原发性高血压患者血管功能与尿微量白蛋白肌酐比值、颈动脉内膜中层厚度的关系

Association between arterial function and urine albumin to creatinine ratio,carotid artery intima-media thickness in essential hypertensive patients

目的评估原发性高血压患者血管功能与尿微量白蛋白肌酐比值(UACR)、颈动脉内膜中层厚度(IMT)的关系。方法入选2007年7月至2008年7月上海交通大学瑞金医院高血压科住院的原发性高血压患者770例为研究对象,年龄(60.0±10.0)岁。采用颈股动脉脉搏波传导速度(cfPWV)、脉搏波分析(PWA)测定中心增强压(CAP)及中心动脉增强指数(AIx),大小动脉弹性指数(C1,C2)评估血管功能,靶器官损害指标包括UACR及颈动脉异常(IMT增高或有斑块)。结果在调整心血管病危险因素之后,只有cfPWV与lg UACR(r=0.114,P=0.008)和颈动脉IMT(r=0.099,P=0.020)呈正相关。多元逐步线性回归分析发现,cfPWV是UACR的独立危险因素(β=0.095,P=0.044),并且独立于年龄和肱动脉脉压。在调整心血管病危险因素之后,尿UACR增高组cfPWV较高(P<0.05),颈动脉异常组cfPWV较高(P<0.05)。cfPWV每增加1个标准差(3m/s),UACR和颈动脉异常的危险增加至约1.2倍。结论 cfPWV是UACR、颈动脉IMT的独立危险因素,并且独立于年龄和肱动脉脉压。

Objective To explore the relationship between arterial function and urine albumin to creatinine ratio （UACR）, carotid artery intima-media thickness（IMT） in patients with essential hypertension. Methods From Ju- ly 2007 to July 2008, a cohort of 770 hypertensive patients aged （60.04-10.0） years were recruited at the Depart- ment of Hypertension, Ruijin Hospital. Arterial stiffness indices including the carotid-femoral pulse wave velocity （cfPWV）, pulse wave analysis （PWA） and large and small artery elasticity （C1, C2 ）were measured. Target organ damage indexes included increased UACR and abnormalities of carotid artery IMT, which was diagnosed by IMT thickening or plaque information in carotid artery ultrasonogram. Results After adjusted for confounding factors, only cfPWV was positively related to the lg UACR （partial r=0. 114, P=0. 008） and IMT （partial r=0. 099, P= 0. 020）. cfPWV was an independent risk factor for UACR （β= 0. 095, P= 0. 044）. Patient with microalbumin- uria or carotid abnormalities showed higher cfPWV as compared with those without it. After adjusted for confoun- ding factors, each standard deviation（SD,3 m/s） increase in cfPWV entails a 1.2 times higher risk of microalbumin- uria or carotid abnormalities. Conclusion cfPWV is associated with UACR and IMT in patients with essential hy- pertension, which is independent to age and brachial arterial blood pressure.