原发性高血压患者动态动脉硬化指数与颈动脉粥样硬化及早期肾损害的相关性研究
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摘要
目的:探讨原发性高血压(EH)患者动态动脉硬化指数(AASI)与颈动脉粥样硬化及早期肾损害的相关性。方法:选取2017年6月～2018年5月期间我院收治的147例EH患者记为EH组,根据患者颈动脉内中膜厚度(IMT)的不同,将IMT≥1.0 mm的患者记为颈动脉硬化组(n=78),IMT<1.0 mm的患者记为无颈动脉硬化组(n=69);根据患者尿微量白蛋白(MAU)水平的不同,将MAU水平为0～30 mg/24 h的患者记为MAU正常组(n=86),MAU水平为30～300 mg/24 h的患者记为MAU升高组(n=61)。另选取同期于我院进行体检的健康志愿者60例记为对照组。比较EH组与对照组临床资料,比较EH患者中颈动脉硬化组、无颈动脉硬化组的AASI、颈动脉弹性功能参数,比较MAU正常组、MAU升高组的AASI、肾功能指标,采用Pearson相关性分析分析EH患者AASI与颈动脉粥样硬化及早期肾损害的相关性。结果:EH组吸烟人数、糖尿病人数、收缩压、舒张压、IMT、AASI、MAU显著高于对照组(P<0.05)。颈动脉硬化组AASI、血管压力应变弹性系数(Ep)、硬度指数均显著高于无颈动脉硬化组(P<0.05),血管顺应性(AC)明显低于无颈动脉硬化组(P<0.05)。MAU升高组AASI显著高于MAU正常组(P<0.05),PRO显著低于MAU正常组(P<0.05);而MAU升高组与MAU正常组肾小球滤过率(GFR)、肌酐清除率(CCr)比较差异无统计学意义(P>0.05)。经Pearson相关性分析显示,EH患者中AASI与IMT、MAU、Ep、硬度指数均呈正相关性(P<0.05),与PRO、AC呈负相关(P<0.05),与GFR、CCr无相关性(P>0.05)。结论:EH患者AASI与颈动脉粥样硬化及早期肾损害情况关系密切,临床可通过监测AASI,以尽早了解患者心血管事件发生风险及靶器官损伤程度。
Objective: To investigate the correlation between ambulatory arterial stiffness index(AASI) and carotid atherosclerosis and early renal damage in patients with essential hypertension(EH). Methods: 147 patients with EH who were admitted to our hospital from June 2017 to May 2018 were selected as EH group. According to the difference of carotid artery intima-media thickness(IMT), the patients with IMT≥1.0 mm were recorded as carotid atherosclerosis group(n=78), and the patients with IMT<1.0 mm were recorded as non-carotid atherosclerosis group(n=69). According to the difference of urine microalbumin(MAU) level, the patients with MAU level of 0～30 mg/24 h were recorded as MAU normal group(n=86), the patients with MAU level of 30～300 mg/24 h were recorded as MAU elevation group(n=61). Another 60 healthy volunteers in our hospital during the same period were selected as control group. The clinical data of EH group and control group were compared. The AASI and carotid artery elasticity function parameters in carotid atherosclerosis group and non-carotid atherosclerosis group were compared in EH patients. The AASI and renal function indexes of MAU normal group and MAU elevation group were compared. Pearson correlation analysis was used to analyze the correlation between AASI and carotid atherosclerosis and early renal damage in EH patients. Results: The smoking number, diabetes number, systolic blood pressure, diastolic blood pressure, IMT, AASI and MAU in the EH group were significantly higher than those in the the control group(P<0.05). The AASI,pressure-strain elastic coefficient(Ep) and hardness index in the carotid atherosclerosis group were significantly higher than those in the non-carotid atherosclerosis group(P<0.05), vascular compliance(AC) was significantly lower than that in the non-carotid atherosclerosis group(P<0.05). The AASI in the MAU elevation group was significantly higher than that in the MAU normal group(P<0.05), PRO was significantly lower than that in the MAU normal group(P<0.05). But there were no significant differences in glomerular filtration rate(GFR) and creatinine clearance rate(CCr) between the MAU elevation group and the MAU normal group(P>0.05). Pearson correlation analysis showed that, there were positive correlation between AASI and IMT, MAU, Ep and hardness index in the EH patients(P<0.05),there was a negative correlation with AC, PRO(P<0.05), there were no correlation with GFR and CCr(P>0.05). Conclusion: AASI in EH patients is closely related to carotid atherosclerosis and early renal damage, the clinic can be monitored through AASI, so it can understand the risk of cardiovascular events and the degree of target organ injury in patients as early as possible.
