安庆市农村高血压患者低密度脂蛋白胆固醇与肾功能轻度下降的关系

The relationship between low-density lipoprotein cholesterol and mild decline of renal function in hypertensive patients of Anqing rural area

目的评估高血压患者血浆低密度脂蛋白胆固醇(LDL-C)与肾功能轻度下降的关系,为早期预防高血压并发慢性肾脏病提供参考。方法本研究于2020年6—9月在安庆市农村地区采用多阶段抽样方法随机抽取7个乡镇,共纳入1959例高血压患者,获取调查对象的一般资料、血浆LDL-C水平等信息。采用logistic回归分析LDL-C与肾功能轻度下降的关系。结果1959例高血压患者年龄为(69.2±7.0)岁,肾功能轻度下降患者1231例(62.8%)。调整性别等相关因素后,高血压患者LDL-C与肾功能轻度下降呈正相关,LDL-C每增加1 mmol/L,肾功能轻度下降发生的风险增加57%(OR=1.570,95%CI:1.359~1.813)。将LDL-C三等分,与最低三分位数(T1,<2.2 mmol/L)的患者比较,中三分位数(T2,2.2~<2.9 mmol/L)和最高三分位数(T3,≥2.9 mmol/L)的患者肾功能轻度下降的风险分别增加1.028倍(OR=2.028,95%CI:1.578~2.605)和2.721倍(OR=3.721,95%CI:2.814~4.920)。舒张压升高与LDL-C水平升高对增加肾功能轻度下降风险具有协同作用(舒张压<90 mm Hg vs.≥90 mm Hg,1 mm Hg=0.133 kPa,P_(交互)=0.006)。结论高血压患者LDL-C与肾功能轻度下降呈正相关关系,尤其在舒张压升高的人群中。提示控制高血压患者LDL-C和血压水平可以降低肾功能轻度下降的风险,减轻肾脏靶器官的早期损害。

Objective To evaluate the relationship between plasma low density lipoprotein cholesterol and mild decline of renal function,and provide clues for early prevention of hypertension complicated with chronic kidney disease.Methods In this study,a multi-stage random sampling method was used in seven randomly selected townships of Anqing City rural areas from June to September 2020,including 1959 hypertensive patients.The general information and plasma low density lipoprotein cholesterol level of the subjects were obtained and logistic regression was used to analyze the relationship between LDL-C and mild decline of renal function.Results The average age of 1959 hypertensive patients was(69.2±7.0)years,including 1231 patients with mild renal dysfunction(62.8%).After optimizing gender and other related factors,there was a significant positive correlation between LDL-C and mild renal decline in hypertensive patients.When plasma LDL-C increased by 1 mmol/L,the risk of mild renal decline will increase 57% in patients with hypertension(OR=1.570,95%CI:1.359-1.813).Dividing LDL-C concentrations into 3 grades,compared with the patients with the lowest tertile of LDL-C(T1,<2.2 mmol/L),the patients with the median tertile of LDL-C(T2,≥2.2 and<2.9 mmol/L)and the highest teitile of LDL-C(T3,≥2.9 mmol/L)had a 1.028-fold(OR=2.028,95%CI:1.578-2.605)and 2.721-fold(OR=3.721,95%CI:2.814-4.920)increased risk of mild renal decline,respectively.In addition,there was a synergistic effect on increasing the risk of mild renal decline between elevated diastolic blood pressure and increased LDL-C levels(diastolic blood pressure<90 mm Hg vs≥90 mm Hg,1 mm Hg=0.133 kPa,P for interaction=0.006).Conclusion There was a positive correlation between LDL-C and mild renal function decline in hypertensive patients,especially in those with increased diastolic blood pressure.It is suggested that controlling LDL-C and blood pressure in patients with hypertension can reduce the risk of mild renal function decline and reduce the early damage of renal target organs.