维生素A与儿童高血压相关性的病例对照研究

The relationship between vitamin A and essential hypertension in children:a case-control study

目的 探讨维生素A与儿童血压之间的相关关系。方法在前期已建立的儿童队列人群中纳入高血压儿童80例与正常血压儿童84人进行病例对照研究,采集受试对象的静脉血完成血生化及基因检测,对受试对象进行体格检查与问卷调查。采用单因素和多因素Logistic回归模型分析维生素A与儿童血压的相关性。结果高血压与正常血压儿童血清维生素A水平差异无统计学意义[(0.87±0.22)比(0.89±0.23)μmol/L,P=0.56]。在两组人群中按照维生素A是否缺乏进行分组,在校正年龄、性别、身高、体质量、腰围与血脂等因素后,高血压组中,维生素A缺乏组收缩压与舒张压高于维生素A正常组[(133.4±1.7)比(127.1±0.7)mm Hg;(78.0±1.9)比(75.4±0.8)mm Hg;P<0.01];在对照组中,维生素A缺乏组儿童收缩压高于维生素A正常组[(105.6±1.3)比(100.4±0.8)mm Hg,P<0.01],舒张压差异无统计学意义(P>0.05)。聚合酶链反应结果显示,维甲酸受体(RAR)在两组间差异无统计学意义,但反映维生素A贮存功能的指标卵磷脂视黄醇酰基转移酶(LRAT)在高血压组低于对照组(P<0.01)。多元Logistic回归分析结果显示体质量指数(BMI)、腰围是儿童高血压的危险因素[OR(95%CI)为1.287(1.041~1.591),1.092(1.012~1.179)],LRAT表达水平高、母乳喂养时间长、高密度脂蛋白胆固醇(HDL-C)是儿童高血压的保护因素[OR(95%CI)为0.748(0.663~0.844),0.858(0.762~0.967),0.144(0.031~0.681)]。结论维生素A在体内的储存水平低是高血压的危险因素,维生素A的缺乏将进一步加重高血压的进程。

Objective To investigate the relationship between vitamin A and blood pressure in children. Methods Based on the childhood study cohort established before,80 hypertensive children and 84 normal blood pressure children were included in the case-control study. The blood samples were collected for blood biochemical and gene detection,and physical examination and questionnaire survey were conducted.Single factor analyses and multivariate logistic regression model were used to analyze the relationship between vitamin A and blood pressure in children.Results The difference of serum vitamin A was not significant between hypertension group and control group[（0.87±0.22）vs（0.89±0.23）μmol/L,P=0.56]. In the subgroup analysis,after adjustment for age,sex,height,weight,waist circumference and blood lipids,the systolic blood pressure and diastolic blood pressure were significantly higher in vitamin A deficient subgroup than normal vitamin A subgroup in the hypertensive children[（133.43±1.69）vs（127.08±0.72）mm Hg,（77.95±1.92）vs（75.45±0.82）mm Hg,P〈0.01],and the systolic blood pressure in vitamin A deficiency subgroup was significantly higher than that in normal vitamin A subgroup[（105.58±1.31）vs（100.36±0.77）mm Hg,P〈0.01]while the diastolic blood pressure was not significantly different between two subgroups in the control subjects. The results of polymerase chain reaction（PCR）showed that there was no significant difference between the two groups in the retinoic acid receptors,but the lecithinretinol acyltransferase（LRAT）,an indicator of the function of vitamin A storage,was lower in hypertensive group than that in control group（P〈0.001）. Multi-Logistic regression analysis showed that the body mass index（BMI）and waist circumference were the risk factors for hypertension [OR（95% CI）was 1.287（1.041-1.591）,1.092（1.012-1.179）,respectively],on the contrary,the high expression level of LRAT,longerduration of breast feeding and high-density lipoprotein cholesterol（HDL-C）were the protective factors for hypertension[OR（95% CI）=0.748（0.663-0.844）,0.858（0.762-0.967）,0.144（0.031-0.681）,respectively]. Conclusion The low level of vitamin A storage is a risk factor for hypertension,and vitamin A deficiency will further aggravate the progression of hypertension in children.