云南省佤族高血压人群摄盐量与早期肾损害的相关性研究
|
摘要
目的:研究云南省佤族原发性高血压人群估测摄盐量与早期肾损害的关系。方法:选取2014年10月云南省临沧市耿马县四排山乡年龄≥18岁的佤族高血压患者260例(高血压组)和佤族非高血压患者286例(非高血压组)。收集所有对象的年龄、性别、身高、体重、血压、腰围、臀围等基本信息。采集空腹静脉血测定空腹葡萄糖(GLU)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、肾功能、电解质等指标。收集点尿标本测定尿电解质、尿白蛋白、尿肌酐,通过点尿法估算24h尿钠的排泄量。结果:高血压组和非高血压组间体重、BMI、腰围、臀围、收缩压、舒张压、尿酸、TG、血钠、尿钾、估测摄盐量、随机尿白蛋白/肌酐比值均差异有统计学意义(均P<0.05)。高血压组估测摄盐量较非高血压组明显升高,差异有统计学意义[(20.21±5.48)g∶(15.08±3.03)g;P<0.05]。在佤族高血压患者中,估测摄盐量和随机尿白蛋白/肌酐比值高度相关(r=0.89,P=0.000),BMI、腰臀比、收缩压、舒张压、GLU、TG、LDL-C、尿钠/尿钾与尿白蛋白/肌酐比值具有相关性(r=0.243、0.351、0.349、0.291、0.327、0.203、0.298、0.178,均P<0.05)。多元线性回归分析显示,年龄、估测摄盐量、收缩压、舒张压、BMI与尿白蛋白/肌酐比值相关,估测摄盐量是影响尿白蛋白/肌酐比值的独立危险因素。结论:佤族人群普遍估测摄盐量高,该人群估测摄盐量和随机尿白蛋白/肌酐比值高度相关,且是早期肾损害的独立危险因素。
Objective:To investigate the correlation between salt intake and early renal damage in hypertensive patients of Wa population in Yunnan Province.Method:In October 2014,260 Wa hypertensive patients(hypertension group)and 286 Wa non-hypertensive controls(non-hypertension group)over 18 years old in Sipaishan Township,Gengma Autonomous County,Lincang City,Yunnan Province were selected.Basic data such as age,gender,height,weight,blood pressure,waist circumference,and hip circumference of all subjects were collected.Fasting venous blood was collected to measure fasting glucose(GLU),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),renal function,serum sodium(Na),serum potassium(K),uric acid and creatinine.Spot voiding urinary samples were taken to measure the urinary concentration of sodium,potassium,creatinine and microalbuminuria.The estimated daily salt intake was calculated by the point urine method.Result:There weresignificant differences in terms of height,BMI,waist circumference,hip circumference,systolic blood pressure(SBP),diastolic blood pressure(DBP),uric acid,TG,serum Na,urinary K,estimated salt intake and urinary albumin-creatinine ratio between hypertension group and non-hypertension group(all P<0.05).The level of estimated salt intake was significantly higher in hypertension group than that in non-hypertension group[(20.21±5.48)g vs(15.08±3.03)g,P<0.05].In hypertension group,estimated salt intake was highly correlated with random urinary albumin/creatinine ratio(r=0.89,P=0.000),BMI,waist-to-hip ratio,SBP,DBP,BLU,TG,LDL-C and urine Na/K were correlated with urinary albumin/creatinine ratio(r=0.243,0.351,0.349,0.291,0.327,0.203,0.298 and 0.178,all P<0.05).Multivariate linear regression analysis showed that age,estimated salt intake,SBP,DBP and BMI were associated with urinary albumin/creatinine ratio,estimated salt intake was an independent risk factor for urinary albumin/creatinine ratio.Conclusion:The salt intake is generally high in Wa population.The estimated salt intake is highly correlated with the random urinary albumin/creatinine ratio and is an independent risk factor for early renal damage.
