盐敏感性高血压病患者静脉盐水负荷后血浆血管紧张素Ⅱ受抑状态与左室重量关系

The association between suppression of angiotensinⅡ after salt loading and left ventricular mass in salt-sensitive hypertensive patients

目的 探讨盐敏感性高血压病患者左室重量指数与静脉盐水负荷后血浆血管紧张素Ⅱ (AngⅡ )受抑与否的关系。方法 71例 1、2级高血压病患者进行静脉盐水负荷试验筛选盐敏感者 ,M型超声心动图测量并计算左心室重量指数 ,并测定 2 4h尿钠排泄量及静脉盐水负荷前、后血浆AngⅡ水平变化。结果 ( 1)高血压盐敏感者的左心室重量指数大于盐不敏感者 [( 114 8± 11 5 )g m2比 ( 10 0 8± 9 6 )g m2 ,P <0 0 1]。 ( 2 )静脉盐水负荷后血浆AngⅡ水平未受抑者左心室重指数量大于受抑者 [( 12 0± 9)g m2 比 ( 10 6± 5 )g m2 ,P <0 0 5 ]。前者的 2 4h平均舒张压、夜间收缩压和舒张压 ,以及 2 4h尿钠量亦均大于后者 ,P <0 0 5。 ( 3)左室重量指数与 2 4h尿钠排泄量呈正相关 (r=0 4 9,P <0 0 1)。结论 高血压盐敏感者左心室重量指数增加与盐负荷后血浆AngⅡ水平是否受抑有一定关系 ,提示肾素血管紧张素系统对钠代谢的调节障碍可能是发生左室肥厚的重要因素之一。

Objective To investigate the association between Left ventricular mass index (LVMI)and the suppression of plasma angiotensinⅡ(AngⅡ) after salt loading. Methods Salt sensitivity was determined by acute saline loading in 71 essential hypertensives ( stage 1 or stage 2). Plasma AngⅡwas determined by radioimmunoassay and LVMI was evaluated by echocardiography. Results (1) Of the 71 hypertensive patients, thirty seven were defined as salt sensitive and their LVMI was significantly higher than that in salt resistant ones[(114.8±11.5) vs (100.8±9.6) g/m2, P<0.01];(2)LVMI was significantly higher in patients with plasma AngⅡnot suppressed than that in those with plasma AngⅡsuppressed after salt loading [(120±9) vs (106±5) g/m2,P<0.05]. Also 24h mean diastolic BP, mean night systolic and diastolic BP, as well as 24h urinary sodium excretion were higher in the patients with plasma AngⅡnot suppressed than those suppressed after salt loading ; (3)LVMI was positively correlated with 24h urinary sodium excretion(r=0.49, P<0.01).Conclusion The increase of LVMI in salt sensitive hypertensive subjects was related to whether the plasma AngⅡ was suppressed after salt loading. It is suggested that abnormal regulation of the renin angiotensin system to sodium metabolism appears to be substantial in the development of left ventricular hypertrophy in salt-sensitive subjects.