24-Hour Urinary Sodium Excretion Association with Cardiovascular Events:A Systematic Review and Dose-Response Meta-Analysis

Objective The relationship between sodium intake and cardiovascular(CV)events remains unconfirmed.Therefore,we carried out a systematic review and dose-response meta-analysis for evaluating the potential impact of 24-hour sodium excretion on CV risk.Besides,24-hour sodium excretion was used to replace daily sodium diet intake.Methods We searched ISI Web of Science,Embase,Pub Med,and the Cochrane Library.Our study included cohort studies reporting hazard ratio(HR).The random-effects model was used for summarizing the total relative risks(RRs)between the included studies.In addition,the generalized least-squares regression was employed to fit the study model.Results A total of 9 studies involving 645,006 participants were included in this study.A significant non-linear relationship was observed between sodium excretion and CV events(P^(non-linearity)<0.001).In studies collecting 24-h urine samples,the sodium excretion and CV events risk were associated linearly(RR:1.04;95%CI:1.01,1.07).Conclusion In a linear dose-response manner,every 1 g increase in sodium intake was associated with an increased risk of CV events up to 4%.Further studies are required to validate our conclusions further.

2型糖尿病患者24 h尿钠排泄及IL-18水平与尿白蛋白的相关性研究

目的以24 h尿钠排泄水平(24 h UNa)作为钠摄入量评估指标,评估不同钠盐的摄入水平与血清炎症因子对2型糖尿病(T2DM)患者尿白蛋白(UA)发生风险的影响。方法纳入T2DM患者130例,依据尿白蛋白/肌酐比值(UACR)水平分为UA阳性组60例和UA阴性组70例。收集患者的临床资料,检测炎性因子及24 h尿液相关指标。采用Spearman相关分析T2DM患者临床指标与UACR的相关性;二元Logistic回归分析T2DM患者临床指标对UA的影响;二分类回归法分析24 h UNa和IL-18关联对UA的影响。结果24 h UNa水平(OR=1.019,95%CI 1.003~1.035,P=0.017)与IL-18(OR=1.204,95%CI 1.060~1.368,P=0.004)是T2DM患者UA阳性的独立危险因素。联合分析提示,与低钠低IL-18组比较,高钠高IL-18组UA阳性风险显著增加(OR=10.774,95%CI 2.105~55.155,P=0.004)。结论24 h UNa、IL-18水平升高是T2DM患者UA发生的危险因素。

利用三种点尿估算方法评估和验证中国人群24小时尿钠排泄量

目的 :本研究旨在验证和评价Kawasaki、INTERSALT和Tanaka三种方法估算24 h尿钠排泄量在中国人群中应用的可行性和准确性。方法:本研究是前瞻性城乡流行病学研究(PURE)的子研究,抽取120名受试者(城乡各60名),同时收集受试者的空腹晨尿和24 h尿液标本,检测点尿和24 h尿液中钠、钾和肌酐水平。使用Bland-Altman法比较三种方法所估算出的24 h尿钠排泄量和实际尿钠排泄量之间的一致性。结果 :最终116名受试者被纳入到最终的统计分析。实测钠排泄的平均值为6 343 mg/d(约为盐16.2 g/d)。Kawasaki法是3种方法中偏差最小的,平均偏差值(估测值减24 h实际观察值)为-740.49 mg/d。Tanaka法的平均偏差值是-2 305.05 mg/d。差距最大的是INTERSALT法,平均偏差值为-2 797.39 mg/d。尽管与其他方法相比,Kawasaki法的估测值与24 h实测值之间的差距较小,Bland-Altman图显示仍有9人(7.76%)超出均数±1.96倍标准差的一致性界线。结论:Kawasaki法、INTERSALT法和Tanaka法三种方法估算中国城乡人群的24 h尿钠排泄量均存在不同程度的低估和局限,故需制定一个适合中国人群的估算24 h尿钠排泄量方法,从而更准确地评估中国人群的盐摄入量。

