老年高血压患者动态动脉硬化指数与估测肾小球滤过率的相关性

Ambulatory arterial stiffness index and estimated glomerular filtration rate in elderly patients with essential hypertension

目的 观察老年高血压患者动态动脉硬化指数（ AASI）与估测肾小球滤过率（eGFR）的相关性,探讨以AASI大小反应的动脉硬化程度在老年高血压患者肾功能受损中的作用.方法 218例行24小时动态血压检测血肌酐水平基本正常的老年高血压患者,根据文献方法计算AASI,以AASI≤0.55或AASI＞ 0.55分为两组,比较各组间eGFR的差异,以及运用Pearson相关分析及多元线性回归分析eGFR与AASI及年龄、平均收缩压、平均舒张压、血肌酐水平等因素的相关性.结果 与AASI≤0.55组比较,在AASI＞ 0.55组中eGFR值明显降低（P＜0.001）.Pearson 相关分析显示,eGFR与AASI呈负相关（r=-0.624,P＜0.001）,控制年龄、平均收缩压、平均舒张压、平均脉压、血肌酐水平等因素后,偏相关分析显示,eGFR仍与AASI显著相关（r=-0.343,P＜0.001）.多元逐步回归分析显示,eGFR 与肌酐水平、AASI独立相关,标准化偏回归系数分别为-0.770、-0.240,P＜0.001.结论 在老年高血压患者,AASI与eGFR呈独立负相关,AASI值增加是老年高血压患者早期肾功减退的独立危险因素.

Objective To observe the relationship between ambulatory arterial stiffness index（AASI） and estimated glomerular filtration rate（eGFR） in elderly patients with essential hypertension, and to explore the roles of arterial stiffness expressed by AASI in evaluating renal function decline in elderly patients with essential hypertension. Methods Totally 218 elderly hypertensive patients with normal serum creatinine level who underwent 24 hours ambulatory blood pressure monitoring were divided into two groups according to AASI （~〈0.55 or 〉 0.55）. The eGFR values were compared between the two groups. The correlations of eGFR with AASI, age, average systolic blood pressure, average diastolic blood pressure and serum creatinine were determined by Pearson correlation and multiple linear regression analysis. Results Compared with AASI~〈0.55 group, the eGFR level was significantly decreased in AASI 〉 0.55 group（ P 〈 0.001）. Pearson correlation analysis showed that eGFR was negatively correlated with AASI （r=- 0.624, P 〈 0.001 ） . After adjustment for age, average systolic blood pressure, average diastolic blood pressure, serum creatinine, there was still correlation between eGFR and AASI （r=-0.343, P〈 0.001）. Stepwise multiple regression analysis showed that eGFR values were independently associated with serum creatinine levels and AASI （standard partial regression coefficient： - 0.770, - 0.240, P 〈 0.001）. Conclusion The eGFR is negatively correlated with AASI and the increase of AASI is one independent risk factor of renal function decline in elderly patients with essential hypertension.