高血压患者微量白蛋白尿的阳性率及相关因素

Prevalence and related factors of microalbuminuria in patients with hypertension

本文研究国内高血压患者微量白蛋白尿(MAU)的阳性率及相关因素.入选102例不伴有糖尿病及原发性肾脏疾病的原发性高血压患者.用酶联免疫法测定早晨第一次尿中微量白蛋白,并以108例健康人做对照.尿中微量白蛋白小于20μg/ml为MAU阴性,在20～200μg/ml为MAU阳性.发现MAU的阳性率为23%,显著高于正常人的5%.高血压患者中,MAU阳性者与MAU阴性者相比,体重指数大、有家族史多、收缩压和平均压较高,与空腹血浆胰岛素、胰岛素敏感性指数及脂质指标无关,而且MAU阳性患者并发中风率高.以尿微量白蛋白为应变量作多元逐步线性回归,发现收缩压、体重指数和病程可进入方程;而以中风为应变量作Logistic回归分析发现尿微量白蛋白、收缩压、体重指数和腰臀比可进入方程.说明在不伴有糖尿病的高血压患者中,MAU阳性与血压升高、肥胖和家族史相关,而与胰岛素抵抗及脂质代谢无关.MAU是中风的独立相关因素.

Objective :To assess the prevalence of microalbuminuria(MAU)and its associations with cardiovascular diseases or its risk factors in patients with hyperension. Methods: The urinary albumin concentration were measured with ELISA in 102 non - diabetic primary hypertensives without primary renal disease and 108 healthy controls. Negative MAU was defined as urinary albumin concentration less than 20μg/ml, and positive MAU as 20 - 200μg/ml, Results: The prevalence of MAU in hypertensives was 23%, significantly higher than that in healthy controls.In hypertensives, the patients with positive MAU had significantly greater body mass indexes, more positive family histories, higher systolic blood pressure and mean blood pressure in contrast to patients with negative MAU.But there were no difference in serum insulin,insulin sensitive index and serum lipid indexes between the hypertensives.with postive and negative MAU. And the hypertensives with postive MAU had significantly greater prevalence of stroke than the hypertensives with negative MAU, Stepwise multiple regression analysis i-dentified systolic blood pressure, body mass index and the duration of hypertension as variables in the equation for urinary albumin concentration. And in a multivariate stepwise logistic regression model,urinary albumin concentration,systolic blood pressure, body mass index and waist hip ratio were sequentially selected as variables independently associated with stroke.Conclusion:MAU is associated with elevated blood pressure,fat and family history,but not with serum insulin,insulin resistance and serum lipid indexes, MAU is independently associated with stroke.