静息心率与青年高血压患者的靶器官损害的关系研究生宋江宏指导教师张源明教授专业学位领域内科学研究方向高血压的基础与临床研究2013年03月The Relationship Between Damage of Target Organs and Resting Heart Rate in Young HypertensionＡDissertation Submitted toXinjiang Medical UniversityIn Partial Fullfillment of the Requirementsfor the Degree ofMaster of MedicineBySong JianghongInternal MedicineDissertation Supervisor:Zhang YuanmingMarch,2013论文独创性说明本人申明所呈交的学位论文是在我个人在导师的指导下进行的研究工作及取得的研究成果。
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学位论文作者签名：签字日期：导师签名：签字日期：中英文缩略词对照表目录摘要 (1)Abstract (3)前言 (5)内容与方法 (6)1研究对象 (6)1.1样本来源 (6)1.2纳入标准 (6)1.3排除标准 (6)1.4分组标准 (6)2 研究方法 (6)2.1 观察指标 (6)2.2统计学处理 (7)结果 (9)讨论 (15)小结 (26)致谢 (27)参考文献 (28)综述 (32)攻读硕士学位期间发表的学位论文 (38)导师评阅表 (39)静息心率与青年高血压患者的靶器官损害的关系研究生：宋江宏导师：张源明教授摘要目的：探讨青年高血压患者的静息心率与靶器官损害的关系。
方法：入选2009-01-2012-011新疆医科大学第一附属医院高血压科住院的青年原发性高血压患者667例，年龄18~45岁，按静息心率水平分为3组，A组（<70次/min，n=170，）；B组(70次/min≤静息心率<80次/min，n=266)；C组（≥80次/min，n=231）。
（1）心脏超声检查左心室结构与收缩功能，对比各组左心室相关参数，进行完全随机设计资料的方差分析和多因素Logistic回归分析影响左心室结构与收缩功能的因素；（2）颈部超声检查颈动脉结构，对比各组颈动脉相关参数，进行完全随机设计资料的方差分析；（3）检查肾功能，对比各组肾功能相关参数，进行完全随机设计资料的方差分析。
结果：（1）3组血压比较，差异有统计学意义(P<0.01)；（2）3组左心室收缩末期内径、左心室质量、左心室射血分数比较，差异有统计学意义(P <0.05)。
C组左心室收缩末期内径、室间隔厚度、左心室质量、左心室质量指数高于B组(P<0.01或P<0.05)，而左心室射血分数低于B组(P<0.01)。
多因素Logistic回归分析结果显示，体质量指数是左心室舒张末期内径（OR=1.078）、左心室收缩末期内径（OR=1.084）的一个危险因素，入院收缩压是左心室后壁厚度（OR=1.020）、左心室收缩末期内径（OR=1.017）、左心室质量指数（OR=1.037）的一个危险因素(P<0.01或P<0.05)。
（3）三组颈动脉结构比较示：右侧颈动脉内径A组高于C组(P<0.05)，左侧颈动脉内径A组高于B组，左侧颈动脉内径A组高于C组(P<0.05)；结论：（1）青年高血压患者体质量指数是左心室舒张末期内径与左心室收缩末期内径的一个危险因素；（2）青年高血压患者入院收缩压是左心室后壁厚度、左心室收缩末期内径和左心室质量指数的一个危险因素；（3）青年高血压患者不同水平的静息心率对左心室结构和收缩功能的影响存在差异；（4）青年高血压患者的静息心率不是左心室结构和收缩功能的危险因素；（5）青年高血压患者静息心率增加颈动脉内径有减小的趋势。
关键词：高血压，静息心率，靶器官损害，青年The Relationship Between Damage of Target Organs and Resting Heart Rate in Young Hypertension Postgraduate:Song Jianghong ervisor:Zhang yuanmingAbstractObjective:To investigate the relationship between resting heart rate（RHR）and the damage of target organs in young hypertensive patients. Methods:A total of 677 primary hypertensive patients aged from 18 to 45was chosen from the first affiliated hospital of Xinjiang Medical University from January,2009 to January,2012,and hypertensives were divided into three groups according to their RHRs:group A(RHR<70bpm,n=170),group B(70bpm≤RHR<80bpm,n=266),and group C(RHR≥80bpm,n=231).（1）Indexes of left ventricular structure and systolic function were examinated by ultrasound cardiograph. The influencing factors of left ventricular structure and systolic function were analyzed by variance analysis and multi-factor Logistic regression analysis.（2）Carotid artery structure was examinated by ultrasound. The groups of carotid artery related parameters were compared and analyzed by completely random design analysis of variance.（3）The renal function was examniated. The parameters related to kidney function were compared and analyzed by completely random design of variance analysis. Results:(1)The differences in the blood pressure between the three groups had statistic significance(P<0.05)；（2）so did the differences in the left ventricular end-systolic dimension,left ventricular mass,and left ventricular ejection fraction(P<0.05).The left ventricular end-systolic dimension, nterventricular septal thickness,left ventricular massand left ventricular mass indexwere significantly higher in group C than in group B(P<0.01or P<0.05),while the left ventricular ejection fraction were significantly lower in group C than in group B(P<0.01). Multi-factor Logistic regression analysis showed that body mass index(BMI) was one of the risk factors of left ventricular end-diastolic dimension(OR value=1.078) and left ventricular end-systolic dimension(OR value=1.084),and the admission systolic blood pressure was one of the risk factors of left ventricular posterior wall thickness(ORvalue=1.020),left ventricular end-systolic dimension(OR value=1.017) and left ventricular mass index(OR value=1.037).(3)The comparison of three groups of carotid artery structure shows:the right side of the carotid artery diameter in group A was higher than group C(P<0.05),the left carotid artery diameter was higher than group B,group A left carotid artery diameter of group A was higher than group C(P<0.05).Conclusions:(1)In young hypertensive patients,BMI is one of the risk factors of left ventricular end-diastolic dimension and left ventricular end-systolic dimension.(2)Admission systolic blood pressure was one of the risk factors of left ventricular posterior wall thickness,left ventricular end-systolic dimension and left ventricular mass index.(3)Different levels of RHR have different effect on the left ventricular functure and systolic function.(4)RHR is not the risk factor of left ventricular functure and systolic function.(5)Resting heart rate increased carotid artery diameter in young patients with high blood pressure has a tendency to decrease.Key words:Hypertension;Resting Heart Rate;the Damage of Target Organs;Youth前言随着经济的快速发展、人口老龄化趋势日益加重,高血压的发病率已经越来越高,目前我国约有2亿高血压患者，每10个成年人中就有2人患有高血压，约占全球高血压总人数的1/5，高血压已成为一个严重的公共卫生风险的主要疾病。