原发性高血压患者高血压类型、脉压、脉压指数与早期肾损害的关系

Relationship of early renal damage with hypertension type,pulse pressure and pulse pressure index in patients with primary hypertension

目的 探讨原发性高血压患者不同高血压类型、脉压、脉压指数与早期肾损害的关系.方法 将原发性高血压患者182例作为高血压组,另选取体检健康者30例作为对照组.收集各组清晨首次清洁中段尿,测定尿微量白蛋白（mALB）、尿足细胞标志蛋白podocalyxin （PCX）,计算比较高血压组和对照组及不同类型高血压组[单纯收缩期高血压（ISH）组,单纯舒张期高血压（IDH）组,收缩期高血压合并舒张期高血压（SDH）组]、不同脉压组（≤50 mmHg组、51 ～60 mmHg组、＞60 mmHg组）、不同脉压指数组（＜0.4％组、0.4％ ～0.5％组、＞0.5％组）mALB、PCX阳性率.结果 高血压组mALB、PCX阳性率较对照组高（P＜0.05或＜0.01）；且高血压组PCX阳性率较mALB阳性率高（P＜0.01）.高血压类型中ISH组、SDH组mALB、PCX阳性率较IDH组高（P均＜0.01）；且ISH组、SDH组PCX阳性率较mALB阳性率高（P均＜0.01）.脉压＞60 mmHg组mALB、PCX阳性率较≤50 mmHg组高（P均＜0.01）,且各不同脉压组PCX阳性率较mALB阳性率高（P均＜0.05）.脉压指数0.4％ ～0.5％组、＞0.5％组mALB、PCX阳性率较＜0.4％组高（P＜0.05或＜0.01）；且不同脉压指数组PCX阳性率较mALB阳性率高（P＜0.01）.结论 原发性高血压患者ISH、SDH比IDH更易发生肾损害,脉压和脉压指数越大肾损害的发生率越高,所以联合检测尿中mALB、PCX有利于早期诊断高血压肾损害.

Objective To investigate the relationship of early renal damage with different types of blood pressure, pulse pressure, pulse pressure index （PPI） in patients with primary hypertension. Methods Totally 182 patients with pri- mary hypertension （ hypertension group） and another 30 cases of healthy people （ control group） were selected. The first clean urine in the morning was collected to determine the urine microalbumin and PCX, and meanwhile, mALB and PCX positive rate was compared between the hypertension group, control group, different types of hypertension groups [ isolated systolic hypertension （ISH） group, isolated diastolic hypertension （IDH） group, systolic hypertension and diastolic hyper- tension （SDH） group], different pulse group （ ≤ 50 mmHg group, 51-60 mmHg group, 〉60 mmHg group） and different PPI group （ 〈0.4% group, the group of 0.4% to 0.5%, 〉 0.5% group）. Results The mALB and PCX positive rate in the hypertension group was higher than that of the control group （P 〈 0.05 or P 〈 0.01 ）, and PCX positive rate was higher than the mALB in the hypertension group （P 〈 0.01 ）. The mALB and PCX positive rates in the ISH group and SDH group were higher than those of the IDH group （all P 〈 0.01 ）, ISH and SDH groups＇PCX positive rates were higher than mALB positive rates （all P 〈 0.01 ）. Pulse pressure 〉 60 mmHg group＇s mALB, PCX positive rates were higher than that of index ≤ 50 mmHg group （ all P 〈 0.01 ） , and the various pulse groups＇PCX positive rates were higher than mALB posi- tive rates （all P 〈 0.05）. PPI of 0.4% -0.5% group and 〉 0.5% group＇s mALB, PCX positive rates were higher than those of 〈0.4% group （P 〈0.05 or P 〈0.01 ）, and the various pulse groups＇PCX positive rates were higher than mALB positive rates （P 〈 0.01 ）. Conclusions Patients with ISI-I and SDH are more likely to get renal damage than patients with IDH. The bigger of pulse pressure and PPI, the greater incidence of renal damage is got. Therefore, the joint detections of mALB and PCX of urine are benefit to the early diagnosis of renal damage in patients with hypertension.