血清γ-谷氨酰转肽酶对高血压无症状性亚临床靶器官损害早期检出的意义
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摘要
目的:旨在探究血清γ-谷氨酰转肽酶水平与高血压无症状性亚临床靶器官损害的联系。方法:纳入2017-09-2018-09于南昌大学第二附属医院心内科住院的高血压患者501例,依据γ-谷氨酰转肽酶水平四分位点分为4组。检测血生化、尿蛋白指标,进行心脏超声、颈动脉超声、眼底照相、颅脑磁共振等检查,比较各组靶器官损害的发生率,分析高血压靶器官损害危险因素。结果:各组间颈动脉、眼底靶器官损害结果无显著差异。与第4组比较,第1组的颅脑(85.8%∶64.7%,P<0.001)、心脏(45.6%∶26.2%,P=0.001)、肾脏(32.0%∶13.5%,P<0.001)靶器官损害比例更低,第2组心脏(85.8%∶32.0%,P=0.027)、肾脏(32.0%∶12.0%,P<0.001)靶器官损害比例更低,第3组肾脏(32.0%∶18.4%,P=0.013)靶器官损害比例更低。线性趋势检验显示患者靶器官损害数量与γ-谷氨酰转肽酶水平呈线性相关(总变异:χ~2=22.522,P=0.032;线性趋势检验:χ~2=13.634,P<0.001)。多元logistic回归显示,高γ-谷氨酰转肽酶血症(>50 U/L)增加2个及以上靶器官损害的风险[比值比(OR):2.876(1.298～6.373)]。结论:高血压患者中高γ-谷氨酰转肽酶水平的患者发生靶器官损害的风险增加。血清γ-谷氨酰转肽酶水平对高血压无症状性亚临床靶器官损害早期检出的临床价值颇为可观。
Objective:To explore the association between serum γ-glutamyl transpeptidase levels and asymptomatic subclinical target organ damage in hypertension.Method:A total of 501 hypertensive patients,who admitted to the Department of Cardiology,Second Affiliated Hospital of Nanchang University from September 2017 to September 2018,were included in this study.They were divided into 4 groups according to the γ-glutamyl transpeptidase level quartile.Blood biochemistry echocardiography,carotid ultrasound,fundus photography,and brain magnetic resonance imaging were performed and urine protein was measured.The incidence of target organ damage in each group was compared,and the risk factors of target organ damage in hypertension were analyzed.Result:There was no significant difference in carotid artery and fundus target organ damage between the groups.Compared with group 4,group 1 had a lower brain(85.8% vs 64.7%,P<0.001),heart(45.6% vs 26.2%,P=0.001),and renal(32.0% vs 13.5%,P<0.001) target organ damage ratio,group 2 had a lower heart(85.8% vs 32.0%,P=0.027),renal(32.0% vs 12.0%,P<0.001) target organ damage ratio,group 3 had a lower renal(32.0% vs 18.4%,P=0.013) target organ damage ratio.Linear trend tests showed a linear correlation between the number of target organ damage and γ-glutamyl transpeptidase levels(total variation:χ~2=22.522,P=0.032;linear trend test:χ~2=13.634,P<0.001).Multivariate logistic regression showed that high γ-glutamyl transpeptidase levels(>50 U/L) increased the risk of damage to 2 or more target organs,OR:2.876(1.298-6.373).Conclusion:Hypertensive patients with high γ-glutamyl transpeptidase levels have an increased risk of target organ damage.The clinical value of serum γ-glutamyl transpeptidase level in the early detection of asymptomatic subclinical target organ damage in hypertension is considerable.
