高血压患者尿微量白蛋白肌酐比值与中心动脉压的相关性
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摘要
目的探讨高血压患者尿微量白蛋白肌酐比值(ACR)与中心动脉压(CAP)的相关性。方法采集了2012年1月至2016年12月在新医大一附院心脏中心高血压科住院的患者673例。根据测定的随机ACR分为两组,即ACR正常组(ACR <30 mg/g,n=485)和ACR异常组(ACR≥30 mg/g,n=188)。收集这些患者的一般临床资料。运用Sphygmocor脉搏波分析系统测定中心动脉压及其相关指标:反射波增强指数(AIX)、中心动脉收缩压(CSP)、中心动脉舒张压(CDP)、脉压(CPP)、增强压(AP),分析上述指标与ACR的相关性和影响因素。结果两组患者的收缩压、舒张压、脉压差、总胆固醇、高密度脂蛋白、载脂蛋白B、CSP、CDP、CPP、AP水平比较,差异均有统计学意义(P <0.05)。Pearson相关性分析显示,ACR与AIX、CSP、CDP、CPP、AP、收缩压、舒张压、空腹血糖、总胆固醇、尿素氮呈正相关(r=0.075,P <0.05;r=0.290,P <0.01;r=0.078,P <0.05;r=0.116,P <0.01;r=0.142,P <0.01;r=0.123,P <0.01;r=0.110,P <0.01;r=0.100,P <0.01;r=0.077,P <0.05;r=0.086,P <0.05)。多元逐步回归分析显示,CSP、AP、收缩压进入回归方程。结论 CSP、AP、收缩压是ACR的危险因素,其升高可导致ACR增高。
Objective To investigate the correlation between urinary albuminto-creatinine ratio and central arterial pressure in patients with essential hypertension(EP).Methods A total of 673 EP patients were divided into the normal ACR group(ACR<30 mg/g,n=485)and the abnormal group(ACR≥30 mg/g,n=188),the clinical data of all patients were collected,Sphygmocor pulse wave analysis system was used to determine central artery-related indicators,such as central systolic pressure(CSP),central diastolic pressure(CDP),central pulse pressure(CPP),augmentation pressure(AP)and the reflected wave augmentation index.The correlation among ACR and influencing factors were analyzed.Results There were significant differences in SBP,DBP,CPP,TC,HDL-C,apolipoprotein B,CSP,CDP,CPP,AP and creatinine level between 2 groups(P<0.05,respectively).Pearson correlation analysis results showed that ACR was positively correlated with AIX,CSP,CDP,CPP,AP,SBP,DBP,fasting blood-glucose,TC and urea nitrogen(r=0.075,P<0.05;r=0.290,P<0.01;r=0.078,P<0.05;r=0.116,P<0.01;r=0.142,P<0.01;r=0.123,P<0.01;r=0.110,P<0.01;r=0.100,P<0.01;r=0.077,P<0.05;r=0.086,P<0.05).The multiple regression analysis revealed that CSP,AP and SBP could entere into the regression equation.Conclusion CSP,AP,SBP and risk factors of ACR can lead to the elevated ACR when they increase.
Objective To investigate the correlation between urinary albuminto-creatinine ratio and central arterial pressure in patients with essential hypertension(EP).Methods A total of 673 EP patients were divided into the normal ACR group(ACR<30 mg/g,n=485)and the abnormal group(ACR≥30 mg/g,n=188),the clinical data of all patients were collected,Sphygmocor pulse wave analysis system was used to determine central artery-related indicators,such as central systolic pressure(CSP),central diastolic pressure(CDP),central pulse pressure(CPP),augmentation pressure(AP)and the reflected wave augmentation index.The correlation among ACR and influencing factors were analyzed.Results There were significant differences in SBP,DBP,CPP,TC,HDL-C,apolipoprotein B,CSP,CDP,CPP,AP and creatinine level between 2 groups(P<0.05,respectively).Pearson correlation analysis results showed that ACR was positively correlated with AIX,CSP,CDP,CPP,AP,SBP,DBP,fasting blood-glucose,TC and urea nitrogen(r=0.075,P<0.05;r=0.290,P<0.01;r=0.078,P<0.05;r=0.116,P<0.01;r=0.142,P<0.01;r=0.123,P<0.01;r=0.110,P<0.01;r=0.100,P<0.01;r=0.077,P<0.05;r=0.086,P<0.05).The multiple regression analysis revealed that CSP,AP and SBP could entere into the regression equation.Conclusion CSP,AP,SBP and risk factors of ACR can lead to the elevated ACR when they increase.
