低钾血症对原发性高血压患者左心室结构及功能的影响

Effect of hypokalemia on left ventricular structure and function in patients with essential hypertension

目的 分析原发性高血压伴低钾血症(HoK+EH)患者左心室结构及功能的改变,为临床诊断和治疗高血压合并低钾血症引起的早期心脏损害提供依据。方法 选取2015年1月-2021年6月在兰州大学第二医院心血管内科住院治疗的原发性高血压患者413例,经倾向性得分匹配(PSM) 1∶1配对后,原发性高血压血钾正常(EH)组和HoK+EH组各108例,获得动态血压、心脏超声参数及生化指标后统计分析。结果 与EH组比较,HoK+EH组收缩压、脉压差、平均动脉压显著升高;血清钠离子、钠钾比值较EH组明显升高(P<0.05);左心房内径、室间隔厚度、左室后壁厚度、左室质量、左室质量指数显著升高(P<0.05);左心室质量指数与24 h平均收缩压、24 h平均舒张压、24 h收缩压负荷率、24 h舒张压负荷率等均呈正相关关系,与钾离子水平呈负相关关系。结论 原发性高血压合并低钾血症时有更明显的心室结构改变;血钾离子浓度及钠钾比值是HoK+EH患者左心室质量指数的独立危险因素。

Objective By analyzing the changes of the left ventricular structure and function in essential hypertension patients with hypokalemia, to provide evidence for clinical diagnosis and treatment of early heart damage caused by hypertension and hypokalemia. Methods A total of 413 hypertensive patients who were hospitalized in the Department of Cardiovascular Medicine, the Second Hospital of Lanzhou University, from January 2015 to June 2021 were selected. After 1:1 matching via propensity score matching(PSM), there were108 cases in both the essential hypertension group(EH) and the essential hypertension group with hypokalemia(HoK+EH). Statistical analysis was performed after collecting ambulatory blood pressure, echocardiography and biochemical indicators. Results Compared with the EH group, the systolic blood pressure, pulse pressure difference, mean arterial pressure in the HoK+EH group were significantly increased. The sodium chloride and the ratio of ions to sodium and potassium in the HoK+EH group were higher than that in the EH group. The left atrial diameter, interventricular septum thickness, left ventricular posterior wall thickness, left ventricular mass and left ventricular mass index in the HoK+EH group were significantly increased. The left ventricular mass index was positively correlated with 24 h average systolic blood pressure, 24 h average diastolic blood pressure, 24 h systolic blood pressure load rate, 24 h diastolic blood pressure load rate and other indicators, it was negatively correlated with the potassium ion level. Conclusion There were more obvious ventricular structural changes in essential hypertension patients with hypokalemia, and serum potassium ion concentration and sodium-to-potassium ratio were independent risk factors for the left ventricular mass index in essential hypertension patients with hypokalemia.