Objective:To investigate the correlation between salt intake and early renal damage in hypertensive patients of Wa population in Yunnan Province.Method:In October 2014,260 Wa hypertensive patients(hypertension group)and 286 Wa non-hypertensive controls(non-hypertension group)over 18 years old in Sipaishan Township,Gengma Autonomous County,Lincang City,Yunnan Province were selected.Basic data such as age,gender,height,weight,blood pressure,waist circumference,and hip circumference of all subjects were collected.Fasting venous blood was collected to measure fasting glucose(GLU),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),renal function,serum sodium(Na),serum potassium(K),uric acid and creatinine.Spot voiding urinary samples were taken to measure the urinary concentration of sodium,potassium,creatinine and microalbuminuria.The estimated daily salt intake was calculated by the point urine method.Result:There weresignificant differences in terms of height,BMI,waist circumference,hip circumference,systolic blood pressure(SBP),diastolic blood pressure(DBP),uric acid,TG,serum Na,urinary K,estimated salt intake and urinary albumin-creatinine ratio between hypertension group and non-hypertension group(all P<0.05).The level of estimated salt intake was significantly higher in hypertension group than that in non-hypertension group[(20.21±5.48)g vs(15.08±3.03)g,P<0.05].In hypertension group,estimated salt intake was highly correlated with random urinary albumin/creatinine ratio(r=0.89,P=0.000),BMI,waist-to-hip ratio,SBP,DBP,BLU,TG,LDL-C and urine Na/K were correlated with urinary albumin/creatinine ratio(r=0.243,0.351,0.349,0.291,0.327,0.203,0.298 and 0.178,all P<0.05).Multivariate linear regression analysis showed that age,estimated salt intake,SBP,DBP and BMI were associated with urinary albumin/creatinine ratio,estimated salt intake was an independent risk factor for urinary albumin/creatinine ratio.Conclusion:The salt intake is generally high in Wa population.The estimated salt intake is highly correlated with the random urinary albumin/creatinine ratio and is an independent risk factor for early renal damage.
引文
[1]Felder RA,White MJ,Williams SM,et al.Diagnostic tools for hypertension and salt sensitivity testing[J].Curr Opin Nephro Hypertens,2013,22(1):65-76.
[2]Alderman MH,Cohen HW.Dietary sodium intake and cardiovascular mortality:controversy resolved?[J].Am J Hypertens,2012,25(7):727-734.
[3]Elijovich F,Weinberger MH,Anderson CA,et al.Salt Sensitivity of Blood Pressure:A Scientific Statement From the American Heart Association[J].Hypertension,2016,68(3):e7-e46.
[4]Meccariello A,Buono F,Verrengia E,et al.Microalbuminuria predicts the recurrence of cardiovascularevents in patien ts with essential hypertension[J].J Hypertens,2016,34(4):646-653.
[5]Tanaka T,Okamura T,Miura K,et al.A simple method to estimate populational 24-h urinary sodium and potassium excretion using a casual urine specimen[J].J Hum Hypertens,2002,16(2):97-103.
[6]孔虹倩,蔡乐,许庆良,等.云南独有少数民族高血压患病及控制现状[J].中国公共卫生,2016,32(6):725-728.
[7]Yang S,Liu S,Wang Y,et al.High blood pressure in Chinese ethnic minorities:report from rural Yunnan province[J].Am J Hypertens,2011,24(11):1209-1214.
[8]Elijovich F,Weinberger MH,Anderson CA,et al.Salt Sensitivity of Blood Pressure:A Scientific Statement From the American Heart Association[J].Hypertension,2016,68(3):e7-e46.
[9]孙宁玲,牟建军,李玉明.高血压患者盐摄入量评估和血压管理临床流程专家建议书[J].中国高血压杂志,2016,24(8):727-728.
[10]Tziakas D,Chalikias G,Kareli D,et al.Spot urine albumin to creatinine ratio outperforms novel acute kidney injury biomarkers in patients with acute myocardial infarction[J].Int J Cardiol,2015,197:48-55.
