【作者】 罗鹏；

【导师】 吴延庆；

【作者基本信息】 南昌大学 ， 内科学（心血管）（专业学位）， 2019， 硕士

【摘要】 目的:旨在探究血清γ-谷氨酰转肽酶及总胆红素水平与高血压无症状性亚临床靶器官损害的联系。方法:本研究纳入2017年9月至2018年9月于南昌大学第二附属医院心内科住院的高血压患者共501例,依据γ-谷氨酰转肽酶水平四分位点分为4组:A组(≤17.07U/L),B组(17.08U/L~22.99U/L),C组(23.00U/L~35.71U/L),D组(≥35.71U/L);依据总胆红素水平四分位点分为另外4组:W组(≤9.70μmol/L),X组(9.71μmol/L~11.91μmol/L),Y组(11.92μmol/L~15.19μmol/L),Z组(≥15.19μmol/L)。检测血生化、尿蛋白指标,进行心脏超声、颈动脉超声、眼底照相、颅脑磁共振等检查,依据《中国高血压防治指南2018年修订版》定义高血压靶器官损害,比较各组靶器官损害的发生率,分析高血压靶器官损害危险因素。结果:1、各组靶器官损害评估的完成比例无统计学差异。不同γ-谷氨酰转肽酶水平组间颈动脉、眼底靶器官损害无显著差异。与D组相比,A组的颅脑(64.7%vs.85.8%,P<0.001)、心脏(26.2%vs.45.6%,P=0.001)、肾脏(13.5%vs.32.0%,P<0.001)靶器官损害比例显著更低,B心脏(32.0%vs.85.8%,P=0.027)、肾脏(12.0%vs.32.0%,P<0.001)靶器官损害比例更低,C组肾脏(18.4%vs.32.0%,P=0.013)靶器官损害比例更低。线性趋势检验显示患者靶器官损害数量与γ-谷氨酰转肽酶水平呈线性相关(总变异:χ2=22.522,P=0.032;线性趋势检验:χ2=13.634,P<0.001)。Spearman相关性分析显示,γ-GT活性水平与总胆固醇(r=0.260,P<0.001)、低密度脂蛋白胆固醇(r=0.193,P<0.001)、尿微量白蛋白(r=0.158,P<0.001)、室间隔厚度(r=0.175,P<0.001)、左室舒张末径(r=0.135,P=0.002)、左心室质量指数(r=0.161,P<0.001)、身体质量指数(r=0.144,P=0.001)、吸烟(r=0.170,P<0.001)、收缩压(r=0.120,P=0.007)、舒张压(r=0.226,P<0.001)均呈正相关,与女性(r=-0.158,P<0.001)呈负相关。多元logistic回归显示,高γ-谷氨酰转肽酶血症(>50U/L)增加2个及以上靶器官损害的风险[OR:2.876(1.298,6.373)]。2、不同总胆红素水平组间颅脑靶器官损害、颈动脉靶器官损害、眼底靶器官损害无显著差异。与Z组相比,X组的心脏靶器官损害比例显著更高(42.7%vs.28.0%,P=0.015),W组也呈更高的趋势(39.4%vs.28.0%,P=0.056),尽管并无统计学差异。而W组的肾脏靶器官损害比例也显著高于Z组(28.3%vs.12.0%,P<0.001)。线性趋势检验未显示靶器官损害数量与胆红素水平之间存在线性联系(总变异:χ2=12.326,P=0.420;线性趋势检验:χ2=1.575,P=0.210)。多元logistic回归显示总胆红素水平未进入方程。结论:1、在已确诊的高血压患者中,高γ-GT水平的患者发生靶器官损害的风险增加。在临床工作中,应特别注意筛查检出血清γ-GT水平较高的高血压患者的靶器官损害情况。特别是对于基层门诊或拒绝完善更多检查以评估靶器官损害的患者,血清γ-GT水平对高血压无症状性亚临床靶器官损害的早期检出颇具有临床参考价值。2、降低的胆红素水平与高血压患者的心脏、肾脏靶器官损害风险增加有关,提示胆红素可能具有一定的心脏、肾脏保护作用,但胆红素水平对高血压靶器官损害预测价值并不可靠,对高血压无症状性亚临床靶器官损害的早期检出价值有限。更多还原

