Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
J Hypertens. 2011 Nov;29(11):2091-8. doi: 10.1097/HJH.0b013e32834b5627.
Although several studies have reported an association between microalbuminuria and pulse wave velocity in patients with hypertension or diabetes, there have been no reports of their significance in apparently healthy individuals.
Microalbuminuria and brachial-ankle PWV (baPWV) were investigated in a sample of 3826 nonhypertensive, nondiabetic individuals (3598 men, mean age 50 ± 11.3 years) at Kangbuk Samsung Health Promotion Center between 2006 and 2009. The patients were classified into two groups according to urinary albumin-creatinine ratio (UACR) in morning urine specimens: normoalbuminuria (<30 μg/mg) and microalbuminuria (30-300 μg/mg).
The prevalence of prehypertension (preHT) and microalbuminuria was 52.5 and 4%, respectively. Abnormal baPWV and microalbuminuria each has unfavorable cardiometabolic profile. The absolute values of baPWV were correlated with those of UACR (r = 0.220, P < 0.001). In multivariate regression analysis, the microalbuminuria group showed an independent association of increasing baPWVs irrespective of potential confounders, compared with the normoalbuminuria group (standard β = 0.049, P < 0.001). In the subspecified analyses, category III (preHT + normoalbuminuria) and IV (preHT + microalbuminuria) had higher odds ratio (ORs) [95% confidence interval (CI)] for the abnormal baPWV group, compared with category I (normal BP + normoalbuminuria) [2.345 (2.010-2.735) and 3.822 (2.367-6.171), respectively].
These findings demonstrate epidemiologic evidence for an independent association between arterial stiffness and microalbuminuria, indices of subclinical target organ damage in nonhypertensive, nondiabetic individuals, which suggests the possibility of a similar pathophysiologic mechanism involved in these two indices of subclinical target organ damage.
尽管已有多项研究报道高血压或糖尿病患者的微量白蛋白尿与脉搏波速度之间存在相关性，但目前尚无关于微量白蛋白尿在非高血压、非糖尿病的健康个体中的意义的报告。
本研究于 2006 年至 2009 年在 Kangbuk Samsung 健康促进中心对 3826 例非高血压、非糖尿病个体（3598 名男性，平均年龄 50±11.3 岁）进行了微量白蛋白尿和肱踝脉搏波速度（baPWV）的调查。根据晨尿标本中的尿白蛋白/肌酐比值（UACR）将患者分为两组：正常白蛋白尿组（<30μg/mg）和微量白蛋白尿组（30-300μg/mg）。
高血压前期（preHT）和微量白蛋白尿的患病率分别为 52.5%和 4%。异常的 baPWV 和微量白蛋白尿均具有不利的心血管代谢特征。baPWV 的绝对值与 UACR 呈正相关（r=0.220，P<0.001）。在多变量回归分析中，与正常白蛋白尿组相比，微量白蛋白尿组的 baPWV 呈独立的递增趋势（标准β=0.049，P<0.001）。在亚组分析中，与类别 I（正常血压+正常白蛋白尿）相比，类别 III（preHT+正常白蛋白尿）和类别 IV（preHT+微量白蛋白尿）发生异常 baPWV 组的比值比（OR）[95%置信区间（CI）]更高[分别为 2.345（2.010-2.735）和 3.822（2.367-6.171）]。
这些发现提供了流行病学证据，表明在非高血压、非糖尿病个体中，动脉僵硬与微量白蛋白尿之间存在独立的相关性，微量白蛋白尿是亚临床靶器官损害的指标之一，这表明这两个亚临床靶器官损害指标可能涉及类似的病理生理机制。
