013年1月至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,根据民族分为汉、维吾尔、哈萨克族3组,再以有无LR分为2个亚组,比较各组原发性高血压患者动态血压参数、LR构型的差异,分析原发性高血压患者发生LR的危险因素。结果共收集原发性高血压患者1481例,其中368例发生LR（发生率为24.85%）,男性218例（发生率为27.05%）,女性150例（发生率为22.22%）,男性患者LR发生率高于女性患者（χ^2=4.580,P〈0.05）。汉族、维吾尔族、哈萨克族原发性高血压患者LR发生率分别为18.55%、35.07%和27.59%,各民族间LR发生率的差异有统计学意义（χ^2=41.636,P〈0.01）。原发性高血压患者LR中以向心性重构（CR）最常见（17.76%）,其次为向心性肥厚（CH）（5.00%）,而离心性肥厚（EH）的发生率最低（2.09%）,差异有统计学意义（χ^2=46.787,P〈0.01）。Logistic回归分析表明,不同民族原发性高血压患者发生LR的风险不同,与汉族人群相比较,维吾尔族原发性高血压患者发生LR的风险增加了1.192倍（OR2.192,95%CI1.440～3.336）,哈萨克族原发性高血压患者发生LR的风险增加了0.660倍（OR1.660,95%CI1.005～2.741）。不同民族发生LR的危险因素不同,汉族为24h平均收缩压（24hSBP）及颈动脉斑块;维吾尔族为24hSBP及心律失常;而哈萨克族为白天平均舒张压（dDBP）。结论新疆原发性高血压患者发生LR存在民族及性别差异,不同民族LR的危险因素不同。

Objective To study the related influence factors and the ethnic differences for left ventricular remodeling（LR）in essential hypertension patients from Han,Uygur and Kazakh ethnic groups in Xinjiang province. Methods Patients with essential hypertension were enrolled from the hypertension department of First Affiliated Hospital of Xinjiang Medical University from January 2013 to January 2015. These patients were divided into three groups according to their ethnicity. Each group was then subdivided into two subgroups according to the presence of LR.The differences of ambulatory blood pressure parameters and left ventricular geometric pattern in different groups were compared and the related risk factors of LR for essential hypertension patients were analysed. Results A total of 1481 patients with essential hypertension were enrolled,368（24.85%）complicated with LR,including 218males（27.05%）and 150females（22.22%）. Males had a higher incidence rate of LR than the females（χ^2=4.580,P〈0.05）. The prevalence of LR in Han,Uygur and Kazakh groups were 18.55%,35.07% and 27.59%respectively,which showed significant difference（χ^2=41.636,P〈0.01）. Concentric remodeling was seen the most frequently（17.76%）,followed by concentric hypertrophy（5.00%）,while eccentric hypertrophy was the rarest（2.09%）in the LR of essential hypertension patients（χ^2=46.787,P〈0.01）. Logistic regression showed that the risk factors of LR were different in three ethnics：compared to Han population,it was 1.192 times higher in Uygur people（OR2.192,95% CI1.440-3.336）,and 0.660 times higher in Kazakh people（OR1.660,95% CI1.005-2.741）. Logistic regression also showed that different ethnics had different risk factors. 24 hours mean systolic blood pressure and carotid plaque were risk factors for Han ethnic group,arrhythmia and 24 hours mean systolic blood pressure were risk factors for Uygur and day mean diastolic blood pressure was a risk factor for Kazakh.Conclusion There is ethnic and gender difference in the prevalence of LR of essential hypertension patients in Xinjiang province. Different ethnic groups have different risk factors.