原发性高血压患者蛋白尿与腔隙性脑梗死的相关性研究
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摘要
目的探讨原发性高血压患者蛋白尿与腔隙性脑梗死的相关性。方法本研究连续性纳入郑州市中心医院2013年1月—2013年12月原发性高血压患者730例,2016年1月—2016年12月对该730例高血压患者进行随访,平均随访周期3年。分析随访前后蛋白尿和腔隙性脑梗死的患病情况,采用多因素Logistic回归方法分析蛋白尿与腔隙性脑梗死之间的相关性。结果蛋白尿基线为阴性末线为阳性的患者,腔隙性脑梗死的患病率较前增加高达23.5%(P<0.05);蛋白尿可在临床上作为高血压人群腔隙性脑梗死的独立危险因素(OR=2.244,95%CI 1.320～3.814);新发蛋白尿患者人群出现腔隙性脑梗死的风险增加至原来的2.739(95%CI 1.168～6.424)倍,同时,年龄与颈动脉斑块均构成高血压患者腔隙性脑梗死发生的独立危险因素(OR=1.055, 95%CI 1.022～1.09;OR=2.446, 95%CI=1.266～4.723)。结论在原发性高血压人群中,蛋白尿与腔隙性脑梗死的发生发展密切相关,蛋白尿发生应作为原发性高血压患者发生腔隙性脑梗死的独立预测因子。
Objective To investigate the correlation between proteinuria and lacunar infarction in patients with essential hypertension.Methods Patients with essential hypertension in Zhengzhou Central Hospital from January 2013 to December 2013 were consecutively enrolled in this study. During January 2016 to December 2016, a detailed follow-up were conducted in above population with an average follow-up period for 3 years. The prevalence of proteinuria and lacunar infarction were analyzed before and after follow-up,respectively. Multivariate Logistic regression was employed to study the correlation between proteinuria and lacunar infarction.Results In patients with negative proteinuria at the baseline and positive proteinuria at the terminal line, the increased prevalence of lacunar infarction was up to 23.5%(P<0.05). Proteinuria can be used as an independent risk factor for lacunar cerebral infarction in hypertensive patients clinically(OR=2.244,95%CI 1.320～3.814). The risk of lacunar cerebral infarction in the population with newly onset proteinuria increased to 2.739 folds(95%CI 1.168～6.424). Meanwhile, age and carotid artery plaques were another two independent risk factors for lacunar cerebral infarction in hypertensive patients(OR=1.055, 95%CI 1.022～1.09); OR=2.446, 95%CI=1.266～4.723).Conclusion Proteinuria is closely related to the occurrence and development of lacunar cerebral infarction in patients with essential hypertension, and proteinuria should be considered as an independent predictor for lacunar cerebral infarction in patients with essential hypertension.
Objective To investigate the correlation between proteinuria and lacunar infarction in patients with essential hypertension.Methods Patients with essential hypertension in Zhengzhou Central Hospital from January 2013 to December 2013 were consecutively enrolled in this study. During January 2016 to December 2016, a detailed follow-up were conducted in above population with an average follow-up period for 3 years. The prevalence of proteinuria and lacunar infarction were analyzed before and after follow-up,respectively. Multivariate Logistic regression was employed to study the correlation between proteinuria and lacunar infarction.Results In patients with negative proteinuria at the baseline and positive proteinuria at the terminal line, the increased prevalence of lacunar infarction was up to 23.5%(P<0.05). Proteinuria can be used as an independent risk factor for lacunar cerebral infarction in hypertensive patients clinically(OR=2.244,95%CI 1.320～3.814). The risk of lacunar cerebral infarction in the population with newly onset proteinuria increased to 2.739 folds(95%CI 1.168～6.424). Meanwhile, age and carotid artery plaques were another two independent risk factors for lacunar cerebral infarction in hypertensive patients(OR=1.055, 95%CI 1.022～1.09); OR=2.446, 95%CI=1.266～4.723).Conclusion Proteinuria is closely related to the occurrence and development of lacunar cerebral infarction in patients with essential hypertension, and proteinuria should be considered as an independent predictor for lacunar cerebral infarction in patients with essential hypertension.
引文
[1] 刘力生.中国高血压防治指南2010[J].中国医学前沿杂志,2011,3(5):42-93.
[2] Sandsmark DK,Messe SR,Zhang X,et al.Proteinuria,but Not eGFR,Predicts Stroke Risk in Chronic Kidney Disease:Chronic Renal Insufficiency Cohort Study[J].Stroke,2015,46(8):2075-80.
[3] 张军.短暂性脑缺血发作患者微量白蛋白尿水平和颈动脉粥样硬化的关系[J].卒中与神经疾病,2015(5):298-301.
[4] 翟志永,高岩,韩冬,等.小血管病变所致急性腔隙性脑梗死与尿微量白蛋白的相关性研究[J].中国脑血管病杂志,2014,11(9):480-484.
[5] O'Rourke MF ,Safar ME .Relationship between aortic stiffening and microvascular disease in brain and kidney:cause and logic of therapy[J].Hypertension,2005,46(1):200.
[6] Toyoda K ,Ninomiya T .Stroke and cerebrovascular diseases in patients with chronic kidney disease[J].Lancet Neurology,2014,13(8):823-833.
