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目的:系统评价原发性醛固酮增多症(PA)患者主要的心血管事件风险相关指标的影响。方法:系统检索PubMed、Web of Science、EMBASE等数据库,寻找PA与颈总动脉内膜中层厚度(CCA-IMT)、颈动脉斑块患病率、血流介导的舒张功能(FMD)、脉搏波传导速度(PWV)、反射波增强指数(AIx)等检测指标相关的文献。结果:共纳入12篇病例对照研究(病例组445例,对照组472例)。PA与原发性高血压病相比,其CCA-IMT明显增厚[MD:0.12 mm;95%CI:(0.09,0.16);P<0.000 01],且大动脉PWV增快[MD:1.39 m/s;95%CI:(0.90,1.87);P<0.000 01],相反,其AIx和心率75次/min时标准反射波增强指数(AIx HR75)无显著差异。与血压正常的人群相比,PA患者CCA-IMT显著增厚[MD:0.16mm;95%CI:(0.05,0.27);P=0.004],大动脉PWV明显增快[MD:3.74m/s;95%CI:(3.43,4.05);P<0.000 01],AIx HR75增高[MD:8.59%;95%CI:(0.69,16.50);P=0.03],而FMD显著降低[MD:-2.52%;95%CI:(-3.64,-1.407);P<0.000 1]。meta回归模型显示糖尿病、吸烟等因素对观察结果有一定影响。结论:PA患者与亚临床动脉粥样硬化和心血管风险因素具有明显的关联性,这一发现有助于在临床工作中建立更有效的心血管事件防控策略。
OBJECTIVE: To systematically evaluate the impact of cardiovascular related risk factors on patients with primary aldosteronism (PA). Methods: The databases of PubMed, Web of Science and EMBASE were searched systematically to search for the relation between PA and carotid artery intima-media thickness (CCA-IMT), carotid plaque prevalence, blood flow-mediated diastolic function Wave velocity (PWV), enhanced reflection index (AIx) and other indicators related to the literature. Results: A total of 12 case-control studies were included (445 cases in the case group and 472 cases in the control group). The CCA-IMT was significantly thicker in PA compared with patients with essential hypertension [MD: 0.12 mm; 95% CI: (0.09, 0.16); P <0.000 01] and increased aortic PWV [MD: 1.39 m /s;95%CI:(0.90,1.87);P<0.000 01]. On the contrary, AIx and heart rate 75 beats / min when the standard reflection enhancement index (AIx HR75) no significant difference. CCA-IMT was significantly thicker in patients with PA than in those with normal normotensive (MD: 0.16 mm; 95% CI: (0.05,0.27); P = 0.004] (MD: 8.59%; 95% CI: (0.69, 16.50); P = 0.03], while FMD was significantly lower [MD: -2.52% ; 95% CI: (-3.64, -1.407); P <0.0001]. Meta-regression model showed that diabetes, smoking and other factors have some impact on the observation. CONCLUSIONS: PA patients are significantly associated with subclinical atherosclerosis and cardiovascular risk factors. This finding may help to establish a more effective cardiovascular control strategy in clinical practice.