社区成年人盐敏感性高血压的影响因素研究

Influencing Factors for Salt- sensitive Hypertension in Community Adults

目的探讨社区成年人盐敏感性高血压的影响因素。方法 2013年12月—2014年4月,采用分层随机抽样法选取浙江省杭州市江干区闸弄口街道社区卫生服务中心辖区居民642例,进行问卷调查,并测量身高、体质量、腰围及血压,检测同型半胱氨酸、肾功能、血糖、血电解质、血脂、空腹胰岛素及尿电解质。采用改良Sullivan急性口服盐水负荷试验进行盐敏感性判定,将居民分为盐敏感性高血压组(n=36)与非盐敏感非高血压组(n=303),比较两组一般情况,采用多因素Logistic回归分析盐敏感性高血压的影响因素。结果 642例居民中,共检出盐敏感者183例(28.5%);盐敏感人群中高血压患者36例(占19.7%)。盐敏感高血压组年龄、BMI、同型半胱氨酸、空腹胰岛素水平和父、母亲高血压患病率及服盐水后平均动脉压均高于非盐敏感非高血压组,服盐水前平均动脉压及服盐水后尿氯、尿钾水平均低于非盐敏感非高血压组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,空腹胰岛素〔OR=0.11,95%CI(0.02,0.69)〕、同型半胱氨酸〔OR=4.92,95%CI(1.13,21.39)〕是盐敏感性高血压的影响因素(P<0.05)。结论空腹低胰岛素水平(<4.50 U/L)是盐敏感性高血压发生的保护因素,而血清高同型半胱氨酸水平(>15.0μmol/L)是盐敏感性高血压发生的危险因素。

Objective To explore the influencing factors for salt-sensitive hypertension in adults. Methods Using stratified random sampling method, we enrolled 642 residents from Zhalongkou Street Community Health Service Center of Jianggan District of Hangzhou in Zhejiang Province from December 2013 to April 2014. Questionnaire survey was conducted;height,body mass, waistline and blood pressure were measured;homocysteine, renal funciton, blood glucose, blood electrolytes,blood lipid,fasting insulin and urinary electrolytes were determined. Using an improved Sullivan＇s acute oral saline loading test,salt sensitivity was determined. Residents were divided into salt-sensitive hypertension group（n=36）and non-salt-sensitivity non-hypertension group（n=303）. Comparison was made between the two groups in general information,and multivariate logistic regression analysis was undertaken to investigate the influencing factors for salt - sensitive hypertension. Results Among the 642 residents,we found salt sensitivity in 183（28. 5%）residents,of which 36（19. 7%） residents had hypertension. The salt-sensitive hypertension group was higher（P﹤0. 05）in age,BMI,homocysteine,fasting insulin level,prevalence of hypertension of parents and average arterial pressure after taking saline and were lower（P﹤0. 05）in the average arterial pressure before taking saline and the levels of urinary chlorine and urine potassium after taking saline than non-salt-sensitivity non -hypertension group. Multivariate logistic regression analysis showed that fasting insulin〔OR =0. 11, 95%CI（0. 02,0. 69）〕and homocysteine〔OR=4. 92,95%CI（1. 13,21. 39）〕were influencing factors for salt-sensitive hypertension（P﹤0. 05）. Conclusion Low fasting insulin level（ ﹤4. 50 U/L）is a protective factor for hypertension,while high serum homocysteine level（ ﹥15. 0 μmol/L） is a risk factor for the occurrence of sensitive hypertension.