引文
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[12]周京敏,崔晓通,金雪娟,等.社区老年人群尿微量白蛋白/尿肌酐比值与心血管病危险因素的关系[J].中华心血管病杂志,2011,39(5):463-467.
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[14]JANKOWSKI P,KAWECKA-JASZCZ K,CZARNECKA D.Ascending aortic blood pressure wave form is related to coronary atherosclerosis in hypertensive as well as in normotensive subjects[J].Blood Press,2007,16(4):246-253.
[15]MORGAN T,LAURI J,BERTRAM D,et al.Effect of different antihypertensive drug classes on central aortic pressure[J].Am J Hypertens,2004,17(2):118-123.
[16]ISHIKAWA T,HASHIMOTO J,MORITO R H,et al.Association of micro-albuminuria with brachial-ankle pulse wave velocity:the Ohasama study[J].Am J Hypertens,2008,21(4):413-418.
[17]MULB G,COTTONE S,CUSIMANO P,et al.The association of micro-albuminuria with aortic stiffness is independent of C-reactive protein in essential hypertension[J].Am J Hypertens,2009,22(10):1041-1047.
[18]CERASOLA G,COTTONE S,MULB G.The progressive pathway of microalbuminuria:from early marker of renal damage to strong cardiovascular risk predictor[J].J Hypertens,2010,28(12):2357-2369.
[19]BUSARI O A,OPADIJO O G,OLAREWAJU O T.Microalbuminuria and its relations with serum lipid abnormalities in adult Nigerians with newly diagnosed hypertension[J].Ann Afr Med,2010,9(2):62-67.
[20]DURAN M,KALAY N,ARDIC I,et al.Mieroalbuminuria is not associated with endothelial dysfunction and coronary atherosclerosis in patients with acute coronary syndromes[J].Ren Fail,2010,32(6):659-665.
[21]KOHARA K,TABARA Y,TACHIBANA R,et al.Microalbuminuria and arterial stiffness in a general population:the Shimanami Health Promoting Program(J-SHIPP)study[J].Hypertens Res,2004,27(7):471-477.
[22]王鲁雁,孙宁玲,常玲,等.高血压糖尿病患者尿微量白蛋白与动脉弹性之间的关系[J].中华心血管病杂志,2006,34(5):387-390.
[23]CUSPIDI C,MACCA G,SAMPIERI L,et al.Target organ damage and non-dipping pattern defined by two sessions of ambulatory blood pressure monitoring in recently diagnosed essential hypertensive patients[J].J Hypertens,2001,19(9):1539-1545.
[24]郭舜奇,唐小玲,许少英.高血压患者脉压对尿微量清蛋白的影响[J].中华高血压杂志,2006,14(10):839-840.
[25]陈筱涛,王益芳,谢红武,等.肾动态显像在原发性高血压肾损害的临床应用[J].实用心脑肺血管病杂志,2010,18(6):769-770.
[2]HARA H,KOUGAMI K,SHIMOKAWA K,et al.The prevalence and risk factors of microalbuminuria in hypertensive patients under current medical treatment[J].Intern Med,2014,53(12):1275-1281.
[3]CHEN S C,CHANG J M,TSAI J C,et al.A systolic parameter defined as the ratio of brachial pre-ejection period to brachial ejection time predicts cardiovascular events in patients with chronic kidney disease[J].Circ J,2010,74(10):2206-2210.
[4]WEBER T,AUER J,O'ROURKE M F,et al.Arterial stiffness,wave reflections,and the risk of coronary artery disease[J].Circulation,2004,109:184-189.
[5]WEBER T,AUER J,O'ROURKE M F,et al.Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions[J]Eur Heart J,2005,26:2657-2663.
[6]BARNES J N,NUALNIM N,SUGAWARA J,et al.Arterial stiffening,wave reflection,and inflammation in habitually exercising systemic lupus erythematosus patients[J].Am J Hypertens,2011,24:1194-1200.