[11]Cowley AW Jr,Ryan RP,Kurth T,et al.Progression of glomerular filtration rate reduction determined in conscious Dahl salt-sensitive hypertensive rats[J].Hypertension,2013,62(1):85-90.
[12]Stephen R,Jolly SE,Nally JV Jr,et al.Albuminuria:when urine predicts kidney and cardiovascular disease[J].Cleve Clin J Med,2014,81(1):41-50.
[13]马慧元,王楠,马丽雅,等.老年非糖尿病高血压患者尿微量白蛋白与颈动脉硬化相关性分析[J].临床心血管病杂志,2017,33(7):667-670.
[14]Bruno RM,Daghini E,Versari D,et al.Predictive role of renal resistive index for clinical outcome after revascularization in hypertensive patients with atherosclerotic renal artery stenosis:a monocentric observational study[J].Cardiovasc Ultrasound,2014,12:9.
[15]曹锐红,陈洁,李献良.原发性高血压患者血压变异性与早期肾功能损害相关性的初步探讨[J].临床心血管病杂志,2017,33(9):880-883.
[16]National Kidney Foundation.K/DOQI clinical practice guidelines for chronic kidney disease:evaluation,classification,and stratification[J].Am J Kidney Dis,2002,39(2Suppl 1):S1-266.
[17]Yilmaz R,Akoglu H,Altun B,et al.Dietary salt intake is related to inflammation and albuminuria in primary hypertensive patients[J].Eur J Clin Nutr,2012,66(11):1214-1218.
[18]Tzemos N,Lim PO,Wong S,et al.Adverse cardiovascular effects of acute salt loading in young normotensive individual[J].Hypertension,2008,51(6):1525-1530.
[19]Ritz E,Koleganova N,Piecha G.Role of sodium Intake in the progression of chronic kidney disease[J].J Ren Nutr,2009,19(1):61-62.
[20]Endres BT,Sandoval RM,Rhodes GJ,et al.Intravital imaging of the kidney in a rat model of salt-sensitive hypertension[J].Am J Physiol Renal Physiol,2017,313(2):F163-F173.
[21]Carlstrom M,Sallstrom J,Skott O,et al.Uninephrectomy in young age or chronic salt loading causes saltsensitive hypertension in adult rats[J].Hypertension,2007,49(6):1342-1350.
[22]Wade B,Abais-Battad JM,Mattson DL.Role of immune cells in salt-sensitive hypertension and renal injury[J].Curr Opin Nephrol Hypertens,2016,25(1):22-27.
[23]Gelber RP,Kurth T,Kausz AT,et al.Association between body mass index and CKD in apparently healthy men[J].Am J Kidney dis,2005,46(5):871-880.
[24]Taylor LE,Gillis EE,Musall JB,et al.High-fat dietinduced hypertension is associated with a proinflammatory T cell profile in male and female Dahl salt-sensitive rats[J].Am J Physiol Heart Circ Physiol,2018,315(6):H1713-H1723.
[2]Alderman MH,Cohen HW.Dietary sodium intake and cardiovascular mortality:controversy resolved?[J].Am J Hypertens,2012,25(7):727-734.
[3]Elijovich F,Weinberger MH,Anderson CA,et al.Salt Sensitivity of Blood Pressure:A Scientific Statement From the American Heart Association[J].Hypertension,2016,68(3):e7-e46.
[4]Meccariello A,Buono F,Verrengia E,et al.Microalbuminuria predicts the recurrence of cardiovascularevents in patien ts with essential hypertension[J].J Hypertens,2016,34(4):646-653.
[5]Tanaka T,Okamura T,Miura K,et al.A simple method to estimate populational 24-h urinary sodium and potassium excretion using a casual urine specimen[J].J Hum Hypertens,2002,16(2):97-103.
