原发性高血压患者盐味觉阈值与高血压肾病的相关性

The association between salt taste threshold and hypertensive nephropathy in patients with essential hypertension

目的探讨原发性高血压患者盐味觉阈值与高血压肾病的关系。方法运用横断面研究,选择2017年12月至2019年2月大坪医院心内科住院治疗的原发性高血压患者作为研究对象,其中符合高血压肾病诊断标准且资料完整的患者94例作为高血压肾病组,符合原发性高血压诊断标准但未发生肾脏损害的患者252例作为高血压对照组。通过服用不同浓度氯化钠溶液测定患者的盐味觉阈值。比较两组患者盐味觉阈值的差异,分析盐味觉阈值与高血压肾病之间的相关性,采用受试者工作特征(ROC)曲线分析盐阈值预测高血压肾病的能力。结果高血压肾病组盐味觉阈值水平高于高血压对照组[0.075(0.050~0.100)比0.050(0.050~0.100)mol/L,Z=-2.559,P=0.010]。随着盐味觉阈值的升高,患者的尿微量白蛋白/肌酐、血肌酐、血尿素氮、尿N-乙酰-β氨基葡萄糖苷酶(NAG)逐渐升高(均P<0.05),而估算的肾小球滤过率(eGFR)逐渐降低[盐味觉阈值0.025,0.050,0.075和0.100~<0.400 mol/L组eGFR分别为120.40(109.92~137.96),117.32(95.88~137.00),114.67(95.78~136.15),114.05(94.26~138.33)mL/(min·1.73 m^(2)),趋势χ^(2)=7.402,P=0.007]。Logistic回归分析结果显示,在校正传统危险因素后,盐味觉阈值(OR=1.299,95%CI 1.020~1.655,P=0.034)是高血压肾病的独立危险因素。盐味觉阈值预测高血压肾病的ROC曲线下面积为0.586(95%CI 0.520~0.652)。结论盐味觉阈值与原发性高血压患者肾功能生化指标相关,其水平升高是高血压患者高血压损害风险增高的危险因素。

Objective To investigate the relationship between salt taste threshold and hypertensive nephropathy in patients with essential hypertension.Methods A cross-sectional study was conducted with a sample of 346 hypertensive patients in the Department of Cardiology of Daping Hospital from December 2017 to February 2019.Ninety-four patients who met the diagnostic criteria of hypertensive nephropathy and had complete data were selected as observations,and 252 patients who met the diagnostic criteria of essential hypertension but had no renal damage were selected as control group.The salt taste threshold of patients was measured by taking different concentrations of NaCl solution.The difference in salt taste threshold between the two groups of patients was compared,and the correlation between salt taste threshold and hypertensive nephropathy was analyzed.Receiver operating characteristic(ROC)curve was used to analyze the value of salt taste threshold to predict hypertensive nephropathy.Results The salt taste threshold level of the hypertensive nephropathy group was significantly higher than that in the control group[0.075(0.050-0.100)vs 0.050(0.050-0.100)mol/L,Z=-2.559,P=0.010].With the increase of salt taste threshold,the renal function decreased gradually,which was manifested by the increase of urine microalbumin to creatinine ratio,blood creatinine,blood urea nitrogen,urine N-Acetyl-β-glucosaminidase(NAG),and the decrease of estimated glomerular filtration rate(eGFR)[eGFR was 120.40(109.92-137.96),117.32(95.88-137.00),114.67(95.78-136.15)and 114.05(94.26-138.33)mL/(min·1.73 m^(2))respectively in 0.025,0.050,0.075 and 0.100-<0.400 mol/L group,χ^(2) for trend=7.402,P=0.007].Logistic regression analysis showed that after adjusting for traditional risk factors,salt taste threshold was the independent risk factor for hypertensive nephropathy(OR=1.299,95%CI 1.020-1.655,P=0.034).The area under ROC curve was 0.586(95%CI 0.520-0.652).Conclusions Salt taste threshold correlates with biochemical indicators of renal function in patients with essential hypertension,and increased levels of salt taste threshold is a risk factor of hypertensive nephropathy in patients with essential hypertension.