24小时尿钠排泄与难治性高血压患者血压达标状态的相关性:单中心横断面研究

目的分析24 h尿钠排泄与难治性高血压(resistant hypertension,RH)患者诊室血压及家庭自测血压(home blood pressure monitoring,HBPM)达标状态的关系。方法通过北京协和医院心内科门诊RH数据库,收集2017年10月至2018年3月间在北京协和医院心内科门诊就诊的RH患者临床资料,进行横断面调查。检测患者24 h尿钠,记录患者同期诊室血压、HBPM水平及临床用药情况,以所有患者24 h尿钠水平四分位数为分界点,将研究对象分为低尿钠、低-中尿钠、中-高尿钠及高尿钠4组。采用多因素Logistic回归,分析影响RH血压达标状态的危险因素。结果共202例RH患者入选本研究,男性107例,女性95例,平均年龄(59. 87±16. 30)岁。24 h尿钠平均水平为(198. 92±96. 59) mmol,年轻患者及体质量指数高者尿钠水平更高(P均<0. 001)。随尿钠升高,降压药物的服用种类显著增多(P=0. 001),早晨及上午的HBPM达标率低(P=0. 040,0. 032)。多因素Logistic回归分析显示,24 h尿钠水平与诊室血压(OR=2. 356,95%CI:1. 004～5. 533,P=0. 049),HBPM早晨血压(OR=2. 408,95%CI:1. 026～5. 650,P=0. 030)及HBPM上午血压(OR=2. 299,95%CI:1. 031～5. 129,P=0. 033)达标状态独立相关,而与下午及夜间HBPM血压达标状态无显著相关(P均>0. 05)。结论 24 h尿钠是RH患者诊室血压及HBPM早晨及上午血压达标的独立相关因素,限制钠盐摄入对减少RH患者血压波动、促进血压达标有重要作用。

Tanaka及SH2法估算上海地区高血压患者24h尿钠排泄量的可行性和准确性

目的验证和评价Tanaka(T法)和SH2(S法)两种方法在上海地区高血压患者中估算24h尿钠排泄量的可行性和准确性。方法留取2017年1月-2018年1月在海军军医大学长海医院内科病房住院的180例高血压患者晨尿、午尿及夜间尿样本,并留取24h尿样。检测3个时点尿样和24h尿样中的钠、钾和肌酐水平,使用T法和S法计算。对T法和S法的估算值与实测值之间的偏差进行比较,采用Bland-Altman法比较两种方法所估算出的24h尿钠排泄量与实际尿钠排泄量之间的一致性。结果共有122例患者纳入最终分析,实测24h尿钠排泄量平均值为151.02mmol(约为盐8.83g)。T法估测尿钠排泄量在3个时点的平均偏差值(估算值–24h实际观察值)分别为34.99、22.72、48.76mmol/L,S法在3个时点的平均偏差值分别为–6.83、–6.82、–6.31mmol/L。T法在晨尿、S法在3个时点尿样中的组内相关系数(ICC)较高。Bland-Altman法显示24h尿钠排泄量水平越高,S法出现的偏倚越大,具有线性趋势。结论因存在不同程度的局限,T法及S法均不适合估算患者个体的24h尿钠排泄量;T法及S法适合估算人群的24h尿钠平均水平,而S法相较T法更为准确。

Cosinor-rhythmometry for 24-h urinary sodium,potassium,creatinine excretion in the Chinese adult population

Background:The low accuracy of equations predicting 24-h urinary sodium excretion using a single spot urine sample contributed to the misclassification of individual sodium intake levels.The application of single spot urine sample is limited by a lack of representativity of urinary sodium excretion,possibly due to the circadian rhythm in urinary excretion.This study aimed to explore the circadian rhythm,characteristics,and parameters in a healthy young adult Chinese population as a theoretical foundation for developing new approaches.Methods:Eighty-five participants(mean age 32.4 years)completed the 24-h urine ollction by sccessively cllecing each of the single-voided specimens within 24 h.The concentrations of the urinary sodium,potassium,and creatinine for cach voided specimen were measured.Cosinor analysis was applied to explore the circadian rhythm of the urinary sodium,potassium,and creatinine excretion.The excretion per hour was computed for analyzing the change over time with repeated-measures analysis of variance and a cubic spline model.Results:The metabolism of urinary sodium,potassium,and creatinine showed different patterns of circadian rhythm,although the urinary sodiurm excretion showed non-significant parameters in the cosinor model.A significant circadian rhythm of urinary creatinine excretion was observed,while the circadian rhythm of sodium was less significant than that of potassium.The circadian rhythm of urinary sodium and creatinine excretion showed synchronization to some extent,which had a nocturnal peak and fell to the lowest around noon to afternoon.In contrast,the peak of potassium was observed in the morning and dropped to the lowest point in the evening.The hourly urinary excretion followed a similar circadian rhythm.Conclusion:It is necessary to consider the circadian rhythm of urinary sodium,potassium,and creatinine excretion in adults while exploring the estimation model for 24-h urinary sodium excretion using spot urine.