Objective: To investigate the correlation between ambulatory arterial stiffness index(AASI) and carotid atherosclerosis and early renal damage in patients with essential hypertension(EH). Methods: 147 patients with EH who were admitted to our hospital from June 2017 to May 2018 were selected as EH group. According to the difference of carotid artery intima-media thickness(IMT), the patients with IMT≥1.0 mm were recorded as carotid atherosclerosis group(n=78), and the patients with IMT<1.0 mm were recorded as non-carotid atherosclerosis group(n=69). According to the difference of urine microalbumin(MAU) level, the patients with MAU level of 0～30 mg/24 h were recorded as MAU normal group(n=86), the patients with MAU level of 30～300 mg/24 h were recorded as MAU elevation group(n=61). Another 60 healthy volunteers in our hospital during the same period were selected as control group. The clinical data of EH group and control group were compared. The AASI and carotid artery elasticity function parameters in carotid atherosclerosis group and non-carotid atherosclerosis group were compared in EH patients. The AASI and renal function indexes of MAU normal group and MAU elevation group were compared. Pearson correlation analysis was used to analyze the correlation between AASI and carotid atherosclerosis and early renal damage in EH patients. Results: The smoking number, diabetes number, systolic blood pressure, diastolic blood pressure, IMT, AASI and MAU in the EH group were significantly higher than those in the the control group(P<0.05). The AASI,pressure-strain elastic coefficient(Ep) and hardness index in the carotid atherosclerosis group were significantly higher than those in the non-carotid atherosclerosis group(P<0.05), vascular compliance(AC) was significantly lower than that in the non-carotid atherosclerosis group(P<0.05). The AASI in the MAU elevation group was significantly higher than that in the MAU normal group(P<0.05), PRO was significantly lower than that in the MAU normal group(P<0.05). But there were no significant differences in glomerular filtration rate(GFR) and creatinine clearance rate(CCr) between the MAU elevation group and the MAU normal group(P>0.05). Pearson correlation analysis showed that, there were positive correlation between AASI and IMT, MAU, Ep and hardness index in the EH patients(P<0.05),there was a negative correlation with AC, PRO(P<0.05), there were no correlation with GFR and CCr(P>0.05). Conclusion: AASI in EH patients is closely related to carotid atherosclerosis and early renal damage, the clinic can be monitored through AASI, so it can understand the risk of cardiovascular events and the degree of target organ injury in patients as early as possible.
引文
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[7]陈云,袁如玉,李广平,等.动态动脉硬化指数的相关因素及其对靶器官损害的研究[J].天津医药,2014,42(5):477-480
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[14]邢舒平,鞠卫萍,张爱娟,等.原发性高血压合并腔隙性脑梗死患者血压晨峰与颈动脉粥样硬化的关系[J].中国医药导报,2016,13(23):75-78
[15]Acar T,Güzey Aras Y,Gül SS,et al.Can high uric acid levels be an independent risk factor for acute ischemic stroke due to large-artery atherosclerosis?[J].Ideggyogy Sz,2018,71(7-08):279-283
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[17]蔡文花,李丽敏,王雪敏,等.原发性高血压患者动脉硬化指数与颈动脉粥样硬化的相关性[J].海南医学院学报,2016,22(8):751-753757
[18]杜国峰,张志敏,向文海,等.高血压患者动态动脉硬化指数对靶器官损害的早期预测[J].临床心血管病杂志,2011,27(8):571-573
[19]Braun MC,Herring SM,Gokul N,et al.Hypertensive renal injury is associated with gene variation affecting immune signaling[J].Circ Cardiovasc Genet,2014,7(6):903-910
[20]Taramasso L,Mirabella M,Cappadona F,et al.Hypertensive Versus HIV-infected Patients:Who Has the Greatest Target Organ Damage Comparison of Carotid Plaque Prevalence,Intima Media Thickness and Renal Resistive Index in the Two Groups of Patients[J].Curr Hypertens Rev,2018,14(1):48-55
[21]Chen Y,Liu JH,Zhen Z,et al.Assessment of left ventricular function and peripheral vascular arterial stiffness in patients with dipper and non-dipper hypertension[J].J Investig Med,2018,66(2):319-324
[22]Peters CD,Mathiassen ON,Vase H,et al.The effect of renal denervation on arterial stiffness,central blood pressure and heart rate variability in treatment resistant essential hypertension:a substudy of a randomized sham-controlled double-blinded trial(the Re SET trial)[J].Blood Press,2017,26(6):366-380
[23]Yan S,Li M,Wang H,et al.Characteristics and risk factors of pulmonary arterial hypertension in patients with primary Sj觟gren's syndrome[J].Int J Rheum Dis,2018,21(5):1068-1075
