Wang Anxin, Liu Xiaoxue, Su Zhaoping, Chen Shuohua, Zhang Nan, Wang Yongjun, Wang Yilong, Wu Shouling
aDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University bChina National Clinical Research Center for Neurological Diseases cCenter of Stroke, Beijing Institute for Brain Disorders dBeijing Key Laboratory of Translational Medicine for Cerebrovascular Disease eDepartment of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing fDepartment of Cardiology, Tangshan People's Hospital, North China University of Science and Technology, Tangshan gDepartment of Epidemiology and Health Statistics, Academy of Public Health and Management, Weifang Medical University, Weifang hDepartment of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China.
J Hypertens. 2017 Nov;35(11):2295-2302. doi: 10.1097/HJH.0000000000001462.
To assess whether changes in proteinuria are associated with the incidence of myocardial infarction (MI) in patients with hypertension.
The Kailuan study was a prospective longitudinal cohort study on cardiovascular risk factors and events. Hazard ratios with 95% confidence intervals (CIs) were calculated using Cox regression models.
A total of 24 926 hypertensive patients (mean age: 55.2 ± 10.9 years) without previous MI were included. After a mean follow-up of 6.8 years, 382 (1.5%) individuals developed MI. Participants with proteinuria at baseline had a 60% higher risk for developing MI as compared with participants without proteinuria at baseline (hazard ratio: 1.60, 95% CI: 1.12-2.29) after adjusting for dyslipidemia, diabetes mellitus and other cardiovascular risk factors. Compared with participants without proteinuria, individuals with incident proteinuria or persistent proteinuria during the follow-up had 54 and 141% higher risks for developing MI, respectively (hazard ratio: 1.54, 95% CI: 1.14-2.09 and hazard ratio: 2.41, 95% CI: 1.59-3.66; all P < 0.05).
Proteinuria is associated with an increased incidence of MI, but the association is likely to be underestimated if baseline measurements of proteinuria are used. Measures of changes in proteinuria, particular persistent proteinuria, are more likely to reflect the lifetime risk for MI.
评估高血压患者蛋白尿的变化是否与心肌梗死（MI）的发生率相关。
开滦研究是一项关于心血管危险因素和事件的前瞻性纵向队列研究。使用Cox回归模型计算95%置信区间（CI）的风险比。
共纳入24926例无既往心肌梗死的高血压患者（平均年龄：55.2±10.9岁）。平均随访6.8年后，382例（1.5%）患者发生心肌梗死。在调整血脂异常、糖尿病和其他心血管危险因素后，基线时有蛋白尿的参与者发生心肌梗死的风险比基线时无蛋白尿的参与者高60%（风险比：1.60，95%CI：1.12 - 2.29）。与无蛋白尿的参与者相比，随访期间出现蛋白尿或持续性蛋白尿的个体发生心肌梗死的风险分别高54%和141%（风险比：1.54，95%CI：1.14 - 2.09；风险比：2.41，95%CI：1.59 - 3.66；均P<0.05）。
蛋白尿与心肌梗死发生率增加相关，但如果使用蛋白尿的基线测量值，这种关联可能被低估。蛋白尿变化的测量，尤其是持续性蛋白尿，更有可能反映心肌梗死的终生风险。
