Chapman A B, Johnson A M, Rainguet S, Hossack K, Gabow P, Schrier R W
Denver Health Medical Center, Colorado, USA.
J Am Soc Nephrol. 1997 Aug;8(8):1292-7. doi: 10.1681/ASN.V881292.
Cardiovascular complications are the most common cause of morbidity and mortality in patients with autosomal dominant polycystic kidney disease (ADPKD). To understand this relationship, known cardiovascular risk factors were examined in ADPKD. Left ventricular hypertrophy (LVH) is a known, important risk factor for premature cardiovascular death in patients with essential hypertension. Hypertension is known to occur frequently and early in ADPKD patients. The frequency of LVH in ADPKD patients and its relation with hypertension and other risk factors, however, is not known. In this study, echocardiographic tests were performed in 116 consecutive adult ADPKD patients and 77 healthy control subjects. There was a significantly higher frequency of LVH in ADPKD men (46 versus 20%, P < 0.05) and women (37 versus 12%, P < 0.005) compared with control subjects. LVH in ADPKD patients was associated with higher systolic and diastolic arterial BP. There also was an association between LVH, diminished renal function, and increased renal volume. When comparing ADPKD patients with and without LVH, the former were older, weighed more, had a higher prevalence of hypertension, and had a lower hematocrit value and more renal impairment. LVH was also present in 23% of normotensive ADPKD patients and 16% of healthy control subjects (P = NS), but did not correlate with BP. The role of BP as a contributing factor to LVH in ADPKD patients may be due in part to earlier onset and inadequate treatment.
心血管并发症是常染色体显性遗传性多囊肾病（ADPKD）患者发病和死亡的最常见原因。为了解这种关系，对ADPKD患者已知的心血管危险因素进行了研究。左心室肥厚（LVH）是原发性高血压患者过早发生心血管死亡的一个已知重要危险因素。已知高血压在ADPKD患者中频繁且较早出现。然而，ADPKD患者中LVH的发生率及其与高血压和其他危险因素的关系尚不清楚。在本研究中，对116例连续的成年ADPKD患者和77例健康对照者进行了超声心动图检查。与对照者相比，ADPKD男性患者（46%对20%，P<0.05）和女性患者（37%对12%，P<0.005）中LVH的发生率显著更高。ADPKD患者的LVH与收缩压和舒张压升高有关。LVH、肾功能减退和肾体积增加之间也存在关联。比较有和没有LVH的ADPKD患者时，前者年龄更大、体重更重、高血压患病率更高、血细胞比容值更低且肾功能损害更严重。正常血压的ADPKD患者中23%以及健康对照者中16%也存在LVH（P=无显著性差异），但与血压无关。血压作为ADPKD患者LVH的一个促成因素，其作用可能部分归因于发病更早和治疗不足。
