心血管疾病危险人群中微量白蛋白尿与颈动脉粥样硬化及外周动脉疾病的关系

Relationship between carotid atherosclerosis,peripheral artery disease and microalbuminuria in patients with risk factors of cardiovascular disease

目的评价存在心血管疾病危险因素但无明确心脑血管疾病的患者中,微量白蛋白尿(MA)与颈动脉粥样硬化(AS)及外周动脉疾病(PAD)的关系。方法采用横断面研究,277例住院有心血管疾病危险因素但无明确心脑血管疾病的患者,根据其尿白蛋白/肌酐(UACR)水平分为两组:微量白蛋白尿组(MA组,男:17 mg/g≤UACR≤250 mg/g;女:25 mg/g≤UACR≤355 mg/g)及不伴微量白蛋白尿组(NMA组,男:0<UACR<17 mg/g;女:0<UACR<25 mg/g),收集一般临床资料及心血管疾病危险因素,留晨尿测定UACR,空腹抽血测高敏C反应蛋白(hsCRP)、血脂、血糖和肌酐等指标,颈动脉超声测量颈总动脉内膜中层厚度(CCIMT)、颈内动脉内膜中层厚度(ICIMT)和分叉部位内膜中层厚度(CBIMT),并进行踝臂指数(ABI)测量,任意一侧肢体ABI<0.95诊断为PAD。结果MA组(53例)PAD患病率高于NMA组(224例),分别为16例(30.2%)和36例(16.1%)(P<0.05);与NMA患者相比,MA组患者表现为更高的收缩压水平、更厚的颈动脉内膜厚度(P<0.05);Logistic回归分析显示,在校正性别、年龄、高血压、糖尿病、吸烟、腰围和血脂等传统心血管危险因素以及hsCRP后,MA与PAD患病率及CCIMT增厚有关,其比值比(95%可信区间)[OR(95%CI)]分别为OR=2.523,95%CI:1.063～5.990(P<0.05)和OR=5.760,95%CI:1.701～19.504(P<0.01);在校正性别、年龄和其他心血管疾病危险因素后,MA与ICIMT及CBIMT增厚的关系消失(P>0.05)。结论心血管疾病高危患者中,伴MA者颈总动脉AS和PAD的危险性均增加,MA与颈总动脉AS的关系较与PAD的关系更加明显。

Objective To evaluate the relationship between carotid atherosclerosis, peripheral artery disease and mieroalbuminuria（MA） in patients with risk factors of cardiovascular disease （CVD） but without established CVD or cerebrovascular disease. Methods A total of 277 consecutive patients with risk factors of CVD were included in this cross-sectional study. According to urinary albumin-to-creatinine ratio （UACR） level, patients were divided into MA （male ： 17≤UACR≤250 mg/g; female： 25 ≤ UACR≤355 rag/g） group and normoalbuminuria （NMA, male： 0 〈 UACR 〈 17 mg/g; female： 0 〈 UACR 〈25 mg/g） group. Clinical data and risk factors of CVD were collected. UACR, high sensitive C-reactive protein （hsCRP）, serum lipid, fasting glucose and creatinine were measured. Common carotid intima-media thickness （CCIMT）, internal carotid intima-media thickness （ICIMT） and carotid bifurcation intima-media thickness （CBIMT） were determined by carotid artery ultrasound. Ankle/brachial blood pressure index （ABI） were measured. Either side of ABI 〈 0. 95 was diagnosed as PAD. Results The prevalence of PAD in patients with MA was significantly higher than those without （30. 2% vs. 16. 1% , P 〈 0. 05 ）. Systolic blood pressure and carotid intima-media thickness were significantly increased in patients with MA compared to those without （P 〈 0. 05 ）. After adjusting for sex, age, traditional risk factors of CVD and hsCRP, PAD and CCIMT were significantly associated with MA [ OR = 2.26, 95% CI： 1.14 -4.49, P 〈 0. 05 and OR = 5.76, 95% CI：I. 70- 19. 50, P 〈0. 01, respectively]. ICIMT and CBIMT were not associated with MA （ P 〉 0. 05 ）. Conclusions Among patients with risk factors of CVD, those with MA have increased risk of common carotid atherosclerosis and PAD. The relationship between MA and common carotid atherosclerosis is more significant than that between MA and PAD.