原发性高血压患者合并代谢异常与血浆纤维蛋白原的关系

Correlation between metabolic abnormalities and plasma fibrinogen levels in patients with essential hypertension

  • 摘要:
    目的  探讨原发性高血压(EH)患者合并血糖、血脂等代谢异常与血浆纤维蛋白原水平升高的关系。
    方法  回顾性分析就诊于福建医科大学附属第一医院老年科门诊的1043例患者的临床资料。依据有无高血压及有无代谢组分异常,分为对照组(无EH以及代谢异常)、单纯EH组、EH合并1个/2个/3个代谢组分异常组,随后按各组标准纳入符合条件的研究对象,最终对照组77例、单纯EH组194例,EH合并1个/2个/3个代谢组分异常组分别为352例、316例、104例,为了进一步明确不同代谢异常类型对EH患者纤维蛋白原水平的影响,将EH合并1个代谢组分异常细分为EH合并肥胖、EH合并血糖异常、EH合并血脂异常亚组,运用多元线性回归分析EH患者纤维蛋白原水平与代谢指标的相关性,同时,以 EH 患者是否合并高纤维蛋白原血症为因变量,以是否合并多重代谢异常为自变量,运用二元logistic回归分析多重代谢异常与高纤维蛋白原血症的关系。
    结果  与对照组和单纯EH患者相比,合并代谢异常组分的EH患者纤维蛋白原水平显著升高EH合并1~3个代谢组分异常:(3.22±0.93)、(3.31±0.97)、(3.49±1.09)g/L 比对照组(2.83±0.59)g/L,单纯EH组(2.97±0.71)g/L,F = 10.4,P<0.001,EH合并血糖异常和EH合并血脂异常患者的纤维蛋白原水平高于单纯EH患者(3.37±0.91)、(3.26±0.92)比(2.97±0.71)g/L,F = 5.75,P<0.05,以 EH 患者是否合并高纤维蛋白原血症为因变量行二元logistic回归分析,经调整相关变量后发现,仅EH合并血糖异常患者患高纤维蛋白原血症的风险是单纯 EH 患者的 2.36倍(OR=2.36,95%CI 1.03~5.44,P<0.05)。合并2个、3个代谢异常的EH患者发生高纤维蛋白原血症的风险分别是对照组的5.18倍(OR=5.18,95%CI 1.47~18.26)、5.51倍(OR=5.51,95%CI 1.32~23.10),是单纯EH患者的3.11倍(OR=3.11,95%CI 1.52~6.37)、3.14倍(OR=3.14,95%CI 1.23~8.02)。多元线性回归分析显示EH患者血纤维蛋白原水平与性别(β=0.201)、年龄(β=0.011)、白细胞计数(β=0.062)、超敏C反应蛋白(β=0.068)、空腹血糖(β=0.013)呈正相关,与总胆红素呈负相关(β=-0.026,P<0.05)。
    结论 EH患者合并代谢异常时,纤维蛋白原水平升高,且纤维蛋白原随着代谢异常数目增加而升高,其中血糖对纤维蛋白原升高的影响较为突出。

     

    Abstract:
    Objective To explore the correlation between metabolic abnormalities in essential hypertension patients and elevated plasma fibrinogen levels. Methods: Retrospective analysis of clinical data of 1 043 patients attending the geriatric clinic of the First Hospital Affiliated with Fujian Medical University. According to the presence or absence of hypertension and metabolic component abnormalities, they were divided into control group (no EH and metabolic abnormalities). The EH group alone and the EH group combined with 1 / 2 / 3 metabolic component abnormalities were subsequently included in the eligible study subjects according to the criteria of the respective groups. The control group consisted of 77 cases, the group with isolated EH consisted of 194 cases, and the groups with EH combined with abnormalities in one, two, or three metabolic components were 352, 316, and 104 cases, respectively.In order to further clarify the impact of different types of metabolic abnormalities on Fib levels in patients with EH, the EH group was subdivided into sub-groups based on the presence of one specific metabolic abnormality, including EH with obesity, EH with glucose metabolism abnormalities, and EH with lipid metabolism abnormalities. Utilize multiple linear regression analysis to study the correlation between Fib levels and various indicators in patients with EH, while also considering other factors. Using hyperfibrinogenemia as dependent variable and multiple metabolic abnormalities as independent variable, the relationship between multiple metabolic abnormalities and hyperfibrinogenemia was analyzed by binary logistic regression analysis.Results: compared to the control group and patients with isolated EH, patients with EH who also had metabolic abnormalities exhibited elevated Fib levels EH combined with 1 to 3 metabolic component abnormalities:(3.22 ± 0.93), (3.31 ± 0.97), (3.49 ± 1.09) g/L vs control (2.83 ± 0.59) g/L, EH (2.97 ± 0.71) g/L, F = 10.4, P<0.001. The levels of vitriol in patients with EH combined with simple dysglycemia and EH combined with simple dyslipidemia were higher than those in patients with simple EH (3.37 ± 0.91, (3.26 ± 0.92) vs (2.97 ± 0.71) g/L, F = 5.75, P<0.05. Binary logistic regression analysis was performed with hyperfibrinogenemia or not as dependent variable.After adjusting for relevant variables, the risk of hyperfibrinogenemia was 2.36 times higher in patients with EH and glucose abnormalities alone (OR=2.36, 95%CI 1.03 to 5.44). The risk of hyperfibrinogenemia was 5.18 times (OR=5.18, 95%CI 1.47 to 18.26) and 5.51 times (OR=5.51, 95%CI 1.32 to 23.10) in patients with two and three metabolic abnormalities, respectively, compared with the control group. It was 3.11 times (OR=3.11, 95%CI 1.52 to 6.37) and 3.14 times (OR=3.14, 95%CI 1.23 to 8.02) of patients with simple EH. Multiple linear regression analysis showed that serum fibrinogen level was significantly correlated with gender (β = 0.201), age (β = 0.011), white blood cell count (β = 0.062), high-sensitivity C-reactive protein (β = 0.068), fasting plasma glucose (β = 0.013), and total bilirubin (β = −0.026) were positively correlated (P < 0.05).
    Conclusions In EH patients , when metabolic abnormalities are combined, fibrinogen levels are elevated, and fibrinogen is elevated with the number of metabolic abnormities. The effect of blood sugar on fibrinogen elevation is more prominent.

     

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