原发性高血压病合并微量蛋白尿患者血压控制程度对动脉弹性功能的影响研究

目的　探讨原发性高血压病合并不同程度微量蛋白尿患者血压控制程度对动脉弹性功能的影响。方法　选取2016年6月—2017年6月在贵州医科大学附属医院心内科及高血压科住院确诊的原发性高血压病患者114例，根据尿清蛋白/肌酐（UACR）水平，将30 mg/g≤UACR<100 mg/g作为Ⅰ组（50例），其中血压控制良好〔收缩压<140 mm Hg（1 mm Hg=0.133 kPa）且舒张压<90 mm Hg〕者25例，血压控制不良（收缩压≥140 mm Hg和/或舒张压≥90 mm Hg）者25例；100 mg/g≤UACR<200 mg/g作为Ⅱ组（34例），其中血压控制良好者17例，血压控制不良者17例；200 mg/g≤UACR<300 mg/g作为Ⅲ组（30例），其中血压控制良好者15例，血压控制不良者15例。根据血压控制情况将患者分为血压控制不良组（57例）、血压控制良好组（57例）。测量患者血压、血糖、三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、UACR、血管弹性功能〔肱踝脉搏波传导速度（BaPWV）、颈-股动脉脉搏波传导速度（C-FPWV）及中心动脉收缩压（CSP）〕。结果　血压控制不良组年龄高于血压控制良好组，血糖低于血压控制良好组（P<0.05）。血压控制不良组收缩压、脉压、UACR、BaPWV、C-FPWV、CSP均高于血压控制良好组（P<0.05）。Ⅱ、Ⅲ组C-FPWV、CSP均高于Ⅰ组，Ⅲ组脉压、BaPWV均高于Ⅰ组（P<0.05）；Ⅲ组BaPWV、C-FPWV、CSP均高于Ⅱ组（P<0.05）。Ⅰ组血压控制良好者收缩压、舒张压、脉压、UACR、C-FPWV、CSP均低于血压控制不良者（P<0.05）。Ⅱ组血压控制良好者收缩压、脉压、UACR、C-FPWV、CSP均低于血压控制不良者（P<0.05）。Ⅲ组血压控制良好者收缩压、脉压、C-FPWV、CSP均低于血压控制不良者，舒张压高于血压控制不良者（P<0.05）。多元线性逐步回归分析结果显示，血糖是血压控制良好组患者C-FPWV的影响因素（β=0.526，P<0.05）；年龄、收缩压、脉压、UACR是血压控制不良组患者C-FPWV的影响因素（β=0.031、0.034、0.048、0.023，P<0.05）；舒张压、脉压、UACR是血压控制良好组患者CSP的影响因素（β=0.349、0.225、0.111，P<0.05）；年龄、脉压、UACR是血压控制不良组患者CSP的影响因素（β=0.321、0.243、0.113，P<0.05）。结论　原发性高血压病合并微量蛋白尿患者存在动脉弹性功能异常，随微量蛋白尿增加患者动脉弹性功能受损程度加重，动脉弹性功能受损与微量蛋白尿及血压控制程度相关。

Effect of Blood Pressure Control on Arterial Elasticity in Patients with Essential Hypertension Complicated with Microalbuminuria

Objective　To investigate the effect of blood pressure control on arterial elasticity in patients with essential hypertension complicated with different degrees of microalbuminuria.Methods　We enrolled 114 inpatients with essential hypertension and microalbuminuria from Department of Cardiology and Hypertension，the Affiliated Hospital of Guizhou Medical University from June 2016 to June 2017.According to the level of urine albumin-to-creatinine ratio （UACR），they were divided into group Ⅰ （30 mg/g≤UACR<100 mg/g） including 25 cases of well controlled hypertension 〔systolic blood pressure （SBP） <140 mm Hg （1 mm Hg=0.133 kPa） and diastolic blood pressure （DBP） <90 mm Hg 〕 and 25 cases of poorly controlled hypertension （SBP≥140 mm Hg and/or DBP≥90 mm Hg），group Ⅱ （100 mg/g≤UACR<200 mg/g） including 17 cases of well controlled hypertension and 17 cases of poorly controlled hypertension，group Ⅲ （200 mg/g≤UACR<300 mg/g） including 15 cases of well controlled hypertension and 15 cases of poorly controlled hypertension.In accordance with the hypertension control status，the patients were divided into poorly controlled hypertension group （57 cases） and well controlled hypertension group （57 cases）.We collected their data about blood pressure，fasting blood glucose （FBG），total triacylglycerol （TG），cholesterol （TC），high-density lipoprotein cholesterol （HDL-C），low-density lipoprotein cholesterol （LDL-C），UACR，indicators of blood vessel elasticity〔brachial-ankle pulse wave velocity （BaPWV），carotid-femoral artery pulse wave velocity （C-FPWV），central systolic pressure （CSP）〕.Results　Compared with those with well controlled hypertension，patients with poorly controlled hypertension were older，and they demonstrated much lower FBG，but significantly higher SBP，pulse pressure，UACR，BaPWV，C-FPWV and CSP （P<0.05）.Group Ⅰ showed much lower levels of C-FPWV and CSP compared with group Ⅱ （P<0.05）.Moreover，it exhibited much lower levels of C-FPWV，CSP，pulse pressure and BaPWV compared with group Ⅲ （P<0.05）.Group Ⅱ demonstrated significantly lower levels of BaPWV，C-FPWV and CSP compared with group Ⅲ （P<0.05）.In group Ⅰ，those with well controlled hypertension showed much lower SBP，DBP，pulse pressure，UACR，C-FPWV and CSP than those with poorly controlled hypertension （P<0.05）.In group Ⅱ，the SBP，pulse pressure，UACR，C-FPWV and CSP were much lower in those with well controlled hypertension instead of those with poorly controlled hypertension（P<0.05）.In group Ⅲ，those with well controlled hypertension were found with obviously lower SBP，pulse pressure，C-FPWV，CSP and higher DBP instead of those with poorly controlled hypertension （P<0.05）.Stepwise multiple linear regression analysis found that FBG was associated with C-FPWV in those with well controlled hypertension （β=0.526，P<0.05）；age，SBP，pulse pressure，and UACR were associated with C-FPWV in those with poorly controlled hypertension （β=0.031，β=0.034，β=0.048，β=0.023，P<0.05）；DBP，pulse pressure，and UACR were associated with CSP in those with well controlled hypertension （β=0.349，β=0.225，β=0.111，P<0.05）；age，pulse pressure，and UACR were associated with CSP in those with poorly controlled hypertension （β=0.321，β=0.243，β=0.113，P<0.05）.Conclusion　Impaired arterial elasticity exists in patients with essential hypertension combined with microalbuminuria，which is aggravated with the increased severity of microalbuminuria，and is directly related to poor pressure control.Impaired arterial elasticity is associated with microalbuminuria and blood pressure control.