[7] Wang A ,Jiang R ,Su Z ,et al.Association of Persistent,Incident,and Remittent Proteinuria With Stroke Risk in Patients With Diabetes Mellitus or Prediabetes Mellitus[J].J Am Heart Assoc,2017,6(10).
[8] Li Z ,Wang A ,Cai J ,et al.Impact of proteinuria and glomerular filtration rate on risk of ischaemic and intracerebral hemorrhagic stroke:a result from the Kailuan study[J].Eur J Neurol,2015,22(2).
[9] Ninomiya T ,Perkovic V ,Verdon C ,et al.Proteinuria and Stroke:A Meta-analysis of Cohort Studies[J].Am J Kidney Dis,2009,53(3):417-425.
[10] 陈芸,周红,王辰龙.尿蛋白与急性缺血性脑梗死预后的相关性研究[J].中国实用神经疾病杂志,2017,20(5):23-25.
[11] Kdoqi Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease[J].Am J Kidney Dis,2007,49(2 Suppl 2):S12-154.
[12] Wang A,Liu X,Su Z,et al.Two-Year Changes in Proteinuria and the Risk of Stroke in the Chinese Population:A Prospective Cohort Study[J].J Am Heart Assoc,2017,6(7).
[13] 苏琳,张庆文,李卫,等.老年高血压患者不稳定性颈动脉斑块与腔隙性脑梗死、脑白质病变及认知功能障碍的关系研究[J].中国全科医学,2014,17(16):1855-1858.
[14] 张元涛.老年高血压患者并发进展性脑梗死血压波动及临床分析[J].青岛院中国老年保健医学,2017,15(3):71-72.
[15] 尹晶,孟庆伟.高血压患者血压变异性与脑梗死的临床关联分析[J].中国继续医学教育,2016,8(17):102-103.
[16] 刘忠志,王普清.老年高血压患者并发进展性脑梗死血压波动及临床分析[J].实用老年医学,2015,29(8):686-687,690.
[17] 顾秋玲.106例老年高血压合并TIA病因病机探讨与临床分析[D].青岛大学,2016.
[2] Sandsmark DK,Messe SR,Zhang X,et al.Proteinuria,but Not eGFR,Predicts Stroke Risk in Chronic Kidney Disease:Chronic Renal Insufficiency Cohort Study[J].Stroke,2015,46(8):2075-80.
[3] 张军.短暂性脑缺血发作患者微量白蛋白尿水平和颈动脉粥样硬化的关系[J].卒中与神经疾病,2015(5):298-301.
[4] 翟志永,高岩,韩冬,等.小血管病变所致急性腔隙性脑梗死与尿微量白蛋白的相关性研究[J].中国脑血管病杂志,2014,11(9):480-484.
[5] O'Rourke MF ,Safar ME .Relationship between aortic stiffening and microvascular disease in brain and kidney:cause and logic of therapy[J].Hypertension,2005,46(1):200.
[6] Toyoda K ,Ninomiya T .Stroke and cerebrovascular diseases in patients with chronic kidney disease[J].Lancet Neurology,2014,13(8):823-833.
[7] Wang A ,Jiang R ,Su Z ,et al.Association of Persistent,Incident,and Remittent Proteinuria With Stroke Risk in Patients With Diabetes Mellitus or Prediabetes Mellitus[J].J Am Heart Assoc,2017,6(10).
[8] Li Z ,Wang A ,Cai J ,et al.Impact of proteinuria and glomerular filtration rate on risk of ischaemic and intracerebral hemorrhagic stroke:a result from the Kailuan study[J].Eur J Neurol,2015,22(2).
[9] Ninomiya T ,Perkovic V ,Verdon C ,et al.Proteinuria and Stroke:A Meta-analysis of Cohort Studies[J].Am J Kidney Dis,2009,53(3):417-425.
[10] 陈芸,周红,王辰龙.尿蛋白与急性缺血性脑梗死预后的相关性研究[J].中国实用神经疾病杂志,2017,20(5):23-25.
[11] Kdoqi Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease[J].Am J Kidney Dis,2007,49(2 Suppl 2):S12-154.
[12] Wang A,Liu X,Su Z,et al.Two-Year Changes in Proteinuria and the Risk of Stroke in the Chinese Population:A Prospective Cohort Study[J].J Am Heart Assoc,2017,6(7).
[13] 苏琳,张庆文,李卫,等.老年高血压患者不稳定性颈动脉斑块与腔隙性脑梗死、脑白质病变及认知功能障碍的关系研究[J].中国全科医学,2014,17(16):1855-1858.
[14] 张元涛.老年高血压患者并发进展性脑梗死血压波动及临床分析[J].青岛院中国老年保健医学,2017,15(3):71-72.
[15] 尹晶,孟庆伟.高血压患者血压变异性与脑梗死的临床关联分析[J].中国继续医学教育,2016,8(17):102-103.
[16] 刘忠志,王普清.老年高血压患者并发进展性脑梗死血压波动及临床分析[J].实用老年医学,2015,29(8):686-687,690.
[17] 顾秋玲.106例老年高血压合并TIA病因病机探讨与临床分析[D].青岛大学,2016.