原发性高血压患者醛固酮肾素比值与心电图指标及夜间血压的相关性分析

Correlation analysis of aldosterone renin ratio with electrocardiogram indicators and nocturnal blood pressure in essential hypertension patients

目的探究原发性高血压患者醛固酮肾素比值(ARR)与心电图指标及夜间血压的相关性。方法回顾性分析2018年6月至2020年1月于延安大学咸阳医院就诊的100例原发性高血压患者临床资料,以其ARR中位数为分界线,将其分为高ARR组(n=51,≥ARR中位数者)和低ARR组(n=49,<ARR中位数者)。比较两组患者心电图指标(QT间期、QTc间期、RR间期)及夜间血压(夜间收缩压、夜间舒张压),采用Pearson相关性分析法分析原发性高血压患者ARR与QT间期、QTc间期、RR间期、夜间收缩压、夜间舒张压的相关性,采用Logistic多元回归分析法分析原发性高血压患者ARR独立风险因素,根据入组患者随访6个月期间是否发生急性冠脉综合征(ACS)将其分为ACS组和非ACS组,采用受试者工作特征曲线(ROC曲线)评估QT间期、QTc间期、RR间期、夜间收缩压、夜间舒张压对原发性高血压患者预后的预测效能。结果高ARR组QT间期、QTc间期、夜间舒张压、夜间收缩压均显著高于低ARR组,差异有统计学意义(P<0.05);Pearson相关分析结果表明,原发性高血压患者ARR与QT间期、QTc间期、夜间收缩压、夜间舒张压呈正相关(P<0.05),与RR间期无明显相关性(P>0.05);经Logistic多元回归分析法分析得出,原发性高血压患者ARR水平可受到QT间期、QTc间期、夜间收缩压、夜间舒张压的独立影响(P<0.05);经ROC曲线评估得出,QT间期、QTc间期、RR间期、夜间收缩压、夜间舒张压预测原发性高血压患者预后的曲线下面积分别为0.955、0.901、0.531、0.876、0.841;截断值分别为432.92 ms、410.27 ms、999.61 ms、136.59 mm Hg、75.39 mm Hg,QT间期、QTc间期、夜间收缩压、夜间舒张压ROC曲线下面积与参考线比较差异有统计学意义(P<0.05),RR间期ROC曲线下面积与参考线比较差异无统计学意义(P>0.05)。结论原发性高血压患者ARR与心电图指标、夜间血压密切相关,其中QT间期、QTc间期、夜间舒张压、夜间收缩压均为原发性高血压患者ARR独立风险因素,且QT间期联合QTc间期及夜间血压可为临床预测预后提供一定参考。

Objective To explore the correlation between aldosterone renin ratio(ARR)and electrocardiogram indicators and nocturnal elevated blood pressure in essential hypertension patients.Methods The clinical data of 100 patients with essential hypertension treated in Xianyang Hospital,Yan'an University from June 2018 to January 2020 were retrospectively analyzed.They were divided into high ARR group(n=51,more than or equal to median ARR)and low ARR group(n=49,less than median ARR)according to their median ARR.Electrocardiogram indicators(QT interval,QTc interval,RR interval)and nighttime blood pressure(nocturnal systolic blood pressure,nocturnal diastolic blood pressure)were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between ARR and QT interval,QTc interval,RR interval,nocturnal systolic blood pressure,nocturnal diastolic blood pressure in essential hypertension patients.Logistic multiple regression analysis was used to analyze the independent risk factors of ARR in essential hypertension patients.According to whether acute coronary syndrome(ACS)occurred during 6-month follow-up,the enrolled patients were divided into ACS group and non-ACS group.Receiver operating characteristic curve(ROC curve)was used to evaluate the predictive efficacy of QT interval,QTc interval,RR interval,nocturnal systolic blood pressure and nocturnal diastolic blood pressure for the prognosis of essential hypertension patients.Results QT interval,QTc interval,nocturnal diastolic blood pressure and nocturnal systolic blood pressure in high ARR group were significantly higher than those in low ARR group,the differ-ences were statistically significant(P<0.05).Pearson correlation analysis showed that ARR was positively correlated with QT interval,QTc interval,nocturnal systolic pressure and nocturnal diastolic pressure(P<0.05),but had no significant correlation with RR interval(P>0.05).The Logistic multiple regression analy-sis showed that the original the ARR level of patients with hypertension can be independently affected by QT interval,QTc interval,night systolic blood pressure,and night diastolic blood pressure(P<0.05).According to ROC curve evaluation,the area under ROC curve of ARR,QTc interval,RR interval,nocturnal systolic blood pressure and nocturnal diastolic blood pressure in predicting prognosis of essential hypertension patients were 0.955,0.901,0.531,0.876 and 0.841,respectively.The cut-off values were 432.92 ms,410.27 ms,999.61 ms,136.59 mm Hg,75.39 mm Hg,respectively,the area under the ROC curve of QT interval,QTc in-terval,night systolic blood pressure,and night diastolic blood pressure was significantly different from the ref-erence line(P<0.05),and the area under the ROC curve of the RR interval was compared with the reference line The difference was not statistically significant(P>0.05).Conclusion ARR in patients with essential hy-pertension is closely related to electrocardiogram indicators and nocturnal blood pressure.QT interval,QTc in-terval,nocturnal diastolic blood pressure and nocturnal systolic blood pressure are independent risk factors for ARR in patients with essential hypertension,and QT interval combined with QTc interval and nocturnal blood pressure can provide certain reference for clinical prognosis prediction.