摘要
目的探讨原发性高血压患者及非高血压人群脂肪肝指数(FLI)与左心室质量指数(LVMI)的相关性。方法回顾性收集分析2016年1月至2018年3月在福建医科大学附属第一医院门诊及住院部就诊的高血压患者511例及非高血压者(未用药治疗的血压<140/90 mm Hg)312人。根据三酰甘油、体质量指数(BMI)、γ谷氨酰转肽酶(γ-GGT)和腰围计算FLI值:FLI=e^(0.953×lg三酰甘油+0.139×BMI+0.718×lgγ-GGT+0.053×腰围-15.745)/(1+e^(0.953×lg三酰甘油+0.139×BMI+0.718×lgγ-GGT+0.053×腰围-15.745))×100。采用多普勒超声心动图测定LVMI。在高血压患者及非高血压人群中按是否合并左心室肥厚(LVH)、年龄、BMI及FLI水平进行亚组分析。采用多元线性回归分析不同亚组人群中FLI对LVMI的影响。结果在非高血压人群及高血压患者中,合并LVH者的年龄[(60.2±9.6)比(53.8±10.2)岁,t=-4.031,P<0.001;(64.2±11.7)比(60.5±12.5)岁,t=-3.261,P<0.001]、收缩压[(119.2±11.1)比(116.5±11.3)mm Hg,t=-1.530,P=0.127;(142.4±20.0)比(136.7±17.1)mm Hg,t=-3.202,P<0.001]、LVMI[(117.1±23.9)比(81.9±13.8)g/m^(2),t=-9.882,P<0.001;(125.7±27.0)比(88.7±13.6)g/m^(2),t=-17.221,P<0.001]高于不合并LVH者,两组间FLI[23.02(15.52~43.13)比18.98(9.50~42.38),U=1.134,P=0.257;33.35(18.35~56.01)比39.28(19.53~58.76),U=-1.446,P=0.148]水平差异无统计学意义。按年龄分层分析发现,在高血压和非高血压人群中,老年(年龄≥60岁)患者LVMI水平高于中青年(年龄<60岁)患者(均P<0.05),高血压组中,老年组FLI水平低于中青年组[33.83(18.30~56.17)比40.94(22.52~62.09),U=-2.446,P=0.014]。按BMI分层分析发现,超重肥胖(BMI≥24 kg/m^(2))组FLI、LVMI高于正常体质量(BMI<24 kg/m^(2))组(均P<0.05)。在非高血压人群中,FLI≥30组LVMI水平高于FLI<30组[(92.0±22.1)比(84.6±18.6)g/m^(2),t=-3.158,P=0.002]。多元逐步线性回归分析发现,对于非高血压人群,FLI、年龄、吸烟、心率是LVMI的影响因素(P<0.05),而在高血压患者中,FLI不是LVMI的影响因素。进一步按年龄分亚组分析发现,FLI是非高血压老年人群LVMI的影响因素(P<0.05);按BMI水平及年龄水平分亚组分析发现,对于非高血压的老年人,无论是否超重,FLI均是LVMI的影响因素(P<0.05)。结论对于非高血压人群(尤其是老年人)而言,FLI是LVMI的主要影响因素。
Objective To investigate the correlation between fatty liver index(FLI)and left ventricular mass index(LVMI)in subjects with essential hypertension(EH)and normotensives(non-EH,blood pressure<140/90 mm Hg without treatment).Methods Between January 2016 and March 2018,a total of 511 cases of hypertensives and 312 normotensives from the outpatient and inpatient departments of the First Hospital of Fujian Medical University were retrospectively analyzed.Using triglycerides,body mass index(BMI),γ-glutamyltransferase(γ-GGT),and waist circumference(WC),FLI was calculated as:FLI=e^(0.953 lg triglycerides(TG)+0.139 BMI+0.718 lgγ-GGT+0.053×WC-15.745)/(1+e^(0.953×lg TG+0.139×BMI+0.718×lgγ-GGT+0.053×WC-15.745))×100.LVMI was determined by Doppler echocardiography.Subgroup analysis was performed by left ventricular hypertrophy(LVH),age,BMI and FLI level in the hypertensive and normotensive populations.Results The age[(60.2±9.6)vs(53.8±10.2)years,t=-4.031,P<0.001;(64.2±11.7)vs(60.5±12.5)years,t=-3.261,P<0.001],systolic blood pressure[(119.2±11.1)vs(116.5±11.3)mm Hg,t=-1.530,P=0.127;(142.4±20.0)vs(136.7±17.1)mm Hg,t=-3.202,P<0.001]and LVMI[(117.1±23.9)vs(81.9±13.8)g/m^(2),t=-9.882,P<0.001;(125.7±27.0)vs(88.7±13.6)g/m^(2),t=-17.221,P<0.001]of the patients with LVH were higher than those without LVH in both hypertensives and normotensives.There was no significant difference in the FLI[23.02(15.52-43.13)vs 18.98(9.50-42.38),U=1.134,P=0.257;33.35(18.35-56.01)vs 39.28(19.53-58.76),U=-1.446,P=0.148]level between the two groups.Among the normotensives and hypertensives,subjects with combined LVH showed higher age,systolic blood pressure,and LVMI than those without combined LVH(all P<0.05).FLI were not statistically significant between both groups(both P>0.05).Stratified analysis by age revealed that LVMI levels were higher in the elderly group(≥60 years)than in the young and middle-aged group(<60 years,P<0.05).In hypertensives,the FLI in olderly group was lower than that in middle-aged grop[33.83(18.30-56.17)vs 40.94(22.52-62.09),U=-2.446,P=0.014].Stratified analysis by BMI revealed that FLI and LVMI in the overweight obese group(BMI≥24 kg/m^(2))were higher than those of the normal body mass group(BMI<24 kg/m^(2))(all P<0.05).In normotensives,LVMI in the FLI≥30 group was significantly higher than that in the FLI<30 group[(92.0±22.1)vs(84.6±18.6)g/m^(2),t=-3.158,P=0.002].Multivariate stepwise linear regression analysis indicated that FLI,age,smoking,and heart rate were the influence factors of LVMI for normotensives(all P<0.05),whereas in hypertensives,FLI was not an influencing factor of LVMI.Further subgroup analysis by age revealed that FLI was the influencing factor for LVMI in the elderly(≥60 years)normotensives(P<0.05).Subgroup analysis based on BMI and age showed that FLI was the influencing factor of LVMI in elderly normotensives whether they were overweight or not(all P<0.05).Conclusion For normotensive people(especially the elderly),FLI is the main influencing factor for LVMI.
作者
欧筱雯
蔡晓琪
吴萍萍
刘宇珑
谢良地
韩英
OU Xiao-wen;CAI Xiao-qi;WU Ping-ping;LIU Yu-long;XIE Liang-di;HAN Ying(Department of General Medicine,the First Affiliated Hospital of Fujian Medical University,Fuzhou,Fujian 350005,China;Department of Geriatric Medicine,the First Affiliated Hospital of Fujian Medical University,Fuzhou,Fujian 350005,China;Fujian Hypertension Research Institute,the First Affiliated Hospital of Fujian Medical University,Fuzhou,Fujian 350005,China)
出处
《中华高血压杂志》
CAS
CSCD
北大核心
2023年第1期67-77,共11页
Chinese Journal of Hypertension
基金
福建省财政补助卫生专项(BPB-HY2021)。
关键词
原发性高血压
非高血压
脂肪肝指数
左心室肥厚
essential hypertension
normotension
fatty liver index
left ventricular hypertrophy
