胱抑素C和尿酸对哈萨克族H型高血压患者初期肾损害的诊断价值研究
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摘要
背景胱抑素C(CysC)、尿酸(UA)与高血压患者的肾损害密切相关,已成为近年来研究的热点。目的探讨CysC、UA对哈萨克族H型高血压患者初期肾损害的诊断价值。方法随机抽取2014年5月—2015年8月参与新疆地区流行病学调查的哈萨克族H型高血压患者318例为研究对象,依据估算肾小球滤过率(eGFR)将患者分为肾损害组[n=174,eGFR<90 ml·min~(-1)·(1.73 m~2)~(-1)]、肾功能正常组[n=144,eGFR≥90 ml·min~(-1)·(1.73m~2)~(-1)]。比较两组患者的基线资料;分析CysC、UA与eGFR的相关性,哈萨克族H型高血压患者初期肾损害的影响因素以及CysC、UA诊断哈萨克族H型高血压患者初期肾损害的价值。结果肾损害组患者年龄、收缩压(SBP)、舒张压(DBP)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、血尿素氮(BUN)、肌酐(Cr)、同型半胱氨酸(Hcy)、CysC、UA高于肾功能正常组(P<0.05)。CysC、UA与e GFR呈负相关(r值分别为-0.791、-0.671,P<0.05)。多因素Logistic回归分析结果显示,LDL-C、CysC、UA是哈萨克族H型高血压患者初期肾损害的影响因素(P<0.05)。CysC、UA诊断哈萨克族H型高血压患者初期肾损害的受试者工作特征曲线(ROC)曲线下面积(AUC)分别为0.967[95%CI(0.946,0.989)]、0.875[95%CI(0.837,0.913)]。结论哈萨克H型高血压患者CysC、UA与初期肾损害有相关性,并对其有一定的诊断价值,可作为诊断初期肾损害的重要指标。
Background Cystatin C(CysC) and uric acid(UA) are closely related to renal impairment in patients with hypertension,and have become a hot research topic in recent years.Objective To investigate the value of CysC and UA in diagnosis of early renal impairment in Kazakh patients with H-type hypertension.Methods A total of 318 Kazakh patients with H-type hypertension who participated in the epidemiological investigation in Xinjiang between May 2014 and August 2015 were selected randomly.According to their eGFR levels,the patients were divided into a renal function impairment group[n=174,eGFR<90 ml·min~(-1)·(1.73 m~2)~(-1)] and a normal renal function group [n=144,eGFR ≥ 90 ml·min~(-1)·(1.73 m~2)~(-1)].Baseline data were compared between the two groups,and the correlations among CysC,UA and eGFR were analyzed.Factors influencing early renal impairment in Kazakh patients with H-type hypertension,as well as the value of CysC and UA in diagnosis of the condition,were investigated.Results The indicators age,systolic blood pressure(SBP),diastolic blood pressure(DBP),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),blood urea nitrogen(BUN),creatinine(Cr),homocysteine(Hcy),CysC and UA were higher in the renal function impairment group than in the normal renal function group(P<0.05).CysC and UA were negatively correlated with eGFR(r=-0.791 and-0.671,P<0.05).Multivariate Logistic regression showed that LDL-C,CysC,and UA were influencing factors for early renal impairment in Kazakh patients with H-type hypertension(P<0.05).The areas under the ROC curve(AUC) of CysC and UA in the diagnosis of early renal impairment in these patients were 0.967[95%CI(0.946,0.989)] and 0.875[95%CI(0.837,0.913)].Conclusion CysC and UA are correlated with early renal impairment in Kazakh patients with H-type hypertension and are a favorable indicator for the diagnosis of early renal impairment.
