原发性高血压患者口服葡萄糖耐量试验血糖水平与早期肾损伤的关系
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摘要
目的在糖尿病前期阶段就可出现微血管病变。文中观察口服葡萄糖耐量试验(OGTT) 1小时血糖(1hPG)及2小时血糖(2hPG)水平与尿微量白蛋白与肌酐比值(ACR)的关系。方法回顾性分析郑州大学第二附属医院心内科2016年10月至2018年4月门诊及住院符合2010中国高血压防治指南诊断标准的2级及以上原发性高血压患者408例,病程10年以内。所有入选者均行OGTT,并记录每位患者空腹血糖(FPG)、1hPG、2hPG。将所有入选患者按照血糖水平分为4组,血糖正常(NGT)组100例、单纯OGTT 1 h血糖升高(1hHPG)组102例、单纯OGTT 2 h血糖升高(2hHPG)组104例、OGTT 1 h和2 h血糖均升高(1 hH PG/2 hH PG)组102例;同时记录408例患者的身高、体重、BMI、性别、年龄、高血压病程、吸烟史、血压、血脂、肌酐等一般临床资料,并根据肌酐值、年龄值计算肾小球滤过率(eG FR)值。分析1hHPG及2hHPG水平与ACR的关系。结果 4组研究对象高血压病程、年龄、性别、体重指数、舒张压、脂代谢指标及空腹血糖等差异均无统计学意义(P>0.05);不同血糖升高水平情况患者的收缩压、血肌酐、eG FR、ACR差异有统计学意义(P<0. 05)。1hHPG组、2hHPG组、1hHPG/2hHPG组ACR均高于NGT组,差异有统计学意义(P <0. 01); 1hHPG/2hHPG组高于1hHPG组,差异有统计学意义(P<0.05); 1hHPG组高于2hHPG组,差异有统计学意义(P<0.05)。Logistic回归分析得出1hPG(OR=2.461,95%CI:1.947～3.112)、肌酐(OR=1.071,95%CI:1.027～1.117)以及2hPG(OR=2.016,95%CI:1.500～2.710)水平均为微量白蛋白尿的危险因素(P<0.01)。结论 1hHPG与2hHPG异常均与ACR相关,可作为预测早期肾损伤的重要指标。
Objective More and more research shows microangiopathy may occur in the early stage of diabetes. The purpose of this study was to observe the relationship between OGTT 1-hour hyperglycemia( 1 hPG) and 2-hour hyperglycemia( 2 hPG) levels and urinary albumin creatinine ratio( UACR). Methods We retrospectively analyzed 408 patients with primary hypertension of grade 2 or above who were eligible for 2015 World Health Organization( WHO) outpatient and inpatient visits from September 2015 to April 2018 in our hospital for a course of up to 10 years. All selected participants underwent an OGTT test( 1 and 2 hour post-sugar glucose) and records were made on fasting plasma glucose( FPG),OGTT1-hour blood glucose( 1 h PG),OGTT 2-hour blood glucose( 2 h PG). All the patients were divided into 4 groups according to blood glucose levels: NGT group( n = 100),1 h PG group( n = 102),2 h PG group( n = 104),1 h PG/2 h PG group( n = 102). Records were made on the clinical data of 408 patients,including height,weight,BMI,gender,age,history of hypertension,smoking history,blood pressure,blood lipids,creatinine and other general clinical data,and the calculation of glomerular filtration rate( e GFR) values was based on creatinine values and age values to analyze the relationship between 1 h HPG and 2 h HPG levels with ACR. Results No significant difference was found among the four groups in the aspects of hypertension course,age,gender,body mass index( BMI),diastolic blood pressure,lipid metabolism index and fasting blood glucose( P>0.05). There were significant difference in systolic blood pressure,serumcreatinine,e GFR,and ACR among different levels of increased blood glucose( P< 0.05). ACR in 1 h PG group,2 h PG group and 1 h PG/2 h PG group were significantly higher than NGT group( P<0.01),ACR in 1 h HPG/2 hHPG was significantly higher than 1 h PG group( P<0.05) and ACR in 1 h PG group was significantly higher than 2 h HPG group( P<0.05). The logistic regression analysis showed that 1 h PG( OR = 2.461,95%CI: 1.947-3.112),creatinine( OR = 1.071,95%CI: 1.027-1.117) and 2 h PG( OR = 2.016,95%CI: 1.500-2.710) were risk factors for microalbuminuria( P<0.01). Conclusion The abnormalities of 1 h PG and 2 h PG are associated with ACR,which may become the key index for predicting early kidney damage.
