Miao Rujia, Wu Liuxin, Ni Ping, Zeng Yue, Chen Zhiheng
Department of Health Management, the Third Xiangya Hospital, Central South University, Tongzipo Road 138, Changsha, 410013, Hunan Province, China.
Institute of Aviation Medicine, Beijing, China.
BMC Cardiovasc Disord. 2018 May 4;18(1):83. doi: 10.1186/s12872-018-0817-1.
Increased arterial stiffness (iAS) and microalbuminuria (MAU), which may occur simultaneously or separately in the general population and share similar risk factors, are markers of macro- and microvascular injuries. Our research investigated the comorbidity of iAS and MAU in the middle-aged population and examined the heterogeneous effects of metabolic risk factors on iAS and MAU.
We selected 11,911 individuals aged 45 to 60 years who underwent a health examination at the 3rd Xiangya Hospital between 2010 and 2014. Metabolic syndrome (MetS) was determined according to IDF/NHLBI/AHA-2009 criteria. Multinomial logistic regression was applied to evaluate the influence of MetS, components of MetS and clusters of MetS on the co-occurrence (MAU(+)/iAS(+)) or non-co-occurrence (MAU(+)/iAS(-) and MAU(-)/iAS(+)) of MAU and iAS.
Reference group was MAU(-)/iAS(-). A positive effect of MetS on the presence of MAU(+)/iAS(-), MAU(-)/iAS(+), or MAU(+)/iAS(+) is listed in ascending order based on odds ratios (ORs = 2.11, 2.41, 4.61, respectively; P < 0.05). Compared with MAU(+)/iAS(-), Elevated blood pressure (BP) (OR = 1.62 vs. 4.83, P < 0.05), triglycerides(TG) (OR = 1.20 vs. 1.37, P < 0.05) were more strongly associated with MAU(-)/iAS(+), whereas fasting blood glucose (FBG) was less associated (OR = 1.37 vs. 1.31, P < 0.05). Decreased high-density lipoprotein cholesterol(HDL-c) (OR = 1.84, P < 0.01) and elevated waist circumference(WC) (OR = 1.28 P < 0.01) were the most strongly associated with MAU(+)/iAS(-). Compared with the individuals without MetS, individuals with the elevated BP, FBG, TG and decreased HDL-c cluster had the greatest likelihood of presenting a MAU(-)/iAS(+) (OR = 5.98, P < 0.01) and MAU(+)/iAS(+) (OR = 13.17, P < 0.01), these likelihood was even greater than the cluster with simultaneous alteration in all five MetS components (OR = 3.89 and 10.77, respectively, P < 0.01), which showed the most strongly association with MAU(+)/iAS(+) (OR = 5.22, P < 0.01).
Based on the heterogeneous influences of MetS-related risk factors on MAU and iAS, these influences could be selectively targeted to identify different types of vascular injuries.
动脉僵硬度增加（iAS）和微量白蛋白尿（MAU）在普通人群中可能同时或分别出现，且具有相似的危险因素，它们是大血管和微血管损伤的标志物。我们的研究调查了中年人群中iAS和MAU的合并症，并研究了代谢危险因素对iAS和MAU的异质性影响。
我们选取了2010年至2014年间在湘雅三医院接受健康检查的11911名45至60岁的个体。根据IDF/NHLBI/AHA - 2009标准确定代谢综合征（MetS）。采用多项逻辑回归评估MetS、MetS各组分以及MetS聚类对MAU和iAS同时出现（MAU(+)/iAS(+)）或不同时出现（MAU(+)/iAS(-)和MAU(-)/iAS(+)）的影响。
参照组为MAU(-)/iAS(-)。基于比值比（OR分别为2.11、2.41、4.61；P < 0.05），MetS对MAU(+)/iAS(-)、MAU(-)/iAS(+)或MAU(+)/iAS(+)出现的正向影响按升序排列。与MAU(+)/iAS(-)相比，血压升高（BP）（OR = 1.62对4.83，P < 0.05）、甘油三酯（TG）（OR = 1.20对1.37，P < 0.05）与MAU(-)/iAS(+)的关联更强，而空腹血糖（FBG）的关联较弱（OR = 1.37对1.31，P < 0.05）。高密度脂蛋白胆固醇（HDL - c）降低（OR = 1.84，P < 0.01）和腰围增加（WC）（OR = 1.28，P < 0.01）与MAU(+)/iAS(-)的关联最强。与无MetS的个体相比，血压、FBG、TG升高且HDL - c降低聚类的个体出现MAU(-)/iAS(+)（OR = 5.98，P < 0.01）和MAU(+)/iAS(+)（OR = 13.17，P < 0.01）的可能性最大，这些可能性甚至大于所有五个MetS组分同时改变的聚类（OR分别为3.89和10.77，P < 0.01），后者与MAU(+)/iAS(+)的关联最强（OR = 5.22，P < 0.01）。
基于MetS相关危险因素对MAU和iAS的异质性影响，可针对性地识别不同类型的血管损伤。
