上海郊区非糖尿病人群中低水平清蛋白尿与肱踝脉搏波传导速度的相关性分析

Correlation between low-grade albuminuria and brachial-ankle pulse wave velocity in a nondiabetic population of suburban Shanghai

目的:探讨上海郊区非糖尿病人群中低水平清蛋白尿与肱踝脉搏波传导速度(baPWV)的相关性。方法:在上海市嘉定区选取1 548名正常清蛋白尿[尿清蛋白/肌酐(UACR)<30 mg/g]的非糖尿病居民,对其进行问卷调查、体格检查、血和尿的生化检测以及baPWV检测,分析人群UACR水平与baPWV的相关性。结果:①按UACR值四分位分组,随着UACR水平的升高,UACR下四分位组到上四分位组的baPWV值分别为(1 459±280)、(1 506±311)、(1 554±349)、(1 621±349)cm/s;动脉硬化患病率分别为51.93%(202/389)、57.25%(221/386)、65.03%(251/386)、71.32%(276/387),组间趋势明显(趋势P<0.000 1)。②Pearson相关分析显示,baPWV与UACR呈显著正相关(r=0.190,P<0.000 1)。③多元Logistic回归分析显示,校正年龄、性别、体质量指数、糖化血红蛋白A1c、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、估测肾小球滤过率、高血压、目前吸烟、目前饮酒、是否大量运动等传统心血管影响因素后,与下四分位组相比,UACR位于第2、第3及上四分位组患动脉硬化的风险逐渐增高,比值比(OR)[95%可信区间(CI)]分别为1.50(1.04～2.15)、1.63(1.12～2.36)和1.67(1.13～2.49),趋势P=0.030 4。结论:非糖尿病人群中,UACR在参考范围内的微量增加与baPWV升高明显相关,低水平清蛋白尿是非糖尿病人群动脉硬化的独立危险因素。

Objective： To evaluate the correlation between low-grade albuminuria and brachial-ankle pulse wave velocity （baPWV） in a nondiabetic population of suburban Shanghai. Methods： This study was performed in 1 548 nondiabetic subjects with normal range of albuminuria [urinary albumin / creatinine ratio （UACR） 〈30 mg/g] from Jiading district, Shanghai, China. Questionnaire survey, physical examination, fasting blood and urine biochemical evaluation and baPWV measurement were performed in all the subjects, and the correlation between UACR and baPWV was analyzed. Results： Subjects were divided into four groups according to UACR quartile. With the increment of UACR quartile, the baPWV value and the prevalence of arteriosclerosis increased, and were （1 459±280）, （1 506±311）, （1 554±349）, （1 621± 349） em/s and 51.93% （202/389）, 57.25% （221/386）, 65.03% （251/386）, 71.32% （276/387） from the lowest to highest UACR quartile, respectively. Statistically significant differences were found between quartiles （P for trend 〈0.000 1）. Pearson＇s correlation analysis revealed that baPWV had a significant positive correlation with UACR （r=0.190, P〈0.000 1）.Multivariate Logistic regression analysis showed that subjects in the highest quartile of UACR had an increased risk of arteriosclerosis than those in the second, third and lowest quartiles after adjustment of conventional cardiovascular factors, such as age, sex, body mass index, glycated hemoglobinAlc, total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, estimated glomerular filtration rate, hypertension, current smoking, current drinking and physical activities in leisure times. Odds ratio （OR） （95%CI） were 1.50 （1.04-2.15）, 1.63（1.12-2.36） and 1.67 （1.13-2.49）, respectively. P for trend =0.030 4. Conclusions： In this nondiabetic population with normal range of albuminuria, slightly elevated UACR was associated with higher baPWV. Low-grade albuminuria was an independent risk factor for arteriosclerosis in nondiabetic subjects.