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目的探讨老年原发性高血压左心室重构患者血浆肾上腺髓质素(ADM)浓度的变化和意义。方法选取原发性高血压患者77例,根据是否存在心肌肥厚以及左心室心腔扩大分为左心室正常组、心肌肥厚组以及心腔扩大组,采用放射免疫法测定血浆ADM的浓度以及肾素、血管紧张素Ⅱ(AngⅡ)和醛固酮的浓度,采用免疫荧光的方法测定B型利钠肽(BNP)的浓度。比较ADM在3组中的差异以及与BNP、肾素、AngⅡ及醛固酮的关系。结果心腔扩大组的ADM、对数转换的BNP(lgBNP)明显高于心肌肥厚组,而心肌肥厚组又高于左心室正常组。左心室肥厚组AngⅡ、醛固酮水平高于左心室正常组。心肌肥厚组和心腔扩大组AngⅡ、醛固酮、左心室质量指数(LVMI)均高于左心室正常组。心腔扩大组射血分数值低于左心室正常组以及心肌肥厚组。ADM与lgBNP、AngⅡ、醛固酮及LVMI均呈正相关(r分别为0·51,0·32,0·39,0·45,均P<0·01)。在30月的随访中,高ADM(ADM≥25ng/L,n=23)患者存在着高的死亡风险(HR=3·81,P=0·022)。结论 ADM水平随老年高血压患者左心室重构进展而增高;ADM可以作为老年原发性高血压预后的预测指标。
Objective To investigate the changes and significance of plasma adrenomedullin (ADM) concentration in left ventricular remodeling in elderly patients with essential hypertension. Methods Totally 77 patients with essential hypertension were divided into normal left ventricular group, cardiac hypertrophy group and cardiac enlargement group according to the presence or absence of cardiac hypertrophy and left ventricular enlargement. Radioimmunoassay was used to determine plasma ADM concentration and renin , Angiotensin Ⅱ (Ang Ⅱ) and aldosterone were measured by immunofluorescence method to determine the concentration of type B natriuretic peptide (BNP). The difference of ADM in three groups and the relationship with BNP, renin, angiotensin II and aldosterone were compared. Results ADM in cardiac enlargement group, logarithm converted BNP (lgBNP) was significantly higher than that in myocardial hypertrophy group, while in hypertrophic cardiac muscle group was higher than that in normal left ventricle group. Ang Ⅱ, aldosterone levels in left ventricular hypertrophy group were higher than those in normal left ventricle group. Angiotensin Ⅱ, aldosterone and left ventricular mass index (LVMI) in cardiac hypertrophy group and cardiac enlargement group were higher than those in normal left ventricle group. Echocardiography increased ejection fraction lower than normal left ventricular and cardiac hypertrophy group. There was a positive correlation between ADM and lgBNP, Ang II, aldosterone and LVMI (r = 0.51,0.32,0.039,0.45, all P <0.01). At the 30-month follow-up, patients with high ADM (ADM ≥ 25 ng / L, n = 23) had a high risk of death (HR = 3.81, P = .022). Conclusions The level of ADM increases with the progression of left ventricular remodeling in elderly hypertensive patients. ADM can be used as a predictor of the prognosis of elderly essential hypertension.