不同盐摄入量高血压患者早期肾损害相关性的临床研究

Clinical study on the correlation of early renal damage in patients with hypertension with different salt intake

目的研究高血压患者不同盐摄入量与早期肾损害的相关性。方法选取上海市宝山区中西医结合医院2015年1月至2017年12月住院且符合入选条件的原发性高血压患者2964例,其中男性1382例,女性1582例,根据摄盐量的四分位数分为低摄入组、中摄入组、中高摄入组、高摄入组,采集相关资料包括年龄、性别、病程、吸烟史、饮酒史、既往史等;对患者的血钾、血钠、血肌酐、血尿素氮、血糖、血尿酸、血清胱抑素C、三酰甘油、总胆固醇、低密度脂蛋白、高密度脂蛋白、24 h尿钠及尿微量白蛋白水平进行检测,进行相关性分析。结果4组一般资料之间无差异性(P>0.05);男性患者盐摄入量11.4(7.4,15.4)g/d高于女性盐摄入量9.2(6.5,12.5)g/d,差异具有统计学意义(P<0.05);不同盐摄入组24 h微量白蛋白分别为(2.31±0.12)、(2.62±0.14)、(2.75±0.13)、(3.09±0.15),中高摄入组和高摄入组24 h微量白蛋白均显著高于低摄入组和中摄入组(P<0.05),高摄入组24 h微量白蛋白高于中高摄入组(P<0.05)。在纳入的2964例患者中有525例(17.71%)患者存在肾损害,不同盐摄入组肾损害检出率分别为88例(11.45%)、91例(11.37%)、155例(20.16%)、191(30.46%),中高摄入组和高摄入组肾损害检出率均显著高于低摄入组和中摄入组(P<0.05);高摄入组肾损害检出率高于中高摄入组(P<0.05)。高血压患者的盐摄入量与24 h尿微量白蛋白存在相关性(r=0.153,t=4.688,P<0.001)。多元线性回归分析显示,观察组患者因变量24 h尿微量白蛋白与自变量患者摄盐量(OR=16.542,95%CI 2.498~25.365,P=0.001)、收缩压(OR=10.582,95%CI 1.046~12.695,P=0.049)、血糖(OR=2.594,95%CI 1.125~15.361,P=0.019)、血尿酸(OR=10.265,95%CI 3.458~24.236,P=0.002)具有显著的相关性。结论长期的高盐摄入是导致患者早期肾损害的独立危险因素,每日摄入盐越多则肾损害程度越重。同时相关因素收缩压、血尿酸及血糖与24 h尿微量白蛋白的发生密切相关。

Objective To study the correlation of early renal injury in hypertension patients with different salt intake.Methods Selection in our hospital between January 2015 and December 2015,in line with the selected conditions of 2964 cases of primary hypertension,male 1382 cases,1582 cases of women,according to quartile is divided into low salt intake,the intake group,high intake group,high intake,collecting relevant data including age,sex,course of past history,smoking,drinking,etc.;Blood samples:blood potassium,blood sodium,blood creatinine,blood urea nitrogen,blood glucose,serum uric acid,serum cystatin C,triglyceride,total cholesterol,low density lipoprotein,HDL.Urine samples:24 hours of urine sodium and urine microalbumin were studied and analyzed.Results the four sets of normal data are no different.(P>0.05);In male patients,the salt intake of 11.4(7.4,15.4)g/d was higher than that of female salt intake by 9.2(6.5,12.5)g/d,with statistical difference(P<0.05).Trace albumin respectively different salt intake group of 24 hours(2.31±0.12),(2.62±0.14),(2.75±0.13),(3.09±0.15),high intake of trace albumin group and a high intake of 24 hours in the group were significantly higher than that of low intake and intake group(P<0.05),high intake of trace albumin is higher than the high intake of 24 hours group(P<0.05).In 2964 patients were included in the 525 patients were detected renal damage,the proportion is 17.71%,renal lesion detection rate is respectively 88 different salt intake group(11.45%),91(11.37%),155(20.16%),191(30.46%),high consumption groups and a high intake of renal damage in the group were significantly higher than that of low intake and intake group(P<0.05);The detection rate of renal damage was higher in the high intake group than in the middle and high intake group(P<0.05).The correlation between salt intake in patients with hypertension and microalbumin in 24 hours(r=0.153,P<0.01).Multivariate linear regression analysis showed that,in the observation group,patients with 24-hour urinary microalbumin and independent variables were observed to have salt content(OR=16.542,95%CI 2.498-25.365).P=0.001),systolic pressure(OR=10.582,95%CI 1.046-12.695 P=0.049),blood glucose(OR=2.594,95%CI 1.125-15.361;P=0.019),blood uric acid(OR=10.265,95%CI 3.458 to 24.236,P=0.02).Conclusions Long-term high salt intake leads to independent risk factors for early renal damage,and the more salt is consumed daily,the greater the damage degree of renal kidney.Systolic blood pressure,blood uric acid and blood glucose were closely related to the occurrence of microalbumin in 24 hours.