肾素-血管紧张素-醛固酮系统检测在高血压急症伴肾损伤患者中的应用价值

Application value of renin-angiotensin-aldosterone system detection in hypertensive patients with renal injury

目的回顾性分析肾素-血管紧张素-醛固酮系统(RAAS)检测在高血压急症(HE)伴肾损伤患者中的临床应用价值。方法本研究纳入2012年1月至2021年1月东部战区总医院国家肾脏疾病临床医学研究中心收治的HE伴肾损伤患者,以卧立位RAAS水平进行分组,分析患者的靶器官损害(HMOD)特征、预后以及RAAS与HMOD相关性。结果176例HE伴肾损伤患者纳入本研究,平均(33.51±8.59)岁,高血压病程11.0(1.0,48.0)个月,慢性肾病(CKD)病程1.0(1.0,3.0)个月。随访24个月后,63例进展至终末期肾病(ESRD),其中5例因心脑血管事件死亡。多因素COX回归发现HE时尿蛋白、血红蛋白(Hb)、血清肌酐(Scr)水平是患者ESRD的独立危险因素(P<0.05)。与RAAS未激活患者相比,RAAS激活的HE伴肾损伤患者CKD病程短,以HN为主,较少合并原发性肾病,尿检轻,容量负荷轻,心肌肥厚重,但肾脏预后好(P<0.05)。结论HE伴肾损伤的患者常见于青年男性。RAAS检测有助于早期识别不伴原发性肾病的HE患者,及时抑制RAAS,改善肾脏预后。

Objective This retrospective study was to evaluate the clinical application value of renin-angiotensin-aldosterone system(RAAS)detection in hypertensive emergency(HE)patients with renal injury.Methods In this study,patients with HE and kidney injury admitted to the National Clinical Research Center of Kidney Diseases,Eastern Theater Command General Hospital from January 2012 to January 2021 were included.The patients were grouped according to the level of RAAS in the lying position,and the characteristics of target organ damage(HMOD),prognosis,and correlation between RAAS and HMOD were analyzed.Results 176 patients with HE and renal injury were included in this study,with an average age of(33.51±8.59)years,and the duration of hypertension was 11.0(1.0,48.0)months,and the duration of chronic kidney disease(CKD)was 1.0(1.0,3.0)months.After 24 months of follow-up,63 patients progressed to end-stage renal disease(ESRD),and 5 of them died due to cardiovascular events.Multivariate COX regression showed that the levels of urinary protein,hemoglobin(Hb)and serum creatinine(Scr)in HE were independent risk factors for ESRD(P<0.05).Compared with RAAS inactive patients,RAAS activated HE patients with renal injury had a shorter CKD course,mainly HN,less primary nephropathy,light urine test,light volume load,and heavy myocardium,but a better renal prognosis(P<0.05).Conclusion HE with renal injury is common in young men.RAAS detection is helpful for early identification of HE patients without primary nephropathy,timely inhibition of RAAS,and improvement of renal prognosis.