[6]孔虹倩,蔡乐,许庆良,等.云南独有少数民族高血压患病及控制现状[J].中国公共卫生,2016,32(6):725-728.
[7]Yang S,Liu S,Wang Y,et al.High blood pressure in Chinese ethnic minorities:report from rural Yunnan province[J].Am J Hypertens,2011,24(11):1209-1214.
[8]Elijovich F,Weinberger MH,Anderson CA,et al.Salt Sensitivity of Blood Pressure:A Scientific Statement From the American Heart Association[J].Hypertension,2016,68(3):e7-e46.
[9]孙宁玲,牟建军,李玉明.高血压患者盐摄入量评估和血压管理临床流程专家建议书[J].中国高血压杂志,2016,24(8):727-728.
[10]Tziakas D,Chalikias G,Kareli D,et al.Spot urine albumin to creatinine ratio outperforms novel acute kidney injury biomarkers in patients with acute myocardial infarction[J].Int J Cardiol,2015,197:48-55.
[11]Cowley AW Jr,Ryan RP,Kurth T,et al.Progression of glomerular filtration rate reduction determined in conscious Dahl salt-sensitive hypertensive rats[J].Hypertension,2013,62(1):85-90.
[12]Stephen R,Jolly SE,Nally JV Jr,et al.Albuminuria:when urine predicts kidney and cardiovascular disease[J].Cleve Clin J Med,2014,81(1):41-50.
[13]马慧元,王楠,马丽雅,等.老年非糖尿病高血压患者尿微量白蛋白与颈动脉硬化相关性分析[J].临床心血管病杂志,2017,33(7):667-670.
[14]Bruno RM,Daghini E,Versari D,et al.Predictive role of renal resistive index for clinical outcome after revascularization in hypertensive patients with atherosclerotic renal artery stenosis:a monocentric observational study[J].Cardiovasc Ultrasound,2014,12:9.
[15]曹锐红,陈洁,李献良.原发性高血压患者血压变异性与早期肾功能损害相关性的初步探讨[J].临床心血管病杂志,2017,33(9):880-883.
[16]National Kidney Foundation.K/DOQI clinical practice guidelines for chronic kidney disease:evaluation,classification,and stratification[J].Am J Kidney Dis,2002,39(2Suppl 1):S1-266.
[17]Yilmaz R,Akoglu H,Altun B,et al.Dietary salt intake is related to inflammation and albuminuria in primary hypertensive patients[J].Eur J Clin Nutr,2012,66(11):1214-1218.
[18]Tzemos N,Lim PO,Wong S,et al.Adverse cardiovascular effects of acute salt loading in young normotensive individual[J].Hypertension,2008,51(6):1525-1530.
[19]Ritz E,Koleganova N,Piecha G.Role of sodium Intake in the progression of chronic kidney disease[J].J Ren Nutr,2009,19(1):61-62.
[20]Endres BT,Sandoval RM,Rhodes GJ,et al.Intravital imaging of the kidney in a rat model of salt-sensitive hypertension[J].Am J Physiol Renal Physiol,2017,313(2):F163-F173.
[21]Carlstrom M,Sallstrom J,Skott O,et al.Uninephrectomy in young age or chronic salt loading causes saltsensitive hypertension in adult rats[J].Hypertension,2007,49(6):1342-1350.
[22]Wade B,Abais-Battad JM,Mattson DL.Role of immune cells in salt-sensitive hypertension and renal injury[J].Curr Opin Nephrol Hypertens,2016,25(1):22-27.
[23]Gelber RP,Kurth T,Kausz AT,et al.Association between body mass index and CKD in apparently healthy men[J].Am J Kidney dis,2005,46(5):871-880.
[24]Taylor LE,Gillis EE,Musall JB,et al.High-fat dietinduced hypertension is associated with a proinflammatory T cell profile in male and female Dahl salt-sensitive rats[J].Am J Physiol Heart Circ Physiol,2018,315(6):H1713-H1723.