[24]Schneider MP,Hilgers KF,Schmid M,et al.Blood pressure control in chronic kidney disease:A cross-sectional analysis from the German Chronic Kidney Disease(GCKD)study[J].PLo S One,2018,13(8):e0202604
[25]Chin HJ,Kim DK,Park JH,et al.Effect of urine urea nitrogen and protein intake adjusted by using the estimated urine creatinine excretion rate on the antiproteinuric effect of angiotensin II type I receptor blockers[J].Nutrition,2015,31(11-12):1333-1338
[2]Band R,Morton K,Stuart B,et al.Home and Online Management and Evaluation of Blood Pressure(HOME BP)digital intervention for self-management of uncontrolled,essential hypertension:a protocol for the randomised controlled HOME BP trial[J].BMJ Open,2016,6(11):e012684
[3]孙磊,孟锦,赵宏伟,等.不同剂量阿伐他汀联合阿司匹林治疗原发性高血压并动脉粥样硬化的临床研究[J].现代生物医学进展,201818(4):681-684
[4]Kurdyukov S,Eccles CA,Desai AA,et al.New cases of Glucose-6-Phosphate Dehydrogenase deficiency in Pulmonary Arterial Hypertension[J].PLoS One,2018,13(8):e0203493
[5]Sata Y,Hering D,Head GA,et al.Ambulatory arterial stiffness index as a predictor of blood pressure response to renal denervation[J].JHypertens,2018,36(6):1414-1422
[6]Walczak-Ga zewska M,Szulińska M,Miller-Kasprzak E,et al.The effect of nebivolol and ramipril on selected biochemical parameters,arterial stiffness,and circadian profile of blood pressure in young men with primary hypertension:A 12-week prospective randomized,open-label study trial[J].Medicine(Baltimore),2018,97(30):e11717
[7]陈云,袁如玉,李广平,等.动态动脉硬化指数的相关因素及其对靶器官损害的研究[J].天津医药,2014,42(5):477-480
[8]Okon T,Fengler K,Rommel KP,et al.Ambulatory arterial stiffness index:a(too)easy predictor for renal denervation success?[J].J Hypertens,2018,36(7):1604-1605
[9]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
[10]Perez-Hernandez J,Olivares D,Forner MJ,et al.Urinary exosome miR-146a is a potential marker of albuminuria in essential hypertension[J].J Transl Med,2018,16(1):228
[11]颜艳,王爽,苏爱军,等.厄贝沙坦联合氨氯地平治疗2型糖尿病合并高血压的疗效及对糖代谢和血压的影响[J].现代生物医学进展2015,15(21):4149-4152
[12]Alexander B,Baranchuk A,Haseeb S,et al.Interatrial block predicts atrial fibrillation in patients with carotid and coronary artery disease[J].J Thorac Dis,2018,10(7):4328-4334
[13]Khutan H,Aggarwal S,Kajal KS,et al.Study of carotid intimal medial thickness in essential hypertension with or without left ventricular hypertrophy[J].Ann Afr Med,2017,16(4):192-195
[14]邢舒平,鞠卫萍,张爱娟,等.原发性高血压合并腔隙性脑梗死患者血压晨峰与颈动脉粥样硬化的关系[J].中国医药导报,2016,13(23):75-78
[15]Acar T,Güzey Aras Y,Gül SS,et al.Can high uric acid levels be an independent risk factor for acute ischemic stroke due to large-artery atherosclerosis?[J].Ideggyogy Sz,2018,71(7-08):279-283
[16]Alissa EM,Helmi SR,Al-Salmi MM.Relationship between diet quality and carotid intima-media thickness in people with and without carotid atherosclerosis[J].J Family Med Prim Care,2018,7(3):531-537
[17]蔡文花,李丽敏,王雪敏,等.原发性高血压患者动脉硬化指数与颈动脉粥样硬化的相关性[J].海南医学院学报,2016,22(8):751-753757
[18]杜国峰,张志敏,向文海,等.高血压患者动态动脉硬化指数对靶器官损害的早期预测[J].临床心血管病杂志,2011,27(8):571-573
[19]Braun MC,Herring SM,Gokul N,et al.Hypertensive renal injury is associated with gene variation affecting immune signaling[J].Circ Cardiovasc Genet,2014,7(6):903-910
[20]Taramasso L,Mirabella M,Cappadona F,et al.Hypertensive Versus HIV-infected Patients:Who Has the Greatest Target Organ Damage Comparison of Carotid Plaque Prevalence,Intima Media Thickness and Renal Resistive Index in the Two Groups of Patients[J].Curr Hypertens Rev,2018,14(1):48-55
[21]Chen Y,Liu JH,Zhen Z,et al.Assessment of left ventricular function and peripheral vascular arterial stiffness in patients with dipper and non-dipper hypertension[J].J Investig Med,2018,66(2):319-324
[22]Peters CD,Mathiassen ON,Vase H,et al.The effect of renal denervation on arterial stiffness,central blood pressure and heart rate variability in treatment resistant essential hypertension:a substudy of a randomized sham-controlled double-blinded trial(the Re SET trial)[J].Blood Press,2017,26(6):366-380
[23]Yan S,Li M,Wang H,et al.Characteristics and risk factors of pulmonary arterial hypertension in patients with primary Sj觟gren's syndrome[J].Int J Rheum Dis,2018,21(5):1068-1075
[24]Schneider MP,Hilgers KF,Schmid M,et al.Blood pressure control in chronic kidney disease:A cross-sectional analysis from the German Chronic Kidney Disease(GCKD)study[J].PLo S One,2018,13(8):e0202604
[25]Chin HJ,Kim DK,Park JH,et al.Effect of urine urea nitrogen and protein intake adjusted by using the estimated urine creatinine excretion rate on the antiproteinuric effect of angiotensin II type I receptor blockers[J].Nutrition,2015,31(11-12):1333-1338