早期维持性透析患者尿钠排泄节律异常及24h尿钠对动态血压及预后的影响研究

目的:探讨早期维持性透析患者尿钠排泄节律异常及24h尿钠对动态血压及预后的影响。方法:选取2015年5月~2016年6月在某院进行维持性透析的患者200例,根据夜间平均动脉压与日间平均动脉压之比分为杓型组52例和非杓型组148例。观察两组患者肝肾功能、尿钠水平、尿钠排泄率和24h动态血压值,随访患者3年预后情况。结果:非杓型组的24h尿蛋白定量、夜间尿钠水平、夜间平均SBP和DBP均显著高于杓型组,差异有统计学意义(P<0.05);根据患者夜间尿钠排泄高低进行三分位,第一、二、三分位中非杓型血压的发生比例分别为89.39%、76.47%和56.06%,差异有统计学意义(P<0.05);随访中,夜间尿钠排泄第一、二、三分位中预后良好比例分别为81.82%、75.00%和62.12%,差异有统计学意义(P<0.05)。结论:尿钠排泄节律异常及高夜间尿钠排泄会显著增加透析患者非杓型血压的发生风险,影响患者预后,值得临床关注。

Can spot urine measurement be a substitute for 24-hour urine measurement to estimate sodium intake in adolescents?

Importance:Several methods have been established in recent decades that allow use of spot urine to estimate dietary sodium intake.However,their accuracies have been controversial in children.Objective:To validate the performance of three commonly used methods-the Kawasaki,Tanaka,and International Cooperative Study on Salt,Other Factors,and Blood Pressure(INTERSALT)methods.Additionally,this study explored the accuracies of the Tanaka and INTERSALT methods by using spot urine samples taken at four separate times.Method:Forty-one adolescents aged 14 to 16 years completed two non-consecutive 24-hour urine collections and their mean values were used as reference data.The second-morning urine was used for assessment with the Kawasaki method;a casual spot urine and spot urine samples taken at four separate times(morning,afternoon,evening,and overnight)were used for assessment with the Tanaka and INTERSALT methods.Results:The mean differences were 1801 mg,542 mg,47 mg,and-31 mg for the Kawasaki,Tanaka,INTERSALT 1(with potassium),and INTERSALT2(without potassium)methods with their required spot urine,respectively.The proportions of relative difference levels within±10%were 4.9%for the Kawasaki method,19.5%for the Tanaka method,36.6%for the INTERSALT 1 method,and 36.6%for the INTERSALT2 method.Interpretation:The INTERSALT method seemed to provide minimally biased estimations of mean population sodium intake with casual spot urine.However,there is a need to be cautious regarding inconsistencies in estimation among different levels of sodium intake.The methods assessed in this study were unable to accurately estimate sodium intake at the individual level.

Nutritional Biomarker Analyses for Hypertension-Related Risk Assessment and Control

A simple method to collect 24-hour urine (24U) by sampling 2.5% of the voided urine each time was developed for analyzing the biomarkers of the intakes of salt (NaCl), vegetables and grains (K, Mg), soys (isoflavones), sea-foods (taurine), protein (urea nitrogen) etc. This method was applied to WHO-coordinated CARDIAC (Cardiovascular Diseases and Alimentary Comparison) study covering 61 populations in 25 countries, and revealed significant positive associations of Na or Na/K with blood pressure (BP) and stroke mortality and significant inverse associations of isoflavones or taurine with coronary heart disease (CHD) mortality, indicating the adverse effect of salt intake on BP and stroke and beneficial effect of soy or sea food intakes on CHD. Furthermore, higher urinary taurine and/or Mg excretions were associated with significantly lower risks of metabolic syndromes such as obesity, hypertension and hypercholestelomia. 24U collections were useful to prove nutritional improvement by intervention studies for observing soy intake effect on BP and atherogenic index in Japanese immigrants living in Brazil, and in Australian Aboriginals, for observing taurine effect on BP in Tibetans and for confirming soy and fish effects on the risks of metabolic syndromes in Japanese businessmen. 24U collection was utilized for population strategy to reduce salt and to increase soy intake in 5.6 million people of Hyogo Prefecture. A simple method for 24U collection has enabled us to utilize nutritional biomarkers for hypertension-related disease risk analyses, and to apply objective nutritional intake estimation to intervention studies as well as to population strategy for nutritional improvement, and therefore, the methodology will contribute to hypertension-related disease prevention and global health promotion.