[7]VLACHOPOULOS C V,TERENTES-PRINTZIOS D G,et al.Prediction of cardiovascular events and all-cause mortality with erectile dysfunction:a systematic review and meta-analysis of cohort studies[J].Circ Cardiovasc Qual Outcomes,2013,6(1):99-109.
[8]MANCIA G,FAGARD R,NARKIEWICZ K,et al.2013ESH/ESC Guidelines for the management of arterial hypertension:the Task Force for the management of arterial hypertension of the European Society of Hypertension(ESH)and of the European Society of Cardiology(ESC)[J].J Hypertens,2013,31(7):1281-1357.
[9]DIMITROVA G,KATO S.Color Doppler imaging of retinal diseases[J].Surv Ophthalmol,2010,55(3):193-214.
[10]MAISEL A S.Cardiovascular and renal surrogate markers in the clinical management of hypertension[J].Cardiovasc Drugs Ther,2009,23(4):317-326.
[11]DING J,PENG H,PENG Y,et al.Urinary albumin-to-creatinine ratio in a first-morning void urine and prehypertension among Chinese Han women[J].Blood Press,2012,21(2):128-133.
[12]周京敏,崔晓通,金雪娟,等.社区老年人群尿微量白蛋白/尿肌酐比值与心血管病危险因素的关系[J].中华心血管病杂志,2011,39(5):463-467.
[13]ROMAN M J,DEVEREUX R B,KIZER J R,et al.Central pressure more strongly relates to vascular disease and outcome than does brachial pressure:Strong Heart Study[J].Hypertension,2007,50(1):197-200.
[14]JANKOWSKI P,KAWECKA-JASZCZ K,CZARNECKA D.Ascending aortic blood pressure wave form is related to coronary atherosclerosis in hypertensive as well as in normotensive subjects[J].Blood Press,2007,16(4):246-253.
[15]MORGAN T,LAURI J,BERTRAM D,et al.Effect of different antihypertensive drug classes on central aortic pressure[J].Am J Hypertens,2004,17(2):118-123.
[16]ISHIKAWA T,HASHIMOTO J,MORITO R H,et al.Association of micro-albuminuria with brachial-ankle pulse wave velocity:the Ohasama study[J].Am J Hypertens,2008,21(4):413-418.
[17]MULB G,COTTONE S,CUSIMANO P,et al.The association of micro-albuminuria with aortic stiffness is independent of C-reactive protein in essential hypertension[J].Am J Hypertens,2009,22(10):1041-1047.
[18]CERASOLA G,COTTONE S,MULB G.The progressive pathway of microalbuminuria:from early marker of renal damage to strong cardiovascular risk predictor[J].J Hypertens,2010,28(12):2357-2369.
[19]BUSARI O A,OPADIJO O G,OLAREWAJU O T.Microalbuminuria and its relations with serum lipid abnormalities in adult Nigerians with newly diagnosed hypertension[J].Ann Afr Med,2010,9(2):62-67.
[20]DURAN M,KALAY N,ARDIC I,et al.Mieroalbuminuria is not associated with endothelial dysfunction and coronary atherosclerosis in patients with acute coronary syndromes[J].Ren Fail,2010,32(6):659-665.
[21]KOHARA K,TABARA Y,TACHIBANA R,et al.Microalbuminuria and arterial stiffness in a general population:the Shimanami Health Promoting Program(J-SHIPP)study[J].Hypertens Res,2004,27(7):471-477.
[22]王鲁雁,孙宁玲,常玲,等.高血压糖尿病患者尿微量白蛋白与动脉弹性之间的关系[J].中华心血管病杂志,2006,34(5):387-390.
[23]CUSPIDI C,MACCA G,SAMPIERI L,et al.Target organ damage and non-dipping pattern defined by two sessions of ambulatory blood pressure monitoring in recently diagnosed essential hypertensive patients[J].J Hypertens,2001,19(9):1539-1545.
[24]郭舜奇,唐小玲,许少英.高血压患者脉压对尿微量清蛋白的影响[J].中华高血压杂志,2006,14(10):839-840.
[25]陈筱涛,王益芳,谢红武,等.肾动态显像在原发性高血压肾损害的临床应用[J].实用心脑肺血管病杂志,2010,18(6):769-770.