摘要
目的:探讨代谢综合征组分与高血压患者早期肾损害的关系。方法:对399例肾功能正常且未治疗的原发性高血压患者进行横断面调查,测定身高、体质量、腰围、血脂、血糖等生化指标。根据Cockcroft-Gault公式计算肾小球滤过率(e GFR)诊断CKD,采用国际糖尿病联盟(IDF)全球共识定义诊断代谢综合征(MS),将患者分为MS组(n=246)和非MS组(n=153),比较两组患者临床特点差异;分析MS组分与高血压早期肾损害的关系。结果:(1)MS组BMI、腰围、TG、HDL-C、舒张压、尿酸、肌酐值、尿微量白蛋白/尿肌酐(ACR)值均高于非MS组,MS组e GFR水平低于非MS组(P<0.05)。(2)在MS组中,组分数与ACR的相关性分析显示,随MS组分的增多ACR水平呈逐渐上升趋势,5个代谢组分时达到最高值(P<0.05)。而在e GFR与代谢综合征组分数相关性分析中发现,2个代谢组分时e GFR水平达到最高(P<0.05),当≥3个代谢组分时,e GFR随着代谢组分的增加而减少。(3)二分类Logistic回归分析结果提示MS组分中空腹血糖受损、TG增高和血压分级是高血压早期肾损害的危险因素,而腹型肥胖和低水平HDL无明显影响。用年龄和性别因素校正后,空腹血糖受损、TG增高、血压分级与高血压早期肾损害仍显著有关(OR分别为1.852,3.622和1.6,P<0.05)。结论:MS组分与高血压早期肾损害之间有显著相关性,这种相关性随MS组分的增多而增加,其中3个代谢综合征组分是e GFR代偿的临界点。代谢综合征组分中空腹血糖受损、高TG和血压与高血压早期肾损害增加相关。
Objective： To explore the relationship between the number of metabolic syndrome（ MS）components and early renal damage in patients with hypertension. Methods： A total of 399 consecutive untreated middle-aged hypertensive patients with either normal renal function were included in the cross-sectional study. Height,body weight,waist circumference,and biochemical indicators such as serum lipid and blood glucose were measured. Stage of CKD was determined by estimated glomerular filtration rate（ e GFR） based on Cockcroft-Gault formula. MS was diagnosed according to the global consensus definition made by International Confederation of diabetes federation and patients with MS were categorized under MS group（ n = 246）,whereas patients without MS were distributed to non-MS group（ n = 153）. Comparison was made between these two groups in terms of clinical characteristics,and then relationship was analysed between the number of MS and eraly renal damage in patients with hypertension. Results： Compared with non-MS group,body mass index,diastolicblood pressure（ DBP）,urinary microalbuminuria-to-creatinine ratio and serum levels of TG,HDL,creatine and uric acid,were significantly increased in MS group,while e GFR was significantly reduced（ P 〈0. 05）.（2）In MS group,the correlation analysis between number of MS components and ACR showed that ACR level rised gradually with the increasing mumber of MS components,and reached the highest value when MS was with 5 components（ P 〈0. 05）. The correlation analysis between e GFR level and MS components number indicated that e GFR levels were found to be the highest（ P〈 0. 05） when with 2 MS components. However,-with 3 or more MS components,a decrease in e GFR levels began to show as MS components were increased.（3）Logistic regression analysis showed that impaired fasting glucose,elevated TG levels and blood pressure grade were the risk factors for early renal injury in hypertensive patients,while abdominal obesity and low level of HDL had
出处
《心肺血管病杂志》
2018年第2期112-116,共5页
Journal of Cardiovascular and Pulmonary Diseases
基金
首都医科大学基础临床合作课题(16JL42)
2016年安贞医院院长基金资助培育项目(2016P01)
南华大学校内博士启动基金项目(2015XQD08)
关键词
高血压
代谢综合征
肾小球滤过率
尿微量白蛋白
早期肾损害
Hypertension
Metabolic syndrome
Estimated glomerular filtration rate
Microalbuminuria
Early renal damage
