卡托普利试验过程中颈动脉斑块与醛固酮含量相关指标变化的相关性研究
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摘要
目的:研究卡托普利试验过程中血浆醛固酮(PAC)相关指标的变化与颈动脉斑块的相关性。方法:选择在本院住院进行高血压病因筛查并完成了卡托普利试验,且颈动脉彩超资料完整的83例患者为研究对象。以颈动脉彩超诊断结果为分组标准,有颈动脉斑块者为斑块组(57例),无颈动脉斑块者为无斑块组(26例),分析两组患者PAC、血浆肾素活性(PRA)、PAC与PRA的比值(ARR)等指标的变化与颈动脉斑块之间的相关性。结果:颈动脉斑块检出率为68.67%。与无斑块组比较,斑块组患者的年龄更大,载脂蛋白A1(APOA1)水平更低(P均<0.05),卡托普利试验前后斑块组患者的ARR差值更低,PAC及PRA的差值更大(P均<0.05);其中,斑块组PAC及PRA的差值为正;无斑块组此二差值为负,斑块组ARR的差值为负,无斑块组该差值为正。Logistic回归分析表明,在排除了性别等因素之后,仅年龄、卡托普利试验前后PAC差值及ARR差值为颈动脉斑块形成独立的危险因素。结论:在进行高血压病因筛查的住院高血压患者中,颈动脉斑块的检出率较高,卡托普利试验前后PAC的差值及ARR的差值为颈动脉斑块形成独立的危险因素。
Objective: To investigate the correlation between the carotid artery plaque and the change of plasma aldosterone level related indexes during captopril challenge test. Methods: The patients with hypertension were enrolled as research objects and the captopril challenge test were carried out when they were hospitalized to screen the cause of hypertension. There were intact carotid artery duplex ultrasonography diagnostic data in them( 83 cases). They were divided into the plaque group( 57 cases) with carotid artery plaque and no plaque group( 26 cases) without carotid artery plaque according to the carotid artery duplex ultrasonography diagnostic data. The correlation between the carotid artery plaque and the changes of aldosterone concentration,renin activity and aldosterone to renin activity ratio( ARR) in two groups were analyzed. Results: The detection rate of carotid artery plaque was 68.67%. Compare with no plaque group,the patients in plaque group were elder and the level of apolipoprotein A1,( APOA1) was lower( all P<0.05). The ARR difference value before and after captopril challenge test was lower( P<0.05).The aldosterone difference value and the renin activity difference value before and after captopril challenge test were higher in plaque group( all P<0.05).The aldosterone difference value and the renin activity difference value were positive in plaque group and were negative in no plaque group. The difference value of the ARR was negative in plaque group and was positive in no plaque group. Logistic regression analysis showed that the age,the difference value of ARR and the aldosterone before and after captopril challenge test could be associated independently with carotid artery plaque occurrence after excluding gender difference and other factors. Conclusion: The detection rate of carotid artery plaque was high among hospitalized patients with hypertension,the difference value of ARR and the aldosterone before and after captopril challenge test could be associated independently with carotid artery plaque occurrence.
Objective: To investigate the correlation between the carotid artery plaque and the change of plasma aldosterone level related indexes during captopril challenge test. Methods: The patients with hypertension were enrolled as research objects and the captopril challenge test were carried out when they were hospitalized to screen the cause of hypertension. There were intact carotid artery duplex ultrasonography diagnostic data in them( 83 cases). They were divided into the plaque group( 57 cases) with carotid artery plaque and no plaque group( 26 cases) without carotid artery plaque according to the carotid artery duplex ultrasonography diagnostic data. The correlation between the carotid artery plaque and the changes of aldosterone concentration,renin activity and aldosterone to renin activity ratio( ARR) in two groups were analyzed. Results: The detection rate of carotid artery plaque was 68.67%. Compare with no plaque group,the patients in plaque group were elder and the level of apolipoprotein A1,( APOA1) was lower( all P<0.05). The ARR difference value before and after captopril challenge test was lower( P<0.05).The aldosterone difference value and the renin activity difference value before and after captopril challenge test were higher in plaque group( all P<0.05).The aldosterone difference value and the renin activity difference value were positive in plaque group and were negative in no plaque group. The difference value of the ARR was negative in plaque group and was positive in no plaque group. Logistic regression analysis showed that the age,the difference value of ARR and the aldosterone before and after captopril challenge test could be associated independently with carotid artery plaque occurrence after excluding gender difference and other factors. Conclusion: The detection rate of carotid artery plaque was high among hospitalized patients with hypertension,the difference value of ARR and the aldosterone before and after captopril challenge test could be associated independently with carotid artery plaque occurrence.
