不同类型高血压人群与健康人群血脂和肾功能差异及血压影响因素分析

Difference in blood fat and renal function and factors influencing blood pressure in population with different types of hypertension and health population

目的研究不同类型高血压人群血脂和肾功能差异及血压影响因素。方法选择2012年7月~2015年7月于中国中医科学院广安门医院南区的体检者1717例，详细记录病史、测量身高、体重、体质指数（BMI)、血压等，检测血常规、血液流变学等指标，应用BeckmanDXI-800全自动化学发光分析仪测定生化指标，包括三酰甘油（TG)、胆固醇（CHO)、高密度脂蛋白胆固醇（HDL-C)、低密度脂蛋白胆固醇（LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、尿素氮（Urea)、肌酐（Cr)、尿酸（UA)。并根据健康状态和血压值分为4组，健康组（1158例），双期高血压组（254例），单纯舒张期高血压组（89例），单纯收缩期高血压组（216例），将4组间的各项检测指标进行比较研究，并运用多元逐步回归分析得出血压的影响因素。结果健康组、双期高血压组、单纯舒张期高血压组、单纯收缩期高血压组受试者平均年龄分别为（36.71±10.23)岁、（46.35±10.72)岁、（44.85±9.34)岁、（46.57±7.68)岁。经单因素方差分析检验，双期高血压组、单纯舒张期高血压组的年龄、体重、BMI、收缩压、舒张压明显高于健康组（P<0.05)。而各组性别、身高、心率比较差异无统计学意义(P>0.05)。双期高血压组、单纯舒张期高血压组、单纯收缩期高血压组3组TG、CHO、Urea、Cr、UA均明显高于健康组（P<0.05);双期高血压组、单纯收缩期高血压组LDL-C明显高于健康组（P<0.05);双期高血压组、单纯舒张期高血压组LDL-C均明显低于单纯收缩期高血压组（P<0.05);双期高血压组UA明显高于单纯舒张期高血压组（P<0.05)。相关性分析：TG、CHO、LDL-C、Urea、Cr、UA均与收缩压呈显著正相关性，TG、CHO、Cr、UA均与舒张压呈显著正相关性。多元逐步回归分析显示：年龄、体重、BMI、TG、CHO、Cr、UA是收缩压的危险因素，而年龄、BMI、TG、CHO、LDL-C、Cr、UA是舒张压的危险因素。结论在临床治疗高血压过程中，除单纯的降压药治疗外，还应同时给予调节脂质代谢和肾脏代谢的药物，更重要的是需要区别对待不同类型的高血压患者，个体化治疗，才能获得更好的疗效，进而达到真正延缓高血压的发展进程。

Objective To study the Difference in blood fat and renal function and factors influencing bloodpressure in population with different types of hypertension.Methods The physical examinees(n=1717)werechosen from the south district of G uang’anmen Hospital of China Academy of Chinese M edical Sciences fromJul.2012to Jul.2015.The indexes of m edical history,height,weight,body mass index(BMI),blood pressure,blood routine and hemorrheology were recorded and detected.The biochem ical indexes were detected by usingBeckm an D X I-800autom atic chem ilum inescence analyzer,including triglyceride(TG),cholesterol(CHO),high-density lipoprotein-cholesterol(H D L-C),low-density lipoprotein-cholesterol(LDL-C),apolipoproteinA1(ApoA1),apolipoprotein B(ApoB),blood urea nitrogen(Urea),creatinine(Cr)and uric acid(UA).All caseswere divided,according to health status and blood pressure values,into health group(n=1158),systolic-diastolichypertension group(SDH group,n=254),isolated diastolic hypertension group(IDH group,n=89)and isolatedsystolic hypertension group(ISH group,n=216).All detected indexes were compared and studied among4groups,and the factors influencing blood pressure were observed by using multiple stepwise regression analysis.ResultsThe average age was(36.71±10.23)in health group,(46.35±10.72)in SDH group,(44.85±9.34)in IDH groupand(46.57±7.68)in ISH group.The results of one-way analysis of variance showed that age,weight,BMI,systolicblood pressure(SBP)and diastolic blood pressure(DBP)were significantly higher in SDH group and IDH group than those in health group(P<0.05).The difference in sex,height and heart rate had no statistical significanceamong all groups(P>0.05).The levels of TG,CHO,Urea,Cr and UA were significantly higher in SDH group,IDH group and ISH group than those in health group(P<0.05).The level of LDL-C was significantly higher inSDH group and ISH group than that in health group(P<0.05).The level of LDL-C was significantly lower in SDHgroup and IDH group than that in ISH group(P<0.05).The level of UA was significantly higher in SDH groupthan that in IDH group(P<0.05).The results of correlation analysis showed that TG,CHO,LDL-C,Urea,Cr andUA were positively correlated to SBP,and TG,CHO,Cr and UA were positively correlated to DBP.The results ofmultiple stepwise regression analysis showed that age,weight,BMI,TG,CHO,Cr and UA were risk factors of SBP,and age,BMI,TG,CHO,LDL-C,Cr and UA were risk factors of DBP.Conclusion In the therapeutic courseof hypertension,in addition to simple antihypertensive medication,the drugs for regulating lipid metabolism andrenal metabolism should be adm inistrated at the same time.It is more important to distinguish different types ofhypertensive patients and to give them individualized therapy for achieving better curative effect and really delayingthe development process of hypertension.