Objective More and more research shows microangiopathy may occur in the early stage of diabetes. The purpose of this study was to observe the relationship between OGTT 1-hour hyperglycemia( 1 hPG) and 2-hour hyperglycemia( 2 hPG) levels and urinary albumin creatinine ratio( UACR). Methods We retrospectively analyzed 408 patients with primary hypertension of grade 2 or above who were eligible for 2015 World Health Organization( WHO) outpatient and inpatient visits from September 2015 to April 2018 in our hospital for a course of up to 10 years. All selected participants underwent an OGTT test( 1 and 2 hour post-sugar glucose) and records were made on fasting plasma glucose( FPG),OGTT1-hour blood glucose( 1 h PG),OGTT 2-hour blood glucose( 2 h PG). All the patients were divided into 4 groups according to blood glucose levels: NGT group( n = 100),1 h PG group( n = 102),2 h PG group( n = 104),1 h PG/2 h PG group( n = 102). Records were made on the clinical data of 408 patients,including height,weight,BMI,gender,age,history of hypertension,smoking history,blood pressure,blood lipids,creatinine and other general clinical data,and the calculation of glomerular filtration rate( e GFR) values was based on creatinine values and age values to analyze the relationship between 1 h HPG and 2 h HPG levels with ACR. Results No significant difference was found among the four groups in the aspects of hypertension course,age,gender,body mass index( BMI),diastolic blood pressure,lipid metabolism index and fasting blood glucose( P>0.05). There were significant difference in systolic blood pressure,serumcreatinine,e GFR,and ACR among different levels of increased blood glucose( P< 0.05). ACR in 1 h PG group,2 h PG group and 1 h PG/2 h PG group were significantly higher than NGT group( P<0.01),ACR in 1 h HPG/2 hHPG was significantly higher than 1 h PG group( P<0.05) and ACR in 1 h PG group was significantly higher than 2 h HPG group( P<0.05). The logistic regression analysis showed that 1 h PG( OR = 2.461,95%CI: 1.947-3.112),creatinine( OR = 1.071,95%CI: 1.027-1.117) and 2 h PG( OR = 2.016,95%CI: 1.500-2.710) were risk factors for microalbuminuria( P<0.01). Conclusion The abnormalities of 1 h PG and 2 h PG are associated with ACR,which may become the key index for predicting early kidney damage.
引文
[1]丁波,高谷,李倩,等.原发性高血压对胰岛素抵抗及胰岛β细胞功能影响的研究[J].医学研究生学报,2009,22(10):1073-1076.
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[12]Cubeddu LX,Hoffmann IS.One-hour postload plasma glucose level,a prediclor of additional risk for diabetes:prevalence,mechanisms and associated cardiovascular and melabolic risk factors in Hispanics[J].Melab Syndr Relat Disord,2010,8:395-402.
[13]孙宁玲,郭晓蒽,林善锬,等.高血压与糖尿病患者微量白蛋白尿的筛查干预中国专家共识[J].中华高血压杂志,2012(5):423-428.
[14]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[15]Nathan DM.Diabetes:advances in diagnosis and treatment[J].JAMA,2015,314(10):1052-1062.
[16]Menne J,Izzo JJ,Ito S,et al.Prevention of microalbuminuria in patients with type 2 diabetas and hypertension[J].J Hypertens,2012,30(4):811-818.
[17]蔡文娟,李洋,门岚,等.尿微量白蛋白/肌酐比值对糖尿病肾病早期诊断价值[J],中国实验诊断学,2013,17(9):1650-1653.
[18]潘斌斌,苏晓飞,朱剑,等.高血压合并糖耐量受损患者肾小球滤过率差异分析[J].医学研究生学报,2013,26(6):568-600.
[2]李辉,李晓华.应用动态血压评估乐卡地平治疗青年原发性高血压患者疗效的临床分析[J].医学研究生学报,2013,26(2):172-174.
[3]中华医学会糖尿病分会.中国2型糖尿病防治指南(2017版)[J].中华糖尿病杂志,2018,10(1):4-67.
[4]李红,李霖.血糖波动与氧化应激[J].中华医学杂志,2010,90:2956-2958.
[5]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华心血管病杂志,2011,39(7):579-616.
[6]孙兵兵,赵玉兰,董静.服糖后1h及2h血糖变化与颈动脉内膜中层厚度的关系[J].中国循环杂志,2015,30(12):1200-1203.
[7]母义明,纪立农,杨文英,等.中国2型糖尿病患者餐后高血糖管理专家共识[J].中国糖尿病杂志,2016,24(5):385-395.
[8]安艳荣,陈凯庭,董学勤.等.单纯口服葡萄糖耐量试验1小时高血糖人群的动态血糖变化[J].临床荟萃,2014,29:333-335.
[9]孙宁玲,王鸿懿.中国高血压病患者微量白蛋白尿检出的分析[J].中华心血管病杂志,2009,37:2-3.
[10]曹永吉,石爱香,孙克德,等.OGTT中1小时高血糖者的代谢特征[J].中外医学研究,2013,11:5-7.
[11]蔡洹,刘新峰.糖尿病与高血压交互作用对缺血性卒中严重程度的影响[J].医学研究生学报,2016,29(11):1131-1135.
[12]Cubeddu LX,Hoffmann IS.One-hour postload plasma glucose level,a prediclor of additional risk for diabetes:prevalence,mechanisms and associated cardiovascular and melabolic risk factors in Hispanics[J].Melab Syndr Relat Disord,2010,8:395-402.
[13]孙宁玲,郭晓蒽,林善锬,等.高血压与糖尿病患者微量白蛋白尿的筛查干预中国专家共识[J].中华高血压杂志,2012(5):423-428.
[14]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[15]Nathan DM.Diabetes:advances in diagnosis and treatment[J].JAMA,2015,314(10):1052-1062.
[16]Menne J,Izzo JJ,Ito S,et al.Prevention of microalbuminuria in patients with type 2 diabetas and hypertension[J].J Hypertens,2012,30(4):811-818.
[17]蔡文娟,李洋,门岚,等.尿微量白蛋白/肌酐比值对糖尿病肾病早期诊断价值[J],中国实验诊断学,2013,17(9):1650-1653.
[18]潘斌斌,苏晓飞,朱剑,等.高血压合并糖耐量受损患者肾小球滤过率差异分析[J].医学研究生学报,2013,26(6):568-600.