引文
[1]陈适,曾正陪,宋爱羚,等.卡托普利试验在原发性醛固酮增多症诊断中的应用[J].中华内科杂志,2017,56(6):402-408.
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[4]Cuspidi C,Valerio C,Negri F,et al.Prevalence and correlates of multiple organ damage in referred treated hypertensives:data from the ETODH study[J].J Hum Hypertens,2008,22(11):801-803.
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[7]de Rita O,Hackam DG,Spence JD.Effects of aldosterone on human atherosclerosis:plasma aldosterone and progression of carotid plaque[J].Can J Cardiol,2012,28(6):706-711.
[8]Lee MY,Lai WT.Plasma renin level and aldosterone to renin ratio are associated with presence of carotid plaques in patients with stable coronary artery disease[J].J Renin Angiotensin Aldosterone Syst,2015,16(4):1159-1167.
[9]冯惠清,崔炜,冯惠平,等.醛固酮对新生大鼠心肌成纤维细胞分泌ET、NO功能的影响[J].中国应用生理学杂志,2005,21(1):78-80.
[10]Brown NJ.Aldosterone and vascular inflammation[J].Hypertension,2008,51(2):161-167.
[11]Cascella T,Radhakrishnan Y,Maile LA,et al.Aldosterone enhances IGF-I-mediated signaling and biological function in vascular smooth muscle cells[J].Endocrinology,2010,151(12):5851-5864.
[12]赵晓雨,刘淑红,赵彤,等.强噪声对豚鼠认知功能和血清某些生化指标的影响[J].中国应用生理学杂志,2016,32(5):385-389.
[13]陆召麟,宁光.内分泌内科学[M].北京:人民卫生出版社,2009,134.
[2]李岩岩,刘玉平,李建薇,等.卡托普利试验诊断原醛症的切点分析[J].四川大学学报(医学版),2014,45(6):1030-1032.
[3]邢卫红,李南方,张菊红,等.45岁及以上高血压患者醛固酮与颈动脉粥样硬化关系研究[J].中国心血管杂志,2012,17(4):268-271.
[4]Cuspidi C,Valerio C,Negri F,et al.Prevalence and correlates of multiple organ damage in referred treated hypertensives:data from the ETODH study[J].J Hum Hypertens,2008,22(11):801-803.
[5]Keidar S,Kaplan M,Pavlotzky E,et al.Aldosterone administration to mice stimulates macrophage NADPH oxidase and increases atherosclerosis development:a possible role for angiotensin-converting enzyme and the receptors for angiotensin II and aldosterone[J].Circulation,2004,109(18):2213-2220.
[6]Hillaert MA,Lentjes EG,Beygui F,et al.Measuring and targeting aldosterone and renin in atherosclerosis-a review of clinical data[J].Am Heart J,2011,162(4):585-596.
[7]de Rita O,Hackam DG,Spence JD.Effects of aldosterone on human atherosclerosis:plasma aldosterone and progression of carotid plaque[J].Can J Cardiol,2012,28(6):706-711.
[8]Lee MY,Lai WT.Plasma renin level and aldosterone to renin ratio are associated with presence of carotid plaques in patients with stable coronary artery disease[J].J Renin Angiotensin Aldosterone Syst,2015,16(4):1159-1167.
[9]冯惠清,崔炜,冯惠平,等.醛固酮对新生大鼠心肌成纤维细胞分泌ET、NO功能的影响[J].中国应用生理学杂志,2005,21(1):78-80.
[10]Brown NJ.Aldosterone and vascular inflammation[J].Hypertension,2008,51(2):161-167.
[11]Cascella T,Radhakrishnan Y,Maile LA,et al.Aldosterone enhances IGF-I-mediated signaling and biological function in vascular smooth muscle cells[J].Endocrinology,2010,151(12):5851-5864.
[12]赵晓雨,刘淑红,赵彤,等.强噪声对豚鼠认知功能和血清某些生化指标的影响[J].中国应用生理学杂志,2016,32(5):385-389.
[13]陆召麟,宁光.内分泌内科学[M].北京:人民卫生出版社,2009,134.