Perticone Francesco, Maio Raffaele, Tripepi Giovanni, Sciacqua Angela, Mallamaci Francesca, Zoccali Carmine
Internal Medicine and Cardiovascular Diseases Unit, Department of Experimental and Clinical Medicine G. Salvatore, University Magna Graecia of Catanzaro, Catanzaro - Italy.
J Nephrol. 2007 Nov-Dec;20 Suppl 12:S56-62.
We investigated the relationship between microalbuminuria (an indicator of systemic and renal endothelial dysfunction), inflammation (high-sensitivity C-reactive protein [CRP]) and endothelial function (hemodynamic response to acetylcholine [ACh] in the forearm) in 110 never-treated subjects with uncomplicated essential hypertension and serum creatinine within the normal range. Microalbuminuria was associated with the hemodynamic response to ACh (r=0.27, p=0.006) and with serum creatinine (r=0.34, p<0.001), and these associations held true in multivariate analyses. On the other hand, microalbuminuria was largely independent of serum CRP. Since microalbuminuria, response to ACh and serum CRP are all considered risk factors for renal insufficiency and since these factors were significantly related to creatinine at univariate analysis, we tested their association with creatinine in a multiple regression model including also the full set of Framingham risk factors. In this analysis, serum CRP and microalbuminuria maintained a significant association with serum creatinine, while the hemodynamic response to ACh lost substantial predictive value for serum creatinine. In conclusion, microalbuminuria in essential hypertension is weakly related to the vasodilatory response to ACh and unrelated to inflammation but maintains an independent link with serum creatinine. Collectively, these associations suggest that microalbuminuria reflects a local (renal) endothelial dysfunction and that it may contribute to renal impairment independently of inflammation and hemodynamic endothelial dysfunction in hypertensive patients.
我们在110名未经治疗、患有单纯原发性高血压且血清肌酐在正常范围内的受试者中，研究了微量白蛋白尿（系统性和肾内皮功能障碍的一个指标）、炎症（高敏C反应蛋白[CRP]）与内皮功能（前臂对乙酰胆碱[ACh]的血流动力学反应）之间的关系。微量白蛋白尿与对ACh的血流动力学反应相关（r = 0.27，p = 0.006），也与血清肌酐相关（r = 0.34，p < 0.001），并且这些关联在多变量分析中依然成立。另一方面，微量白蛋白尿在很大程度上独立于血清CRP。由于微量白蛋白尿、对ACh的反应和血清CRP均被视为肾功能不全的危险因素，且在单变量分析中这些因素与肌酐显著相关，我们在一个多元回归模型中测试了它们与肌酐的关联，该模型还纳入了全套弗明汉姆危险因素。在这项分析中，血清CRP和微量白蛋白尿与血清肌酐仍保持显著关联，而对ACh的血流动力学反应对血清肌酐的预测价值大幅降低。总之，原发性高血压中的微量白蛋白尿与对ACh的血管舒张反应弱相关，与炎症无关，但与血清肌酐保持独立关联。总体而言，这些关联表明微量白蛋白尿反映了局部（肾脏）内皮功能障碍，并且在高血压患者中，它可能独立于炎症和血流动力学内皮功能障碍而导致肾功能损害。
