螺内酯治疗顽固性高血压疗效的影响因素分析Multiple Factors for the Efficacy of Spironolactone in the Treatment of Resistant Hypertension
谢立,张文颖
XIE Li,ZHANG Wenying
摘要(Abstract)：
目的通过对顽固性高血压患者加用螺内酯治疗,分析影响螺内酯疗效的因素。方法选择2013年6月~2016年6月本院收治的使用螺内酯治疗顽固性高血压的患者222例,按照螺内酯疗效分为无效组102例及有效组120例。收集入组患者年龄、性别、BMI、吸烟情况、肾小球率过滤、低密度脂蛋白、同型半胱氨酸、尿白蛋白肌酐比、左心室肥厚、缺血性心脏病、糖尿病、脑卒中及抑郁焦虑状态基线资料。比较两组间基线指标并进行Logistic多因素分析。结果无效组与有效组相比,患者的年龄越大、血清同型半胱氨酸越高,左心室肥厚、糖尿病及抑郁焦虑状态人数也升高,差异有统计学意义(P<0.05)。两组患者在性别、BMI、吸烟、肾小球率过滤、低密度脂蛋白、尿白蛋白肌酐比、缺血性心脏病、脑卒中几个因素比较,差异无统计学意义(P>0.05)。多元Logistc分析结果表明年龄(OR=3.831,95%Cl 1.852~9.27)、糖尿病(OR=3.259,95%Cl 1.477~7.189)、左心室肥厚(OR=3.434,95%Cl 1.665~7.081)、高同型半胱氨酸(OR=11.067,95%Cl 5.217~23.475)、抑郁焦虑状态(OR=4.194,95%Cl1.712~10.275)是螺内酯治疗顽固性高血压的影响因素。结论高龄、糖尿病、左心室肥厚、高同型半胱氨酸、抑郁焦虑状态显著影响了螺内酯治疗顽固性高血压的疗效,这些状态单独或并存时,螺内酯治疗顽固性高血压无效的风险增高。
OBJECTIVE To add the low dose of spironolactone to the patients with resistant hypertension( RHTN),and analyse factors for the efficacy of spironolactone in the treatment of resistant hypertension. METHODS 222 RHTN participants were recruited from our hospital. There were 102 RHTN patients with ineffective treatment of spironolactone and 120 RHTN patients with effective treatment of spironolactone. The biochemical indexes were collected,including age,gender,BMI,smoke,e GFR( estimated glomerular filtration rate),LDL( low density lipoprotein),HCY( homocysteine),UACR( Urinary albumin/creatinine ratio), LVH( left ventricular hypertrophy),IHD( ischemic heart disease),diabetes,stroke,depression/anxiety status of all the participants. The indexes between the two group were analyzed and logistic regression analysis were analyzed with age,diabetes,LVH,HCY and depression/anxiety status. RESULTS Age and HCY were higher in ineffective treatment of spironolactone group than those in the effective treatment of spironolactone group,and the number of LVH,diabetes,depression/anxiety status were also higher in ineffective treatment of spironolactone group than those in the effective treatment of spironolactone( P<0.05). Multiple logistic regression analysis showed that age( OR = 3.831,95%Cl 1.852-9.27),diabetes( OR = 3. 259,95% Cl 1. 477-7. 189),LVH( OR = 3. 434,95% Cl 1. 665-7. 081),HCY( OR = 11.067,95%Cl 5.217-23.475),depression/anxiety status( OR = 4.194,95% Cl 1.712-10.275) were independent factors for the efficacy of spironolactone in the treatment of RHTN. CONCLUSION Advanced age,diabetes,LVH,elevated HCY and depression/anxiety status notably affect the efficacy of spironolactone in the treatment of RHTN. when these factors exist alone or simultaneously,the efficacy of spironolactone decline.
关键词(KeyWords)：
顽固性高血压;螺内酯;影响因素;疗效
resistant hypertension;spironolactone;factor;efficacy
基金项目(Foundation): 广东省医院药学研究基金(2015A29)
作者(Author):
谢立,张文颖
XIE Li,ZHANG Wenying
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