CAJ | 학술논문

目的比较原发性醛固酮增多症(PA)和原发性高血压(EH)患者内皮损伤标志物的水平,探讨其对早期靶器官损害的预测价值.方法选择因“高血压查因”住院确诊的资料完整的36例PA患者与同期确诊的年龄、性别、高血压水平及其病程等相匹配的39例EH患者为研究对象,观察两组患者内皮损伤标志物包括血浆血管性假血友病因子(vWF)、可溶性细胞间黏附分子-1(slCAM-1)和氧化型低密度脂蛋白(ox-LDL),以左心室质量指数(LVMI)、24 h尿蛋白及尿白蛋白排泄率(UAER)评估早期靶器官损害.结果 (1) PA组内皮损伤标志物血浆vWF、sICAM-1和ox-LDL水平均较EH组高(均P＜0.01),且具有更高的24h尿蛋白、UAER(均P＜0.01)和LVMI (P ＜0.05).(2)相关性分析显示血浆醛固酮水平(PAC)与vWF、sICAM-1和ox-LDL水平均呈正相关(均P＜0.05).LVMI与PAC、ox-LDL、vWF和入院收缩压均呈正相关(均P＜0.05),与入院时血K+呈负相关(P＜0.05)；UAER与PAC、经自然对数转换的血浆醛固酮/肾素比值(lnARR)、vWF和sICAM-1均呈正相关(均P＜0.05),与人院时血K+呈负相关(P＜0.05).(3)多元线性回归分析在调整了混杂因素后提示血浆vWF、sICAM-1和PAC对微量白蛋白尿有独立的预测价值；vWF、ox-LDL、PAC和入院收缩压对左心室肥厚有独立的预测价值.结论 PA患者较EH患者具有更明显的内皮功能障碍及早期靶器官损害,PAC和多种内皮损伤标志物是早期靶器官损害独立的预测因子.
목적 비교원발성철고동증다증(PA)화원발성고혈압(EH)환자내피손상표지물적수평,탐토기대조기파기관손해적예측개치.방법 선택인“고혈압사인”주원학진적자료완정적36례PA환자여동기학진적년령、성별、고혈압수평급기병정등상필배적39례EH환자위연구대상,관찰량조환자내피손상표지물포괄혈장혈관성가혈우병인자(vWF)、가용성세포간점부분자-1(slCAM-1)화양화형저밀도지단백(ox-LDL),이좌심실질량지수(LVMI)、24 h뇨단백급뇨백단백배설솔(UAER)평고조기파기관손해.결과 (1) PA조내피손상표지물혈장vWF、sICAM-1화ox-LDL수평균교EH조고(균P＜0.01),차구유경고적24h뇨단백、UAER(균P＜0.01)화LVMI (P ＜0.05).(2)상관성분석현시혈장철고동수평(PAC)여vWF、sICAM-1화ox-LDL수평균정정상관(균P＜0.05).LVMI여PAC、ox-LDL、vWF화입원수축압균정정상관(균P＜0.05),여입원시혈K+정부상관(P＜0.05)；UAER여PAC、경자연대수전환적혈장철고동/신소비치(lnARR)、vWF화sICAM-1균정정상관(균P＜0.05),여인원시혈K+정부상관(P＜0.05).(3)다원선성회귀분석재조정료혼잡인소후제시혈장vWF、sICAM-1화PAC대미량백단백뇨유독립적예측개치；vWF、ox-LDL、PAC화입원수축압대좌심실비후유독립적예측개치.결론 PA환자교EH환자구유경명현적내피공능장애급조기파기관손해,PAC화다충내피손상표지물시조기파기관손해독립적예측인자.
Objective To compare plasma concentrations of biomarkers of endothelial dysfunction between patients with primary aldosteronism (PA) and essential hypertension (EH),and to determine whether elevated levels of these biomarkers could predict development of early organ damage.Methods Thirty-six PA patients and 39 EH patients matched for age,sex,blood pressure and duration of hypertension were included in this study.Plasma levels of biomarkers reflecting endothelial dysfunction (von Willebrand factor,vWF; soluble intercellular adhesion molecule 1,sICAM-1; and oxidized low density lipoprotein,ox-LDL) were detected and compared between PA and EH patients. Left ventricular mass index (LVMI)determined by echocardiography,24-hour urinary protein quantitative determination and urinary albumin excretion rate (UAER) were analyzed to evaluate early organ damage. Left ventricular hypertrophy was defined as LVMI ＞ 125 g/m2 in men and ＞ 120 g/m2 in women,and UAER between 20 μg/min and 200 μg/min was defined as microalbuminuria.Results vWF [(122.3 ±53.8)％ vs.(113.1 ±68.3)％],sICAM-1 [(401.0±74.1) μg/Lvs.(300.9±87.0) μg/L],ox-LDL[ (13.6±10.0) U/Lvs.( 8.1±5.9) U/L ],LVMI [ ( 124.7 ± 33.6) g/m2 vs.( 109.1 ± 25.7) g/m2 ],24-hour urinary protein quantitation [24 h UPQ,(0.17±0.10) gvs.( 0.09±0.04 ) g] and UAER [(25.9±7.7 ) μg/min vs.( 9.7±5.9) μg/min] were significantly higher in PA group than in EH group (all P ＜0.05),Elevated plasma vWF,sICAM-1 levels and plasma aldosterone concentration independently predicted microalbuminuria.Whereas,elevated plasma vWF and ox-LDL levels,plasma aldosterone concentration and systolic blood pressure independently predicted left ventricular hypertrophy.Conclusion Patients with PA have severer endothelial dysfunction reflected by multiple biomarkers and earlier organ damage than patients with EH,and plasma aldosterone concentration and multiple endothelial dysfunction biomarkers could independently predict early organ damage.