动脉硬化指数与血清Smad1水平与高血压肾损伤患者肾功能转归的相关性

Correlation of arteriosclerosis index and serum Smad1 level with renal function regression in patients with hypertensive kidney injury

目的探讨Smad同源物1(Smad1)、动脉硬化指数(ambulatory arterial stiffness index,AASI)与高血压肾损伤患者肾功能转归的关系。方法选取高血压患者400例。依据是否合并肾损伤,分为肾损伤组(242例)、单纯组(158例)。肾损伤组患者根据治疗后肾小球的滤过率(GFR)分为预后良好组(n=180,GFR>90)及预后不佳组(n=62,GFR≤90)。检测患者总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG)、血肌酐(Scr)、尿素氮(BUN)、尿酸(SUA)及Smad1水平,计算肾小球滤过率(GFR)及AASI。多因素logistic回归分析高血压肾损伤患者肾功能转归的影响因素,受试者工作特征(ROC)曲线分析AASI、Smad1对高血压肾损伤患者预后不佳的预测价值。结果与单纯组比较,预后良好组及预后不佳组患者血清Scr、BUN、SUA、Smad1水平、GFR及AASI升高(P<0.01),与预后良好组比较,预后不佳组患者血清Scr、BUN、SUA、Smad1水平、GFR及AASI升高(P<0.01)。Smad1与Scr、BUN、SUA、GFR均成正相关(P<0.01),AASI与Scr、BUN、SUA、GFR均成正相关(P<0.01)。Smad1、AASI及两项联合预测高血压肾损伤患者肾功能不良转归的曲线下面积(AUC)分别为0.67、0.74及0.85。血清Scr、BUN、SUA、Smad1水平、GFR及AASI升高是高血压肾损伤患者肾功能不良转归的独立危险因素(P<0.05)。结论血清Smad1水平、AASI与高血压肾损伤患者的肾功能转归有关,是高血压肾损伤患者肾功能不良转归的高危因素。

Objective This paper aims to investigate the relationship between Smad homolog 1(Smad1),atherosclerosis index(AASI)and renal function regression in patients with hypertensive kidney injury.Methods A total of 400 hypertensive patients were divided into renal injury group(242 cases)and simple group(158 cases)according to whether they were com⁃bined with renal injury.Patients in the renal injury group were divided into good prognosis group(n=180,GFR>90)and poor prognosis group(n=62,GFR≤90)according to the glomerular filtration rate(GFR)after treatment.The total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),fasting blood glucose(FPG),blood creatinine(Scr),urea nitrogen(BUN),uric acid(SUA)and Smad1 levels were measured.The glomerular filtration rate(GFR)and AASI were calculated.Multifactorial logistic regression was used to analyze the factors influencing the regression of renal function in patients with hypertensive kidney injury.The receiver operating charac⁃teristic curve(ROC)was used to analyze the predictive value of AASI and Smad1 for poor prognosis in patients with hyperten⁃sive kidney injury.Results Compared with the simple group,serum Scr,BUN,SUA,Smad1 levels,GFR and AASI were higher in the good prognosis group and the poor prognosis group(P<0.01).Compared with the good prognosis group,serum Scr,BUN,SUA,Smad1 levels,GFR and AASI were higher in the poor prognosis group(P<0.01).Smad1 was positively corre⁃lated with Scr,BUN,SUA,and GFR(P<0.01),and AASI was positively correlated with Scr,BUN,SUA,and GFR(P<0.01).The area under the curve(AUC)of Smad1,AASI,and the combination for predicting poor renal regression in patients with hypertensive kidney injury were 0.67,0.74,and 0.85,respectively.Elevated serum levels of Scr,BUN,SUA,Smad1,as well as elevated GFR and AASI,were independent risk factors for poor renal regression in patients with hypertensive kidney injury(P<0.05).Conclusion Serum Smad1 level and AASI are associated with renal function regression in patients with hypertensive kidney injury and are high risk factors for poor renal function regression in patients with hypertensive kidney injury.