Background Cystatin C(CysC) and uric acid(UA) are closely related to renal impairment in patients with hypertension,and have become a hot research topic in recent years.Objective To investigate the value of CysC and UA in diagnosis of early renal impairment in Kazakh patients with H-type hypertension.Methods A total of 318 Kazakh patients with H-type hypertension who participated in the epidemiological investigation in Xinjiang between May 2014 and August 2015 were selected randomly.According to their eGFR levels,the patients were divided into a renal function impairment group[n=174,eGFR<90 ml·min~(-1)·(1.73 m~2)~(-1)] and a normal renal function group [n=144,eGFR ≥ 90 ml·min~(-1)·(1.73 m~2)~(-1)].Baseline data were compared between the two groups,and the correlations among CysC,UA and eGFR were analyzed.Factors influencing early renal impairment in Kazakh patients with H-type hypertension,as well as the value of CysC and UA in diagnosis of the condition,were investigated.Results The indicators age,systolic blood pressure(SBP),diastolic blood pressure(DBP),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),blood urea nitrogen(BUN),creatinine(Cr),homocysteine(Hcy),CysC and UA were higher in the renal function impairment group than in the normal renal function group(P<0.05).CysC and UA were negatively correlated with eGFR(r=-0.791 and-0.671,P<0.05).Multivariate Logistic regression showed that LDL-C,CysC,and UA were influencing factors for early renal impairment in Kazakh patients with H-type hypertension(P<0.05).The areas under the ROC curve(AUC) of CysC and UA in the diagnosis of early renal impairment in these patients were 0.967[95%CI(0.946,0.989)] and 0.875[95%CI(0.837,0.913)].Conclusion CysC and UA are correlated with early renal impairment in Kazakh patients with H-type hypertension and are a favorable indicator for the diagnosis of early renal impairment.
引文
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[13]魏丽丽,徐新娟,珠勒皮亚·司马义,等.血清胱抑素C在高血压患者肾功能评价中的应用[J].中华高血压杂志,2014,22(1):79-81.DOI:10.16439/j.cnki.1673-7245.2014.01.019.
[14]ORTUNO-ANDERIZ F,CABELLO-CLOTET N,VIDART-SIMON N,et al.Cystatin C as an early marker of acute kidney injury in septic shock[J].Rev Clin Esp,2015,215(2):83-90.DOI:10.1016/j.rce.2014.09.010.
[15]黄国秀,余文珊.2型糖尿病患者动态脉压与胱抑素C及尿微量蛋白的相关性[J].广东医学,2011,32(3):367-368.DOI:10.3969/j.issn.1001-9448.2011.03.040.
[16]刘华,林娜.高尿酸血症患者早期肾损害特点[J].中国老年学杂志,2015,35(12):3312-3313.DOI:10.3969/j.issn.1005-9202.2015.12.057.
[17]寇惠娟,韩振华,董新,等.高血压高尿酸血症患者与肾损害的关系[J].陕西医学杂志,2016,45(4):415-416.DOI:10.3969/j.issn.1000-7377.2016.04.015.
[18]KANG D H,NAKAGAWA T,FENG L,et al.A role for uric acid in the progression of renal disease[J].J Am Soc Nephrol,2002,13(12):2888-2897.
[19]ANAND N N,PADMA V,PRASAD A,et al.Serum uric acid in new and recent onset primary hypertension[J].J Pharm Bioallied Sci,2015,7(Suppl 1):S4-8.DOI:10.4103/0975-7406.155763.
[20]NAKANISHI N,OKAMOTO M,YOSHIDA H,et al.Serum uric acid and risk for development of hypertension and impaired fasting glucose or typeⅡdiabetes in Japanese male office workers[J].Eur J Epidemiol,2003,18(6):523-530.
[2]高向阳,杨春显,周紫燕,等.胱抑素C在原发性高血压早期肾损害诊断中的临床意义[J].中国卫生检验杂志,2015,25(23):4090-4091,4094.GAO X Y,YANG C X,ZHOU Z Y,et al.The clinical significance of serum cystatin C in the diagnosis of patients with essential hypertension early renal damage[J].Chinese Journal of Health Laboratory Technology,2015,25(23):4090-4091,4094.
[3]莫新玲,杨锡恒,谢婷,等.H型高血压患者Hcy、Cyst-C、UACR与早期肾损害的关系[J].广东医学,2015,36(23):3623-3626.MO X L,YANG X H,XIE T,et al.Relationship of homocysteine,cystain C,urinary albumin to creatinine ratio with early renal injury in H-type hypertension patients[J].Guangdong Medical Journal,2015,36(23):3623-3626.
[4]GUO S,PANG H,GUO H,et al.Ethnic differences in the prevalence of high homocysteine levels among low-income rural Kazakh and Uyghur adults in far western China and its implications for preventive public health[J].Int J Environ Res Public Health,2015,12(5):5373-5385.DOI:10.3390/ijerph120505373.
[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].中华高血压杂志,2011,19(8):701-706.Writing Group of 2010 Chinese Guidelines for the Management of Hypertension.2010 Chinese guidelines for the management of hypertension[J].Chin J Hypertens,2011,19(8):701-706.
