与血压正常的人相比，微量白蛋白尿与糖尿病的关联在高血压前期人群中更强。

Wang Qing, Huang Jingjing, Sun Yuemin, Zhang Wenjuan, Gao Yuxia, Yao Wei, Bian Bo, Li Yongle, Wu Xianming, Niu Kaijun

Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China.

Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China.

Nephrology (Carlton). 2018 Jul;23(7):690-696. doi: 10.1111/nep.13082.

AIM

Microalbuminuria (MA) has been demonstrated as a biomarker for microvascular dysfunction. This study is aimed to evaluate the association of glycaemic status with MA in prehypertensive and ideal BP subjects and to evaluate the interaction between glycaemic and blood pressure status as risk factors for MA prevalence.

METHODS

1059 subjects aged 40-70 with non-hypertension who were recruited from six districts of Tianjin were divided into a prehypertensive group (622 cases) and an ideal blood BP group (437 cases). Subjects of the prehypertensive group and the ideal BP group were divided respectively into three subgroups: normoglycaemia subgroup, prediabetes subgroup and diabetes subgroup. The prevalence of MA in the above three subgroups of subjects with prehypertension and ideal BP were assessed. We performed a statistical analysis for interaction test between glycaemia and BP status on microalbuminuria in the overall study sample by a multivariate logistic regression model. The association of glycaemic status (defined as normoglycaemia, prediabetes, and diabetes) with MA was evaluated separately in prehypertensive and ideal BP subjects.

RESULTS

Results showed that the prevalence of MA in both prehypertensive and ideal BP groups rose with the increasing of classification of glycaemic level of subgroups (32.6%, 18.3%, 14.8% vs. 23.1%, 16.2%, 13.4%), the differences in prehypertensive group were statistically significant (Pearson χ = 15.24, P < 0.001). The ORs (95% CI) of MA were 1.25 (0.86-1.83) for prediabetes and 2.56 (1.62-4.03) for diabetes in the fully adjusted model. There was no interaction between prediabetes and BP status regarding MA (P = 0.237) but we found a significant interaction between diabetes and BP status (P < 0.001). In the prehypertensive group, multivariate logistic regression models showed that the diabetes subgroup had a significant association with MA, and the adjusted odds ratio of the diabetes subgroup to the normoglycaemia subgroup was 2.68 (95%CI 1.54-4.67) (P < 0.001). However, there was no significant association of glycaemic status with MA in the ideal BP group. Stratified analysis by a multivariate logistic regression model in the whole study population showed that people with both prehypertension and diabetes had the highest risk of MA (adjusted OR = 2.50, 95%CI 1.16-5.36; P = 0.019), compared with those with ideal BP and normoglycaemia (reference group).

CONCLUSIONS

Our findings suggest that there was a statistically significant association between diabetes and microalbuminuria only in prehypertensive subjects. In addition, our study highlights the interaction between prehypertension and diabetes as a risk factor for MA.

目的

微量白蛋白尿（MA）已被证明是微血管功能障碍的生物标志物。本研究旨在评估高血压前期和理想血压受试者的血糖状态与MA的关联，并评估血糖和血压状态作为MA患病率危险因素之间的相互作用。

方法

从天津市六个区招募的1059名40 - 70岁非高血压受试者被分为高血压前期组（622例）和理想血压组（437例）。高血压前期组和理想血压组的受试者分别分为三个亚组：血糖正常亚组、糖尿病前期亚组和糖尿病亚组。评估上述高血压前期和理想血压受试者三个亚组中MA的患病率。我们通过多变量逻辑回归模型对整个研究样本中血糖和血压状态对微量白蛋白尿的相互作用进行了统计分析。分别在高血压前期和理想血压受试者中评估血糖状态（定义为血糖正常、糖尿病前期和糖尿病）与MA的关联。

结果

结果显示，高血压前期组和理想血压组中MA的患病率均随着亚组血糖水平分类的增加而升高（32.6%、18.3%、14.8%对23.1%、16.2%、13.4%），高血压前期组的差异具有统计学意义（Pearson χ = 15.24，P < 0.001）。在完全调整模型中，糖尿病前期MA的OR（95%CI）为1.25（0.86 - 1.83），糖尿病为2.56（1.62 - 4.03）。糖尿病前期和血压状态在MA方面没有相互作用（P = 0.237），但我们发现糖尿病和血压状态之间存在显著相互作用（P < 0.001）。在高血压前期组中，多变量逻辑回归模型显示糖尿病亚组与MA有显著关联，糖尿病亚组与血糖正常亚组的调整比值比为2.68（95%CI 1.54 - 4.67）（P < 0.001）。然而，在理想血压组中血糖状态与MA没有显著关联。在整个研究人群中通过多变量逻辑回归模型进行分层分析显示，与理想血压和血糖正常（参照组）的受试者相比，高血压前期和糖尿病患者患MA的风险最高（调整后OR = 2.50，95%CI 1.16 - 5.36；P = 0.019）。