摘要
目的 探讨原发性高血压患者血甲状旁腺激素(PTH)、N末端脑钠肽前体(NT-proBNP)、脂代谢指标变化及与骨质疏松症(OP)的关系,以提高原发性高血压合并OP的诊断率,避免延误诊断.方法 选取 2022 年 1 月至2024 年4 月诊治的 164 例原发性高血压患者作为研究对象,根据骨密度值分 3 组,骨量减少组 55 例(-2.5～-1.0 SD)、骨量正常组73 例(≥-1.0 SD)、OP组36 例(＜-2.5 SD).比较3 组临床资料,血PTH、NT-proBNP及脂代谢指标[高密度脂蛋白胆固醇(HDL-C)、三酰甘油、总胆固醇、低密度脂蛋白胆固醇]水平;分析血PTH、NT-proBNP及脂代谢指标与原发性高血压合并OP的关系及预测价值.结果 3 组年龄、高血压分级、血钙、血磷、第一～第四腰椎骨密度、股骨颈骨密度比较差异有统计学意义(P＜0.05,P＜0.01).OP组PTH、NT-proBNP、三酰甘油、总胆固醇高于骨量减少组、骨量正常组,HDL-C低于骨量减少组、骨量正常组(P＜0.05).多因素Logistic回归分析结果显示,PTH、NT-proBNP、HDL-C、三酰甘油、总胆固醇与原发性高血压合并OP独立相关(P＜0.01);PTH、NT-proBNP、HDL-C、三酰甘油、总胆固醇联合预测原发性高血压合并 OP 的曲线下面积明显大于各指标单独预测.结论 PTH、NT-proBNP、HDL-C、三酰甘油、总胆固醇联合检测能明显提高原发性高血压合并OP预测价值及诊断率,避免延误诊断.
Abstract
Objective To investigate the changes in blood parathyroid hormone(PTH),N-terminal brain natriuretic peptide precursor(NT-proBNP),lipid metabolism indexes and their relationship with osteoporosis(OP)in patients with pri-mary hypertension,to improve the diagnosis rate of primary hypertension complicated with OP and avoid delayed diagnosis.Methods In total,164 patients with primary hypertension diagnosed and treated from January 2022 to April 2024 were se-lected as the research subjects.According to bone mineral density(BMD)value,they were divided into three groups:os-teopenia group(-2.5--1.0 SD,n=55),normal bone mass group(≥-1.0 SD,n=73),and OP group(＜-2.5 SD,n=36).The clinical data,the levels of blood PTH,NT-proBNP and lipid metabolism indexes[high density lipoprotein cho-lesterol(HDL-C),triacylglycerol(TAG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C)]in the three groups were compared.The relationship of blood PTH,NT-proBNP and lipid metabolism indexes with primary hypertension complicated with OP as well as their predictive value was analyzed.Results There were significant differences in age,hyper-tension grade,blood calcium,blood phosphorus,BMD of the first lumbar vertebra to the fourth lumbar vertebra,and BMD of femoral neck among the three groups(P＜0.05,P＜0.01).PTH,NT-proBNP,TAG and TC in OP group were higher than those in osteopenia group and normal bone mass group,while HDL-C was lower than that in osteopenia group and normal bone mass group(P＜0.05).Multivariate Logistic regression analysis showed that PTH,NT-proBNP,HDL-C,TAG and TC were independently correlated with primary hypertension complicated with OP(P＜0.01).The area under the curve of PTH,NT-proBNP,HDL-C,TAG and TC in combination for predicting hypertension complicated with OP was significantly greater than that predicted by each index alone.Conclusion Combined detection of PTH,NT-proBNP,HDL-C,TAG and TC can signif-icantly improve the predictive value and the diagnostic rate of primary hypertension complicated with OP,and avoid delayed diagnosis.
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