原发性高血压患者24h尿微量清蛋白与血清25-羟维生素D_3水平的相关性

Correlation between 24h Microalbumin-uria and 25(OH)-vitamin D_3 Levels in Essential Hypertension Patients

目的探讨原发性高血压(EH)患者24 h尿微量清蛋白(MAU)与血清25-羟维生素D3〔25(OH)D3〕水平的相关性。方法收集2012年2月—2013年9月在新疆医科大学第一附属医院高血压科住院的EH患者500例,其中男284例,女216例。根据MAU的测定结果分为EH组和EH+MAU组。收集患者一般临床资料〔入院时间、年龄、性别、病史、高血压病程、服降压药史、入院收缩压(SBP)和舒张压(DBP)、计算体质指数(BMI)和脉压〕、统一检测实验室指标〔血肌酐(Cr)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)〕、MAU、血清25(OH)D3水平及肾小球滤过率(eGFR);分析MAU与血清25(OH)D3水平的相关性。结果根据MAU的测定结果,EH组305例,EH+MAU组195例。两组患者的病程、eGFR、BMI、24 hSBP、24 hDBP、TG、入院SBP、入院DBP、脉压、尿酸、服降压药史比较,差异均有统计学意义(P<0.05)。EH+MAU组的血清25(OH)D3水平低于EH组〔(11.27±5.72)ng/ml与(12.60±8.16)ng/ml;t=-1.977,P<0.05〕。EH组血清25(OH)D3缺乏者有260例(85.2%),不足者有34例(11.2%),充足者有11例(3.6%);EH+MAU组血清25(OH)D3缺乏者有173例(88.7%),不足者有20例(10.3%),充足者有2例(1.0%)。多元线性回归分析显示,MAU水平与病程、BMI、TG、24 hSBP、24 hDBP、入院SBP、入院DBP呈正相关,与血清25(OH)D3水平及eGFR呈负相关(P<0.05);与尿酸、TC、LDL-C、HDL-C、服降压药史无直线相关性(P>0.05)。Pearson相关性分析显示,校正性别、年龄、病史等因素后,血清25(OH)D3水平与24 hSBP、24 hDBP、入院SBP、MAU水平呈负相关,与HDL-C呈正相关(P<0.05);与BMI、TG、TC、LDL-C、入院DBP以及脉压无直线相关性(P>0.05)。结论 EH患者存在血清25(OH)D3不足或缺乏,且MAU异常时,MAU与血清25(OH)D3水平呈负相关。故应重视血清25(OH)D3在EH患者治疗中的作用。

Objective To investigate the correlation between 24 h microalbumin-uria（MAU）and 25（OH）-vitamin D3 levels[25（OH）D3] in essential hypertension（EH） patients.Methods Five hundred EH patients（284 males, 216 females） hospitalized in department of hypertension,the First Affiliated Hospital of Xinjiang Medical University from February 2012 to September 2013 were enrolled in this study. According to MAU results,they were divided into EH group and EH＋MAU group.The clinical data including admission time, age, gender, medical history, duration of hypertension, history of antihypertensive drugs, admission SBP and DBP, BMI, pulse pressure（PP） were collected, laboratory indexes including serum creatinine（Cr）, triacylglycerol（TG）, total cholesterol（TC）,high density lipoprotein cholesterol（HDL-C）, low density lipoprotein cholesterol（LDL-C）,levels of MAU,serum 25（OH）D3,glomerular filtration rate（eGFR） were determined.The correlation of MAU with 25（OH）D3 were analyzed.Results The patients were divided,according to MAU results, into groups EH（n=305）, EH＋MAU（n=195）.There was significant difference in duration of disease, eGFR,BMI,24 hSBP,24 hDBP,TG,admission SBP and DBP,PP,uric acid（UA）, history of hypotensive drug administration between the 2 groups（P＜0.05）. Serum 25（OH）D3 level was lower in EH＋MAU group than in EH group[（11.27±5.72）ng/ml vs. （12.60±8.16）ng/ml;t=-1.977,P＜0.05]. In EH group, 260 were short of 25（OH）D3（85.2%）, 34 had insufficient（11.2%）, 11 had adequate（3.6%）; in EH＋MAU group, 173（88.7%）, 20（10.3%）, 2（1.0%）, respectively. By multivariate linear regression analysis, in EH patients MAU level was positively correlated with duration of disease, BMI, TG, 24 hSBP,24 hDBP,admission SBP and DBP, negatively with serum 25（OH）D3 level and eGFR（P＜0.05）;not correlated with UA, TC, LDL-C,HDL-C,history of hypotensive drug administration（P＞0.05）.By Pearson correlation analysis, after adjusted gender, age and history of disease, serum 25（OH）D3 level was negatively correlated with 24 hSBP,24 hDBP, admission SBP,MAU,positively with HDL-C（P＜0.05）;not correlated with BMI,TG,TC, LDL-C, admission DBP, PP（P＞0.05）.Conclusion EH patients have not enough 25（OH）D3 or are lack of that,and when MAU be abnormal, MAU with serum 25（OH）D3 levels were negatively correlated. So the role of serum 25（OH）D3 in treatment of EH patients.