盐摄入量对不同盐敏感性高血压患者反应性充血指数及颈-股动脉脉搏波传导速度的影响

Effect of salt intake on reactive hyperemia index and carotid-femoral pulse wave velocity in hypertensive patients with different salt sensitivity

目的探讨不同盐敏感性高血压患者盐摄入量对反应性充血指数(RHI)及颈-股动脉脉搏波传导速度(cfPWV)的影响。方法纳入徐州市中心医院2016年6月至2022年8月住院的高血压患者299例。根据急性盐水负荷试验分为盐敏感组(n=146)、中间型盐敏感组(n=84)、盐抵抗组(n=69)。收集24h尿液,通过24h尿钠水平评估盐摄入量,根据盐摄入量将3组患者分别分为低(盐摄入量<6g/d),中(盐摄入量6~12g/d),高(盐摄入量>12g/d)3个亚组。比较不同亚组中心动脉压、cfPWV、RHI等指标的差异。采用Pearson相关分析cfPWV、RHI与盐摄入量之间的关系。采用多元线性回归分析探究高血压患者RHI、cfPWV的影响因素。结果RHI比较:盐抵抗组高于中间型盐敏感组,高于盐敏感组,差异有统计学意义(1.99±0.42比1.81±0.35比1.68±0.28,F=19.335,P<0.001);cfPWV比较:盐抵抗组、中间型盐敏感组低于盐敏感组[(8.90±2.40)、(9.45±2.86)比(11.00±2.91)m/s,F=16.187,P<0.001]。在盐抵抗组及中间型盐敏感组,高盐摄入量亚组的RHI低于低盐摄入量亚组(均P<0.05);在盐敏感组,高盐摄入量亚组的RHI低于中、低盐摄入量亚组(P<0.001),cfPWV高于中、低盐摄入量亚组(P<0.001)。Pearson相关性分析显示,高血压患者盐摄入量与RHI呈负相关(r=-0.293,P<0.001),与cfPWV呈正相关(r=0.165,P=0.004)。多元线性回归分析显示,RHI的影响因素有盐抵抗(β=0.371)、中间型盐敏感(β=0.150)、盐摄入量(β=-0.298)、中心动脉收缩压(β=-0.294)、男性(β=-0.146)、高血压病程(β=-0.135),cfPWV的影响因素有盐抵抗(β=-0.221)、中间型盐敏感(β=-0.162)、盐摄入量(β=0.143)、中心动脉脉压(β=0.358)、增强压(β=0.128)、年龄(β=0.237)、男性(β=0.106)。结论在高血压患者中,盐敏感较非盐敏感加重血管内皮功能损害和动脉硬化,中间型盐敏感较盐抵抗加重血管内皮功能的损害。盐敏感性、盐摄入量是RHI、cfPWV的独立影响因素,且两因素对cfPWV的影响具有交互作用。

Objective To explore the effect of salt intake on reactive hyperemia index(RHI)and carotid-femoral pulse wave velocity(cfPWV)in hypertensive patients with different salt sensitivity.Methods Two hundred and ninety-nine hypertensive patients admitted to Xuzhou Central Hospital from June 2016to August 2022were included.According to the acute saline loading test,the patients were divided into 3groups:salt sensitive group(n=146),intermediate salt sensitive group(n=84)and salt resistant group(n=69).The urine samples of 24-hour were collected and the salt intake was evaluated based on 24-hour urine sodium levels.According to salt intake,the patients in three groups were divided into three subgroups respectively:low(salt intake<6g/d),medium(6-12g/d),and high(>12g/d).Central arterial pressure,cfPWV,and RHI were compared among different sub-groups.Pearson correlation was used to analyze the relationship between cfPWV,RHI and salt intake.Multiple linear regression analysis was used to explore the influencing factors of RHI and cfPWV in hypertensive patients.Results RHI in the salt resistant group was higher than that in the intermediate salt sensitive group,and higher than that in the salt sensitive group(1.99±0.42 vs 1.81±0.35 vs 1.68±0.28,F=19.335,P<0.001).CfPWVs in the salt resistant group and intermediate salt sensitive group were lower than that in the salt sensitive group[(8.90±2.40),(9.45±2.86)vs(11.00±2.91)m/s,F=16.187,P<0.001].In the salt resistant group and intermediate salt sensitive group,the RHI of the high salt intake subgroup was lower than that of the low salt intake subgroup(both P<0.05).In the salt sensitive group,RHI was lower,while cfPWV was higher in the high salt intake subgroup compared with the middle and low salt intake subgroup(P<0.001).Pearson correlation analysis showed that salt intake was negatively correlated with RHI(r=-0.293,P<0.001),while positively correlated with cfPWV(r=0.165,P=0.004).Multiple linear regression analysis showed that the influencing factors of RHI included salt resistance(β=0.371),intermediate salt sensitivity(β=0.150),salt intake(β=-0.298),central systolic blood pressure(β=-0.294),males(β=-0.146)and hypertension duration(β=-0.135);the influencing factors of cfPWV included salt resistance(β=-0.221),intermediate salt sensitivity(β=-0.162),salt intake(β=0.143),central pulse pressure(β=0.358),augmentation pressure(β=0.128),age(β=0.237)and males(β=0.106).Conclusions In hypertensives,salt sensitivity exacerbates endothelial dysfunction and arteriosclerosis compared to non-salt sensitivity,and salt sensitivity exacerbates endothelial dysfunction compared to salt resistance.Salt sensitivity and salt intake are independent influencing factors for RHI and cfPWV,and the two factors have an interactive effect on cfPWV.