原发性高血压患者微量白蛋白尿与亚临床动脉粥样硬化的相关性

Correlation between microalbuminuria and subclinical atherosclerosis in patients with essential hypertension

目的:探讨原发性高血压(EH)患者尿微量白蛋白(UMA)水平与颈总动脉粥样硬化及踝臂指数(ABI)的相关性。方法:收集2014年4月至2015年8月我院收治的215例EH患者。根据24hUMA水平,患者被分为正常UMA组(116例)和微量白蛋白尿(MAU)组(99例)。测量比较两组一般资料、UMA水平、颈动脉内膜中层厚度(CIMT)、颈动脉管腔内径、斑块发生率以及ABI。分析EH合并MAU患者UMA水平与CIMT、ABI的相关性。结果:两组年龄、性别、血压、空腹血糖、血脂、血肌酐水平均无显著差异(P均>0.05)。与正常UMA组比较,MAU组UMA水平[20.25(15.75,25.75)mg/d比86.50(56.50,104.50)mg/d]、CIMT[(1.20±1.09)mm比(1.76±0.81)mm]、斑块发生率(55.17%比75.76%)显著升高,ABI[(1.12±0.11)比(0.97±0.11)]显著降低,P均<0.01。直线相关分析显示,EH合并MAU患者UMA水平与CIMT呈显著正相关(r=0.551,P=0.001),与ABI呈显著负相关(r=-0.266,P=0.008)。结论:EH合并MAU患者微量白蛋白尿水平和颈动脉内膜中层厚度显著正相关,与踝臂指数显著负相关,提示微量白蛋白尿不仅和高血压肾脏病变有关,也是亚临床期动脉粥样硬化的早期标志。

Objective： To explore the correlation among carotid atherosclerosis, ankle-brachial index （ABI） and urinary microalbumin （UMA） level in patients with essential hypertension （EH）. Methods： A total of 215 EH patients treated in our hospital from Apr 2014 to Aug 2015 were selected. According to 24h UMA level, patients were divided into normal UMA group （n = 116） and microalbuminuria （MAU） group （n = 99）. General data, UMA level, carotid intima-media thickness （CIMT）, carotid artery lumen diameter, incidence rate of plaque and ABI were measured and compared between two groups. Correlation among CIMT, ankle-brachial index （ABI） and urinary microalbumin （UMA） level was analyzed in EH ± MAU patients. Results： There were no significant difference in age, gender, levels of blood pressure, fasting blood glucose, blood lipids and serum creatinine between two groups, P〉0. 05 all. Compared with normal UMA group, there were significant rise in UMA level [21.25 （15. 75, 25. 75） mg/d vs. 86. 50 （56. 50, 104. 50） mg/d], CIMT [ （1.20 ± 1.09） mm vs. （1.76 ± 0. 81） mm] and incidence rate of plaque （55.17% vs. 75. 76%）, and significant reduction in ABI [ （1.12 ± 0. 11） vs. （0. 97 ± 0. 11）] in MAU group, P〈0.01 all. Linear correlation analysis indicated that UMA level was significant positively correlated with CIMT （r = 0. 551, P = 0. 001）, and significant inversely correlated with ABI （ r = - 0. 266, P = 0. 008） in EH ＋ MAU patients. Conclusion： In EH ＋ MAU patients, MAU is significant positively correlated with CIMT, and significant inversely correlated with ABI, suggesting MAU is not only related to hypertensive renal di ease, but also an early sign of subclinical atherosclerosis.