高血压合并动脉粥样硬化性肾动脉狭窄患者的危险因素及其预测价值分析

Analysis of risk factors and their predictive value in patients with hypertension combined with atherosclerotic renal artery stenosis

目的分析高血压合并动脉粥样硬化性肾动脉狭窄(ARAS)患者的危险因素及相关危险因素的预测价值。方法纳入2017年07月至2022年12月于贵州医科大学附属医院高血压科住院的高血压合并ARAS患者71例(ARAS组),同时按1∶2纳入期间在高血压科住院的无ARAS的原发性高血压患者142例(EH组)。收集两组患者的临床资料并进行比较分析,筛选高血压合并ARAS的独立危险因素,评估相关危险因素对高血压合并ARAS的预测价值。结果ARAS组中性粒细胞绝对值(NEUT)、中性粒细胞/淋巴细胞比值(NLR)、同型半胱氨酸(Hcy)、纤维蛋白原(FIB)、纤维蛋白原/白蛋白比值(FAR)、血浆肾素活性(PRA)均高于EH组(P<0.05)。ARAS组诊室收缩压、诊室脉压、24 h平均收缩压、24 h动态脉压(24 hAPP)、白昼平均收缩压、夜间平均收缩压、最高收缩压、最高脉压明显高于EH组(P<0.05)。ARAS组肌酐、估算的肾小球滤过率(eGFR)、胱抑素-C(Cys-C)、尿微量白蛋白(UAlb)、Crouse积分高于EH组(P<0.05),左心室舒张末期内径(LVDd)小于EH组(P<0.05)。Logistic回归分析结果显示,NLR、eGFR、Cys-C、Hcy、FAR、UAlb、PRA、Crouse评分、诊室脉压、24 h平均收缩压、最高脉压与高血压合并ARAS相关(P<0.05),Cys-C、PRA、最高脉压、24 h平均收缩压是高血压合并ARAS患者的独立危险因素(P<0.05)。预测高血压合并ARAS的受试者工作曲线(ROC)分析显示,Cys-C、PRA、最高脉压、24 h平均收缩压预测高血压患者发生ARAS的曲线下面积(AUC)分别为0.758、0.739、0.733、0.722(均P<0.01),敏感度分别为62.0%、64.8%、53.5%、70.4%,特异度分别为81.7%、79.6%、83.8%、66.9%;Cys-C联合PRA的AUC为0.823(P<0.01),敏感度和特异度分别为71.8%和90.1%。结论Cys-C、PRA、24 h平均收缩压、最高脉压是高血压合并ARAS患者的独立危险因素。Cys-C、PRA、24 h平均收缩压、最高脉压对高血压合并ARAS均有预测价值,其中最佳的预测指标为Cys-C联合PRA。

Objective To analyze the risk factors and the predictive value of associated risk factors in patients with hypertension combined with atherosclerotic renal artery stenosis(ARAS).Methods Seventy-one patients with hypertension combined with ARAS treated in the Department of Hypertension,the Affiliated Hospital of Guizhou Medical University from July 2017 to December 2022 were selected(ARAS group),and 142 essential hypertension patients without ARAS,who were hospitalized in the same department during this period,were also included in a 1∶2 ratio as the EH group(EH group).Clinical data of the two groups were collected and compared to analyze independent risk factors for hypertension combined with ARAS and evaluate the predictive value of relevant risk factors.Results Neutrophil(NEUT),neutrophil-lymphocyte ratio(NLR),homocysteine(Hcy),fibrinogen(FIB),fibrinogen/albumin ratio(FAR)and plasma renin activity(PRA)were all higher in the ARAS group than in the EH group(P<0.05).Office systolic blood pressure,office pulse pressure,24 hour mean systolic blood pressure,24 hour ambulatory pulse pressure(24 hAPP),daytime mean systolic blood pressure,nighttime mean systolic blood pressure,maximum systolic blood pressure and maximum pulse pressure were significantly higher in the ARAS group than in the EH group(P<0.05).Creatinine,estimated glomerular filtration rate(eGFR),Cystatin-C(Cys-C),urinary albumin(UAlb)and Crouse scores were higher in the ARAS group than in the EH group(P<0.05),and left ventricular end diastolic diameter(LVDd)was smaller than in the EH group(P<0.05).Logistic regression analysis showed that NLR,eGFR,Cys-C,Hcy,FAR,UAlb,PRA,Crouse score,office pulse pressure,24 hour mean systolic blood pressure,and maximum pulse pressure were associated with hypertension combined with ARAS(P<0.05),and Cys-C,PRA,maximum pulse pressure,and 24 hour mean systolic blood pressure were independent risk factors for patients with ARAS(P<0.05).Analysis of the receiver operating characteristic(ROC)curve for predicting hypertension combined with ARAS showed that the area under the curve(AUC)for Cys-C,PRA,maximum pulse pressure,and 24 hour mean systolic blood pressure to predict the occurrence of ARAS in hypertensive patients were respectively 0.758,0.739,0.733,and 0.722(all P<0.01),with sensitivities of 62.0%,64.8%,53.5%and 70.4%,and the specificity were 81.7%,79.6%,83.8%and 66.9%respectively;the AUC of Cys-C combined with PRA was 0.823(P<0.01),and the sensitivity and specificity were 71.8%and 90.1%respectively.Conclusions Cys-C,PRA,24 hour mean systolic blood pressure,and maximum pulse pressure were found to be independent risk factors for patients with hypertension combined with ARAS.These factors are all predictive of hypertension combined with ARAS,with the best predictor being Cys-C combined with PRA.