[6]全国eGFR课题协作组.MDRD方程在我国慢性肾脏病患者中的改良和评估[J].中华肾脏病杂志,2006,22(10):589-595.DOI:10.3760/j.issn:1001-7097.2006.10.002.Chinese eGFR Investigation Collaboration.Modification and evaluation of MDRD estimating equation for Chinese patients with chronic kidney disease[J].Chinese Journal of Nephrology,2006,22(10):589-595.DOI:10.3760/j.issn:1001-7097.2006.10.002.
[7]梁海峰,杨明,刘瑜,等.血浆同型半胱氨酸水平对非ST段抬高急性冠脉综合征患者围术期心肌梗死及预后的影响研究[J].中国全科医学,2017,20(7):823-827.DOI:10.3969/j.issn.1007-9572.2017.07.013.LIANG H F,YANG M,LIU Y,et al.Effect of plasma homocysteine level on the myocardial infarction during perioperative period and prognosis of patients with non-ST segment elevation acute coronary syndrome[J].Chinese General Practice,2017,20(7):823-827.DOI:10.3969/j.issn.1007-9572.2017.07.013.
[8]ILHAN N,KUCUKSU M,KAMAN D,et al.The 677 C/TMTHFR polymorphism is associated with essential hypertension,coronary artery disease,and higher homocysteine levels[J].Arch Med Res,2008,39(1):125-130.DOI:10.1016/j.arcmed.2007.07.009.
[9]MALDONADO C,SONI C V,TODNEM N D,et al.Hyperhomocysteinemia and sudden cardiac death:potential arrhythmogenic mechanisms[J].Curr Vasc Pharmacol,2010,8(1):64-74.
[10]李瑞瑞,庞晓.血同型半胱氨酸与高血压患者脑出血的关系[J].中华高血压杂志,2014,22(2):181-183.
[11]左希宏,张会珍,王景俊.H型高血压与早期肾损害的相关性分析[J].中华临床医师杂志(电子版),2015,9(7):27-29.DOI:10.3877/cma.j.issn.1674-0785.2015.07.008.ZUO X H,ZHANG H Z,WANG J J.Correlation analysis of H type hypertension and the early renal damage[J].Chinese Journal of Clinicians(Electronic Edition),2015,9(7):27-29.DOI:10.3877/cma.j.issn.1674-0785.2015.07.008.
[12]李小雷,王忠,陈少泽,等.哈萨克族H型高血压患者血清同型半胱氨酸水平与临床特征的关系[J].山东医药,2016,56(5):13-15.DOI:10.3969/j.issn.1002-266X.2016.05.005.LI X L,WANG Z,CHEN S Z,et al.Serum homocysteine level in H-type hypertensive patients of Kazakh and its relationships with clinical features[J].Shandong Pharmaceutical,2016,56(5):13-15.DOI:10.3969/j.issn.1002-266X.2016.05.005.
[13]魏丽丽,徐新娟,珠勒皮亚·司马义,等.血清胱抑素C在高血压患者肾功能评价中的应用[J].中华高血压杂志,2014,22(1):79-81.DOI:10.16439/j.cnki.1673-7245.2014.01.019.
[14]ORTUNO-ANDERIZ F,CABELLO-CLOTET N,VIDART-SIMON N,et al.Cystatin C as an early marker of acute kidney injury in septic shock[J].Rev Clin Esp,2015,215(2):83-90.DOI:10.1016/j.rce.2014.09.010.
[15]黄国秀,余文珊.2型糖尿病患者动态脉压与胱抑素C及尿微量蛋白的相关性[J].广东医学,2011,32(3):367-368.DOI:10.3969/j.issn.1001-9448.2011.03.040.
[16]刘华,林娜.高尿酸血症患者早期肾损害特点[J].中国老年学杂志,2015,35(12):3312-3313.DOI:10.3969/j.issn.1005-9202.2015.12.057.
[17]寇惠娟,韩振华,董新,等.高血压高尿酸血症患者与肾损害的关系[J].陕西医学杂志,2016,45(4):415-416.DOI:10.3969/j.issn.1000-7377.2016.04.015.
[18]KANG D H,NAKAGAWA T,FENG L,et al.A role for uric acid in the progression of renal disease[J].J Am Soc Nephrol,2002,13(12):2888-2897.
[19]ANAND N N,PADMA V,PRASAD A,et al.Serum uric acid in new and recent onset primary hypertension[J].J Pharm Bioallied Sci,2015,7(Suppl 1):S4-8.DOI:10.4103/0975-7406.155763.
[20]NAKANISHI N,OKAMOTO M,YOSHIDA H,et al.Serum uric acid and risk for development of hypertension and impaired fasting glucose or typeⅡdiabetes in Japanese male office workers[J].Eur J Epidemiol,2003,18(6):523-530.