原发性高血压患者血清Hcy、尿ACR、动态脉压指数水平与早期肾损害关系的分析

Analysis of the relationship between serum Hcy,urine ACR,dynamic pulse pressure index and earlyrenal damage in patients with essential hypertension

目的:探讨原发性高血压患者血清同型半胱氨酸(Hcy)、尿微量白蛋白/尿肌酐(ACR)、动态脉压指数(PPI)水平与早期肾损害的关系。方法:选取2021年1月至2024年1月在郑州市第二人民医院治疗的105例原发性高血压早期肾损害患者设为观察组,另选取同期在同一家医院治疗的98例原发性高血压未发生肾损害患者设为对照组。比较两组Hcy、ACR、PPI等实验室指标及一般临床资料,利用试者工作特征(ROC)曲线分析原发性高血压出现早期肾损害的危险因素及Hcy、ACR、PPI对原发性高血压早期肾损害的诊断价值。将观察组患者依据肾小球滤过率不同分成轻度组、中度组及重度组,比较3组间Hcy、ACR、PPI水平,分析上述指标与疾病严重程度的关系。结果:观察组与对照组一般临床资料及血脂、血糖比较无明显差异(P>0.05),但两组Hcy、ACR及PPI比较差异有统计学意义(P<0.001);行Logistic回归分析发现,Hcy、ACR及PPI均是原发性高血压发生早期肾损害的危险因素(P<0.05)。绘制Hcy、ACR及PPI诊断早期肾损害的ROC曲线,结果显示其曲线下面积分别为0.713、0.723及0.611(P<0.05)。轻度、中度及重度组间Hcy、ACR及PPI水平比较差异有统计学意义(P<0.05);经Spearman相关性分析,Hcy、ACR及PPI水平与肾损害程度呈正相关(P<0.05)。结论:Hcy、ACR及PPI水平升高是原发性高血压患者发生早期肾损害的危险因素,与损害程度密切相关,且可辅助诊断早期肾损害。

Objective:To investigate the relationship between serum homocysteine(Hcy),urine albumin-tocreatinine ratio(ACR),dynamic pulse pressure index(PPI)and early renal damage in patients with essential hypertension.Methods:A total of 105 patients with early renal damage caused by essential hypertension who were treated in the Second People'sHospital of Zhengzhou from January 2021 to January 2024 were selected as the observation group,and 98 patients with essential hypertension treated in the same hospital during the same period without renal damage were selected as the control group.Laboratory indicators(Hcy,ACR and PPI)and general clinical data of the two groups were compared.The risk factors of early renal damage in essential hypertension and the diagnostic value of Hcy,ACR and PPI in early renal damage in essential hypertension were analyzed by the receiver operating characteristic(ROC)curve.Patients in the observation group were dividedinto mild group,moderate group and severe group according to the glomerular filtration rate.Hcy,ACR and PPI in the three groups were compared.The relationship between above indicators and disease severity was discussed.Results:There were no significant differences in general clinical data,blood lipid and blood glucose between the observation group and the control group(P>0.05),but there were statistically significant differences in Hcy,ACR and PPI between the two groups(P<0.001).Logistic regression analysis showed that Hcy,ACR,and PPI were risk factors for early renal damage in essential hypertension(P<0.05).ROC curves of Hcy,ACR,and PPI in the diagnosis of early renal damage were plotted,and the result showed that the areas under the curves were 0.713,0.723,and 0.611,respectively(P<0.05).There were statistically significant differences in Hcy,ACR and PPIamong the mild group,the moderate group and the severe group(P<0.05).Spearman correlation analysis showed that Hcy,ACR and PPI were positively correlated with the degreeof renal damage(P<0.05).Conclusions:The elevated Hcy,ACR and PPI are risk factors for early renal damage in patients with essential hypertension,which are closely related to the degree of damage and can assist the diagnosis of early renal damage.