高血压前期肥胖患者非药物治疗效果的观察

目的:观察高血压前期肥胖患者生活方式改变对其血压的影响。方法:随访2011年3月—2013年2月就诊的高血压前期、肥胖、有明显心血管病风险,使用单一药物即可控制血压的患者。使用方差分析和t检验评估生活方式改变对血压的影响趋势。结果:经随访分析连续入选的421名高血压前期患者,发现两组的血压变化趋势无显著性差异。生活方式改变+安慰剂组73%的患者体重减轻,与单一抗高血压药物组比较差异有统计学意义(P<0.05)。并且该组患者平均24 h尿钠排泄量减低,与单一抗高血压药物组比较差异有统计学意义(P<0.001)。尽管与单一药物抗高血压组比较,无论是收缩压或舒张压的变化,生活方式改变+安慰剂组都处于略高水平,但同时发生在单一药物抗高血压组与抗高血压药物服用相关的不良反应高达16.7%。结论:对高血压前期的肥胖患者,采用针对性的非药物治疗方式联合应用,可能有显著控制血压的作用。

2型糖尿病患者24 h尿钠排泄和25-羟维生素D与白蛋白尿的相关性研究

目的以24 h尿钠排泄作为钠摄入量评估指标,评估24 h尿钠排泄和25-羟维生素D(25-hydroxy vitamin D,25-OHD)水平对2型糖尿病患者白蛋白尿发生风险的关联影响。方法回顾性纳入2018年1月至2021年10月期间郑州大学第一附属医院内分泌与代谢病科住院成年2型糖尿病患者670例。根据24 h尿白蛋白排泄水平分为白蛋白尿阳性组与阴性组;根据24 h尿钠排泄水平分为高钠组和低钠组;根据25-OHD水平分为低VD组和高VD组。关联24 h尿钠排泄和25-OHD两分类变量进一步将患者分为4组,即高VD低钠组(85例)、高VD高钠组(122例)、低VD低钠组(248例)和低VD高钠组(215例);采用二分类回归法分析24 h尿钠排泄和25-OHD关联对白蛋白尿的影响。结果4组患者组间24 h尿白蛋白排泄水平差异有统计学意义(P<0.01);低VD高钠组的24 h尿白蛋白排泄水平显著高于低VD低钠组、高VD低钠组和高VD高钠组[39.00(13.00,319.00)mg/24 h对22.00(10.00,99.00)mg/24 h,22.00(9.00,72.50)mg/24 h,22.45(9.69,72.75)mg/24 h;P=0.047,P=0.019,P=0.030]。相关分析显示,低VD组24 h尿钠排泄与24 h尿白蛋白排泄呈正相关(P=0.017),高VD组二者间无相关性(P=0.411)。二分类回归分析显示,24 h尿钠排泄水平(P=0.017)和25-OHD(P=0.023)是2型糖尿病患者白蛋白尿阳性的独立危险因素。低VD高钠组白蛋白尿阳性风险是高VD低钠组的1.789倍(P=0.037)。结论24 h尿钠排泄和25-OHD二者关联影响2型糖尿病患者24 h尿白蛋白排泄,低25-OHD水平增加高钠摄入2型糖尿病患者白蛋白尿的发生风险。

点尿法及24h尿收集法估算高血压病患者24h尿钠钾排泄量的应用比较

目的探讨利用点尿法及24 h尿收集法估算高血压病患者24 h尿钠钾排泄量的应用价值。方法研究对象为2017年2月至2018年1月就诊于新疆医科大学第一附属医院高血压科的高血压病患者,共264例。收集患者24 h尿及相应的清晨空腹点尿,分别测定所有尿样的钠、钾、肌酐水平。采用Tanaka、Kawasaki和INTERSALT公式分别估算点尿法24 h尿钠钾排泄量,采用配对秩和检验比较公式估算值与实际测量值的差异;利用Spearman相关分析评价各公式估算的24 h尿钠钾排泄量与实测24 h尿钠钾排泄量的相关关系。结果 Tanaka法公式估算的24 h尿钠值(167. 99 mmol/d)高于实际24 h尿钠值(157. 73 mmol/d),差异无统计学意义(Z=-0. 23,P>0. 05); Kawasaki法公式估算的24 h尿钠值(217. 66 mmol/d)亦高于实际24 h尿钠值,差异有统计学意义(Z=-8. 81,P <0. 01);INTERSALT法公式估算的24 h尿钠值(154. 71 mmol/d)低于实际24 h尿钠值,差异有统计学意义(Z=-3. 53,P <0. 01)。Tanaka、Kawasaki和INTERSALT公式估算的24 h尿钠值与实际24 h尿钠值的相关系数分别为0. 68,0. 55,0. 58(均P <0. 01); Tanaka公式估算的24 h尿钾值(39. 51 mmol/d)低于实际测量值(42. 90 mmol/d),差异有统计学意义(Z=-3. 47,P <0. 05),相关系数为0. 50(P <0. 01)。结论在高血压病患者中,公式法估算的24 h尿钠钾排泄量与实际测量值,存在不同程度的低估与高估,且相关性差。利用点尿法公式估算高血压病患者24 h尿钠钾排泄量存在一定程度的不准确性和局限性。