原发性高血压患者 E/E' 及 NT-proBNP 与肾功能的关系。

Association of E/E' and NT-proBNP with renal function in patients with essential hypertension.

机构信息

State Key Laboratory of Medical Genomics, Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

出版信息

PLoS One. 2013;8(1):e54513. doi: 10.1371/journal.pone.0054513. Epub 2013 Jan 28.

DOI:10.1371/journal.pone.0054513

PMID:23382907

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3557266/

Abstract

OBJECTIVES

To evaluate the association of left ventricular (LV) diastolic function and N-terminal pro-brain natriuretic peptide (NT-proBNP) with renal function in essential hypertension.

METHODS

LV diastolic function was estimated by the ratio of early diastolic velocities (E) from transmitral inflow to early diastolic velocities (E') of tissue Doppler at mitral annulus (septal corner); NT-proBNP was measured in 207 hypertensive patients (mean age 56±14 years). The subjects were classified into 3 groups: E/E'≤10 group (n = 48), 10<E/E'≤15 group (n = 109) and E/E'>15 group (n = 50). The renal function was estimated by glomerular filtration rate (GFR) with (99m)Tc-DTPA. GFR from 30 to 59 ml/min/1.73 m(2) was defined as Stage 3 chronic kidney disease (CKD). GFR was also estimated using the modified MDRD equation. Albuminuria was defined by urinary albumin/creatinine ratio (UACR).

RESULTS

GFR was lower and UACR was higher in E/E' >15 group than in 10< E/E' ≤15 group or E/E' ≤10 group (p<0.0001), GFR was significantly negative and UACR was positive correlated with E/E' and NT-proBNP (p<0.0001). In multivariate stepwise linear analysis, GFR had significant correlation with age (p = 0.001), gender (p = 0.003), E/E' (p = 0.03), lgNT-proBNP (p = 0.001) and lgUACR (p = 0.01), while eGFR had no significant correlation with E/E' or lgNT-proBNP. Multivariate logistic regression analysis, adjusted for potential confounding factors, showed that participants in E/E'>15 group were more likely to have Stage 3 CKD compared with those in E/E'≤10 group with an adjusted odds ratio of 8.31 (p = 0.0036).

CONCLUSIONS

LV diastolic function, assessed with E/E' and NT-proBNP is associated with renal function in essential hypertension.

摘要

目的

评估左心室（LV）舒张功能和 N 末端脑利钠肽前体（NT-proBNP）与原发性高血压患者肾功能之间的关系。

方法

通过测量二尖瓣前向血流的早期舒张速度（E）与二尖瓣环组织多普勒早期舒张速度（E'）的比值来评估 LV 舒张功能；共纳入 207 例高血压患者（平均年龄 56±14 岁），测量 NT-proBNP 水平。将患者分为 3 组：E/E'≤10 组（n=48）、10<E/E'≤15 组（n=109）和 E/E'>15 组（n=50）。用（99m）Tc-DTPA 计算肾小球滤过率（GFR）来评估肾功能。GFR 为 30-59 ml/min/1.73 m(2)定义为 3 期慢性肾脏病（CKD）。采用改良 MDRD 方程估计 GFR。尿白蛋白/肌酐比值（UACR）定义为白蛋白尿。

结果

E/E' >15 组的 GFR 低于 10< E/E' ≤15 组或 E/E' ≤10 组，UACR 高于 10< E/E' ≤15 组或 E/E' ≤10 组（p<0.0001）。GFR 与 E/E'和 NT-proBNP 呈显著负相关（p<0.0001），UACR 与 E/E'和 NT-proBNP 呈显著正相关（p<0.0001）。多元逐步线性分析显示，GFR 与年龄（p=0.001）、性别（p=0.003）、E/E'（p=0.03）、lgNT-proBNP（p=0.001）和 lgUACR（p=0.01）显著相关，而 eGFR 与 E/E'或 lgNT-proBNP 无显著相关性。多因素 logistic 回归分析显示，在校正潜在混杂因素后，E/E' >15 组发生 3 期 CKD 的可能性高于 E/E' ≤10 组，调整后的比值比为 8.31（p=0.0036）。