Objective:To explore the association between serum γ-glutamyl transpeptidase levels and asymptomatic subclinical target organ damage in hypertension.Method:A total of 501 hypertensive patients,who admitted to the Department of Cardiology,Second Affiliated Hospital of Nanchang University from September 2017 to September 2018,were included in this study.They were divided into 4 groups according to the γ-glutamyl transpeptidase level quartile.Blood biochemistry echocardiography,carotid ultrasound,fundus photography,and brain magnetic resonance imaging were performed and urine protein was measured.The incidence of target organ damage in each group was compared,and the risk factors of target organ damage in hypertension were analyzed.Result:There was no significant difference in carotid artery and fundus target organ damage between the groups.Compared with group 4,group 1 had a lower brain(85.8% vs 64.7%,P<0.001),heart(45.6% vs 26.2%,P=0.001),and renal(32.0% vs 13.5%,P<0.001) target organ damage ratio,group 2 had a lower heart(85.8% vs 32.0%,P=0.027),renal(32.0% vs 12.0%,P<0.001) target organ damage ratio,group 3 had a lower renal(32.0% vs 18.4%,P=0.013) target organ damage ratio.Linear trend tests showed a linear correlation between the number of target organ damage and γ-glutamyl transpeptidase levels(total variation:χ~2=22.522,P=0.032;linear trend test:χ~2=13.634,P<0.001).Multivariate logistic regression showed that high γ-glutamyl transpeptidase levels(>50 U/L) increased the risk of damage to 2 or more target organs,OR:2.876(1.298-6.373).Conclusion:Hypertensive patients with high γ-glutamyl transpeptidase levels have an increased risk of target organ damage.The clinical value of serum γ-glutamyl transpeptidase level in the early detection of asymptomatic subclinical target organ damage in hypertension is considerable.
引文
[1] 中国高血压防治指南修订委员会.中国高血压防治指南(2018年修订版)[C].第27届国际高血压学会科学会议,北京.2018.
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[10] Meister A.On the enzymology of amino acid transport[J].Science,1973,180(4081):33-39.
[11] G?zükara MY,B?rek?i A,Gür M,et al.Gamma Glutamyl Transferase Activity is Associated With Both Paraoxonase Activity and Aortic Stiffness in Hypertensive Patients[J].J Clin Lab Anal,2015,29(5):390-396.
[12] Ikai E,Ishizaki M,Suzuki Y,et al.Association between hepatic steatosis,insulin resistance and hyperinsulinaemia as related to hypertension in alcohol consumers and obese people[J].J Hum Hypertens,1995,9(2):101-105.
[13] Petrie JR,Malik MO,Balkau B,et al.Euglycemic clamp insulin sensitivity and longitudinal systolic blood pressure:role of sex[J].Hypertension,2013,62(2):404-409.
[14] Ermis N,Yagmur J,Acikgoz N,et al.Serum gamma-glutamyl transferase (GGT) levels and inflammatory activity in patients with non-dipper hypertension[J].Clin Exp Hypertens,2012,34(5):311-315.
[15] Fulsen B.Gamma-Glutamyl Transferase Activity as a Predictive Marker for Severity of Obstructive Sleep Apnea Syndrome and Concomitant Hypertension?[J].Clin Respir J,2018,12(5):1964-1973.
[16] Elsurer R,Afsar B.Morning blood pressure surge is associated with serum gamma-glutamyltransferase activity in essential hypertensive patients[J].J Hum Hypertens,2015,29(5):331-336.
[17] Li WX,Li W,Cao JQ,et al.Folate Deficiency Was Associated with Increased Alanine Aminotransferase and Glutamyl Transpeptidase Concentrations in a Chinese Hypertensive Population:A Cross-Sectional Study[J].J Nutr Sci Vitaminol (Tokyo),2016,62(4):265-271.
[18] Shen Z,Xing J,Wang Q,et al.Association between serum γ-glutamyltransferase and chronic kidney disease in urban Han Chinese:a prospective cohort study[J].Int Urol Nephrol,2017,49(2):303-312.
[19] Toshikuni N,Asaji T,Nakanishi Y,et al.Elevated Serum Gamma-glutamyl Transpeptidase Levels and Fatty Liver Strongly Predict the Presence of Carotid Plaque[J].J Atheroscler Thromb,2015,22(10):1051-1060.