【Abstract】 Objective:To explore the association between serumγ-glutamyl transpeptidase levels or total bilirubin levels and asymptomatic subclinical target organ damage in hypertension.Methods:A total of 501 hypertensive patients admitted to the Department of Cardiology,Second Affiliated Hospital of Nanchang University from September 2017 to September 2018 were included in this study.Divided into 4 groups according to the quaternary point ofγ-glutamyl transpeptidase:Group A(≤17.07U/L),Group B(17.08U/L~22.99U/L),Group C(23.00U/L~35.71U/L),Group D(≥35.71U/L).Divided into another 4 groups based on the total bilirubin level quartile:Group W(≤9.70μmol/L),Group X(9.71μmol/L~11.91μmol/L),Group Y(11.92μmol/L~15.19μmol/L),Group Z(≥15.19μmol/L).Blood biochemistry and urine protein were measured,and echocardiography,carotid ultrasound,fundus photography,and brain magnetic resonance imaging were performed.Define hypertensive target organ damage according to the "Chinese Hypertension Prevention Guide 2018 Revision".The incidence of target organ damage in each group was compared,and the risk factors of target organ damage in hypertension were analyzed.Results:1.There was no significant difference in the proportion of each target organ damage assessment performed by each group.There was no significant difference in carotid artery and fundus target organ damage among the groups.Compared with group D,group A had a lower brain(64.7% vs.85.8%,P<0.001),heart(26.2% vs.45.6%,P=0.001),and renal(13.5% vs.32.0%,P<0.001) target organ damage ratio,group B had a lower heart(32.0% vs.85.8%,P=0.027),renal(12.0% vs.32.0%,P<0.001) target organ damage ratio,group C had a lower renal(18.4% vs.32.0%,P=0.013) target organ damage ratio.Linear trend tests showed a linear correlation between the number of target organ damage andγ-glutamyl transpeptidase levels(total variation:χ~2=22.522,P=0.032;linear trend test:χ~2=13.634,P<0.001).Spearman correlation analysis showed thatγ-GT levels were positively correlated with total cholesterol(r=0.260,P<0.001),low-density lipoprotein cholesterol(r=0.193,P<0.001),urinary microalbumin(r=0.158,P<0.001),septal thickness(r=0.175,P<0.001),left ventricular end diastolic diameter(r=0.135,P=0.002),left ventricular mass index(r=0.161,P<0.001),body mass index(r=0.144,P=0.001),smoking(r=0.170,P<0.001),systolic blood pressure(r=0.120,P=0.007),and diastolic blood pressure(r=0.226,P<0.001),but were negatively correlated with women(r=-0.158,P<0.001).Multivariate logistic regression showed that highγ-glutamyl transpeptidase levels(>50 U/L)increased the risk of damage to 2 or more target organs,[OR:2.876(1.298,6.373)].2.There were no significant differences in brain target organ damage,carotid target organ damage,and fundus target organ damage among the different total bilirubin levels.Compared with group Z,the proportion of target target organ damage in group X was significantly higher(42.7% vs.28.0%,P=0.015),and group W also showed a higher trend(39.4% vs.28.0%,P=0.056),despite without a statistical difference.The proportion of renal target organ damage in Group W was also significantly higher than that in Group D(28.3% vs.12.0%,P<0.001).Linear trend tests did not show a linear relationship between the number of target organ damage and bilirubin levels(total variation:χ~2=12.326,P=0.420;linear trend test:χ~2=1.575,P=0.210).Multivariate logistic regression showed that total bilirubin levels did not enter the equation.Conclusion:1.In patients with established hypertension,patients with high γ-GT levels have an increased risk of target organ damage.In clinical work,special attention should be paid to screening for target organ damage in hypertensive patients with high serum γ-GT levels.Serum γ-GT levels have certain clinical reference value for the early detection of asymptomatic subclinical target organ damage in hypertension,especially for outpatients or patients who refuse more examinations to assess target organ damage.2.Reduced bilirubin levels are associated with increased risk of heart and kidney target organ damage in hypertensive patients,suggesting that bilirubin may have a protective effect on the heart and kidneys.However,the predictive value of bilirubin levels on target organ damage of hypertension is not reliable.And the value of early detection of asymptomatic subclinical target organ damage in hypertension is limited.更多还原