Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.
J Hypertens. 2013 Mar;31(3):568-75; discussion 575. doi: 10.1097/HJH.0b013e32835cd607.
To evaluate whether the relationship between early glomerular dysfunction and left-ventricular mass (LVM) occurs in a community sample and whether this relationship depends on haemodynamic factors.
In 621 randomly selected participants from a community sample (332 were normotensive), estimated glomerular filtration rate (eGFR), LVM and dimensions were determined using echocardiography, and aortic blood pressure (BP) assessed from applanation tonometry and SphygmoCor software. Aortic pulse wave velocity (PWV) and high-quality 24-h BP values were available from 554 and 437 participants, respectively.
With adjustments for confounders (including clinic SBP), eGFR was associated with LVM index (LVMI) and LVM in excess of that predicted from stroke work (inappropriate LVM, LVMinappr) in all participants (LVMI: partial r = -0.18, P < 0.0001; LVMinappr: partial r = -0.17, P < 0.0001) and normotensive (LVMI: partial r = -0.23, P < 0.0001; LVMinappr: partial r = -0.22, P < 0.0001) separate from hypertensive patients. Marked differences in LVMinappr were noted in the eGFR range below 132 compared to at least 132 ml/min per 1.73 m (P < 0.0005). When replacing clinic BP with either aortic SBP, 24-h BP, PWV, stroke work (for LVMI), left-ventricular end-diastolic diameter (LVEDD), or circumferential wall stress in the regression models, eGFR retained strong associations with LVMI (P = 0.01 to <0.0001) and LVMinappr (P < 0.005 to <0.0001) and these effects were replicated in normotensive separate from hypertensive patients.
Strong relationships between eGFR and LVM occur at a community level irrespective of the presence of hypertension and independent of 24-h and aortic BP, PWV, LVEDD, stroke work and wall stress. Non-haemodynamic factors explain a considerable proportion of the relationship between early glomerular dysfunction and left-ventricular hypertrophy.
评估肾小球早期功能障碍与左心室质量（LVM）之间的关系是否存在于社区样本中，以及这种关系是否取决于血液动力学因素。
在社区样本中随机选择了 621 名参与者（332 名血压正常），使用超声心动图确定估算肾小球滤过率（eGFR）、LVM 和维度，并使用平板测压法和 SphygmoCor 软件评估主动脉血压（BP）。来自 554 名和 437 名参与者的主动脉脉搏波速度（PWV）和高质量 24 小时 BP 值分别可用。
在调整混杂因素（包括诊所 SBP）后，eGFR 与所有参与者的 LVM 指数（LVMI）和超出从工作量推断的 LVM（不合适的 LVM，LVMinappr）相关（LVMI：偏相关 r =-0.18，P<0.0001；LVMinappr：偏相关 r =-0.17，P<0.0001）和血压正常的（LVMI：偏相关 r =-0.23，P<0.0001；LVMinappr：偏相关 r =-0.22，P<0.0001）分别从高血压患者中分离出来。在 eGFR 范围低于 132 与至少 132 ml/min/1.73 m 相比，LVMinappr 差异显著（P<0.0005）。当用主动脉 SBP、24 小时 BP、PWV、工作量（用于 LVMI）、左心室舒张末期直径（LVEDD）或周向壁应力代替诊所 BP 时，eGFR 与 LVMI（P=0.01 至<0.0001）和 LVMinappr（P<0.005 至<0.0001）之间仍然存在强烈关联，并且这些影响在血压正常的参与者中分别从高血压患者中复制出来。
无论是否存在高血压，肾小球早期功能障碍与左心室肥大之间的关系在社区水平上都非常密切，并且独立于 24 小时和主动脉 BP、PWV、LVEDD、工作量和壁应力。非血液动力学因素解释了肾小球早期功能障碍与左心室肥厚之间关系的相当大比例。