[2] Ren J,Sun J,Ning F,et al.Gender differences in the association of hypertension with gamma-glutamyltransferase and alanine aminotransferase levels in Chinese adults in Qingdao,China[J].J Am Soc Hypertens,2015,9(12):951-958.
[3] Ndrepepa G,Colleran R,Kastrati A.Gamma-glutamyl transferase and the risk of atherosclerosis and coronary heart disease[J].Clin Chim Acta,2017,476:130-138.
[4] Zhang XW,Li M,Hou WS,et al.Association between Gamma-Glutamyltransferase Level and Risk of Stroke:A Systematic Review and Meta-analysis of Prospective Studies[J].J Stroke Cerebrovasc Dis,2015,24(12):2816-2823.
[5] Ndrepepa G,Kastrati A.Gamma-glutamyl transferase and cardiovascular disease[J].Ann Transl Med,2016,4(24):481.
[6] Foyer CH,Noctor G.Redox homeostasis and antioxidant signaling:a metabolic interface between stress perception and physiological responses[J].Plant Cell,2005,17(7):1866-1875.
[7] 诸骏仁,高润霖,赵水平,等.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):937-953.
[8] Yi S,Lee S,Hwang H,et al.Gamma-glutamyltransferase and cardiovascular mortality in Korean adults:A cohort study[J].Atherosclerosis,2017,265:102-109.
[9] Kunutsor S K,Apekey TA,Cheung BM.Gamma-glutamyltransferase and risk of hypertension:a systematic review and dose-response meta-analysis of prospective evidence[J].J Hypertens,2015,33(12):2373-2381.
[10] Meister A.On the enzymology of amino acid transport[J].Science,1973,180(4081):33-39.
[11] G?zükara MY,B?rek?i A,Gür M,et al.Gamma Glutamyl Transferase Activity is Associated With Both Paraoxonase Activity and Aortic Stiffness in Hypertensive Patients[J].J Clin Lab Anal,2015,29(5):390-396.
[12] Ikai E,Ishizaki M,Suzuki Y,et al.Association between hepatic steatosis,insulin resistance and hyperinsulinaemia as related to hypertension in alcohol consumers and obese people[J].J Hum Hypertens,1995,9(2):101-105.
[13] Petrie JR,Malik MO,Balkau B,et al.Euglycemic clamp insulin sensitivity and longitudinal systolic blood pressure:role of sex[J].Hypertension,2013,62(2):404-409.
[14] Ermis N,Yagmur J,Acikgoz N,et al.Serum gamma-glutamyl transferase (GGT) levels and inflammatory activity in patients with non-dipper hypertension[J].Clin Exp Hypertens,2012,34(5):311-315.
[15] Fulsen B.Gamma-Glutamyl Transferase Activity as a Predictive Marker for Severity of Obstructive Sleep Apnea Syndrome and Concomitant Hypertension?[J].Clin Respir J,2018,12(5):1964-1973.
[16] Elsurer R,Afsar B.Morning blood pressure surge is associated with serum gamma-glutamyltransferase activity in essential hypertensive patients[J].J Hum Hypertens,2015,29(5):331-336.
[17] Li WX,Li W,Cao JQ,et al.Folate Deficiency Was Associated with Increased Alanine Aminotransferase and Glutamyl Transpeptidase Concentrations in a Chinese Hypertensive Population:A Cross-Sectional Study[J].J Nutr Sci Vitaminol (Tokyo),2016,62(4):265-271.
[18] Shen Z,Xing J,Wang Q,et al.Association between serum γ-glutamyltransferase and chronic kidney disease in urban Han Chinese:a prospective cohort study[J].Int Urol Nephrol,2017,49(2):303-312.
[19] Toshikuni N,Asaji T,Nakanishi Y,et al.Elevated Serum Gamma-glutamyl Transpeptidase Levels and Fatty Liver Strongly Predict the Presence of Carotid Plaque[J].J Atheroscler Thromb,2015,22(10):1051-1060.