正常高值血压人群微量白蛋白尿和小动脉顺应性的变化

The changes of microalbuminuria and small arterial compliance in high-normal blood pressure people

目的研究正常高值血压和理想血压人群中微量白蛋白尿和小动脉顺应性(C2)的变化及其影响因素。方法入选正常血压受试者153例,分成两组:理想血压组(n=53)和正常高值血压组(n=100)。检测腰围、身高、体重、坐位血压,晨起静脉空腹血糖、血脂、肝肾功能,尿液肌酐等指标;放射免疫法检测尿液微量白蛋白,计算尿液微量白蛋白与肌酐比(ACR);用HDI CVprofilorDO-2020检测大小动脉顺应性。结果理想血压组和正常高值血压组收缩压、舒张压、脉压和C2、ACR均有明显差异(P<0.05);相关分析显示,收缩压与log C2呈负相关(r=-0.439,P<0.001),与log ACR正相关(r=0.460,P<0.001);log ACR与log C2之间也有明显负相关性(r=-0.461,P<0.001);多元回归分析发现,收缩压是独立影响微量白蛋白尿和C2的指标。结论随血压水平的上升,C2逐渐降低,微量白蛋白尿水平逐渐提高,其水平的提高能一定程度上反映C2的减退;收缩压是影响正常高值血压人群微量白蛋白尿和C2的独立因素。

Objective To investigate the changes and risk factors of microalbuminuria（MAU） and small arterial compliance in subjects with high-normal blood pressure and optimal blood pressure. Methods One hundred and fifty three subjects without hypertension and diabetes were enrolled. They were divided into two groups： optimal blood pressure group and high-normal blood pressure group. Urinary microalbuminuria was detected by radioimmunoassay and arterial compliance was determined by the device of HDI CVprofilorDO-2020. MAU was defined as ACR（albumin creatinine ratio, urinary concentration of microalbuminuria/urinary concentration of creatinine） higher than 30 mg/g. Results Compared with group of optimal blood pressure, group of high-normal blood pressure was characterized by higher systolic blood pressure, diastolic blood pressure , and wider pluse pressure. Reduced small arterial compliance（C2） and increased ACR further distinguished optimal blood pressure group from high-normal blood pressure group （all P 〈 0.05）. Similar results were obtained when the above variables were analyzed by correlation analysis（SBP-log ACR, r = 0.460, P 〈 0.001; logC2-logACR, r =- 0.461, P 〈0.001; logC2-SBP, r =- 0.439, P 〈0.001）. Multivariate regression analysis showed that systolic blood pressure was an independent predictor of small arterial compliance and MAU. Conclusions High-normal blood pressure subjects were characterized by decreased C2 and increased MAU. MAU was negatively correlated with C2. The major factor influencing MAU and C2 was systolic blood pressure in highnormal blood pressure people.