在无糖尿病的高血压男性中，蛋白尿与无症状心肌缺血及心率恢复延迟是否相关？

Does albuminuria correlate with silent myocardial ischemia and delayed heart rate recovery in hypertensive men without diabetes mellitus.

作者信息

Winata Johan, Panda Agnes L, Azis R Abdul

机构信息

Cardiology and Vascular Medicine Department, Faculty of Medicine, University of Sam Ratulangi/Cardiovascular and Brain Center, RD Kandou General Hospital, Raya Tanawangko Street, Manado, North Sulawesi, Indonesia,

出版信息

High Blood Press Cardiovasc Prev. 2015 Jun;22(2):143-8. doi: 10.1007/s40292-015-0085-4. Epub 2015 Apr 8.

DOI:10.1007/s40292-015-0085-4

PMID:25851840

Abstract

BACKGROUND

In diabetes patients, albuminuria has been proven to be an independent predictor for SMI and delayed heart rate recovery (HRR). However, in hypertensive patients without diabetes the correlation is still unclear.

AIM

To determine the correlation between albuminuria to SMI and delayed HRR in hypertensive patients without diabetes.

METHODS

Fourty consecutive asymptomatic primary hypertensive men, aged 40-60 years, without diabetes were included. They underwent treadmill stress testing (TST) and collection of spot urine to measure albumin urine to creatinine ratio (ACR). SMI and HRR at first, second, and third minute were then recorded. SMI was diagnosed if positive ischemic criteria of TST was met without anginal symptom. Albuminuria and delayed HRR were diagnosed based on the treshold value respectively.

RESULTS

SMI was diagnosed in 15 % patients. The prevalence of delayed HRR at the first-, second-, and third-minute after exercise were 60, 80, and 52.5 % respectively. Albuminuria was significantly associated with SMI [OR 13.889 (95 % CI 1.423-135.544), p = 0.014]. ROC curve analysis demonstrated the area under the curve (AUC) = 0.784 [(95 % CI 0.588-0.98), p = 0.028], with subsequent calculated sensitivity, specificity, positive- and negative-predictive value of albuminuria to predict SMI were 83.3, 73.5, 35.7, and 96.2 % respectively. Those were no significant correlation between albuminuria and delayed HRR at first, second, and third minute.

CONCLUSION

Albuminuria is a potential marker for excluding SMI in asymptomatic hypertensive men without diabetes.

摘要

背景

在糖尿病患者中，蛋白尿已被证明是骨骼肌指数（SMI）和心率恢复延迟（HRR）的独立预测指标。然而，在无糖尿病的高血压患者中，这种相关性仍不明确。

目的

确定无糖尿病的高血压患者中蛋白尿与SMI和HRR延迟之间的相关性。

方法

纳入40名年龄在40 - 60岁、无糖尿病的连续无症状原发性高血压男性。他们接受了平板运动试验（TST）并收集随机尿样以测量尿白蛋白肌酐比值（ACR）。然后记录第1、2和3分钟时的SMI和HRR。如果满足TST的阳性缺血标准且无心绞痛症状，则诊断为SMI。蛋白尿和HRR延迟分别根据阈值进行诊断。

结果

15%的患者被诊断为SMI。运动后第1、2和3分钟时HRR延迟的患病率分别为60%、80%和52.5%。蛋白尿与SMI显著相关[比值比（OR）13.889（95%置信区间1.423 - 135.544），p = 0.014]。ROC曲线分析显示曲线下面积（AUC）= 0.784 [（95%置信区间0.588 - 0.98），p = 0.028]，随后计算出的蛋白尿预测SMI的敏感性、特异性、阳性预测值和阴性预测值分别为83.3%、73.5%、35.7%和96.2%。在第1、2和3分钟时，蛋白尿与HRR延迟之间无显著相关性。