血清脂质与肾功能正常的治疗后高血压成人肾功能快速下降风险。

Serum Lipids and Risk of Rapid Renal Function Decline in Treated Hypertensive Adults With Normal Renal Function.

机构信息

Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Institute for Biomedicine, Anhui Medical University, Hefei, China.

出版信息

Am J Hypertens. 2019 Mar 16;32(4):393-401. doi: 10.1093/ajh/hpz001.

DOI:10.1093/ajh/hpz001

PMID:30615058

Abstract

BACKGROUND

We aim to evaluate the effect of different lipids parameters, including triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), the TG to HDL-C (TG:HDL-C) ratio, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C), on the risk of rapid renal function decline and examine any possible effect modifiers in general hypertensive patients with normal renal function.

METHODS

A total of 12,549 hypertensive patients with estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2 in the renal sub-study of the China Stroke Primary Prevention Trial were included in the analyses. The primary outcome was rapid renal function decline, defined as an average decline in eGFR ≥ 5 ml/min/1.73 m2 per year.

RESULTS

The median treatment duration was 4.4 years. After the full adjustment for TC, TG, HDL-C, and other major covariates, a significantly higher risk of rapid renal function decline was found in participants with higher TG [≥150 vs. <150 mg/dl, 7.7% vs. 5.5%; odds ratios (OR): 1.27; 95% confidence interval (CI): 1.06-1.51], higher TG:HDL-C ratio [≥2.7 (median) vs. <2.7, 7.7% vs. 5.0%; OR: 1.39; 95% CI: 1.14-1.71), lower TC (≥200 vs. <200 mg/dl, 6.0% vs. 7.0%; OR: 0.79; 95% CI: 0.67-0.93), or lower LDL-C levels (≥130 vs. <130 mg/dl, 6.1% vs. 7.0%; OR: 0.79; 95% CI: 0.67-0.94). Moreover, the increased risk of the primary outcome associated with elevated TG was particularly evident among individuals with lower total homocysteine levels [<12.4 (median) vs. ≥ 12.4 μmol/l, P interaction = 0.036].

CONCLUSIONS

Higher TG and TG:HDL-C ratio were independent risk factors for rapid renal function decline in hypertensive adults with normal renal function.

摘要

背景

本研究旨在评估不同脂质参数（包括甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、TG 与 HDL-C 的比值（TG:HDL-C）、总胆固醇（TC）和低密度脂蛋白胆固醇（LDL-C））对肾功能快速下降风险的影响，并探讨一般高血压合并正常肾功能患者中可能存在的任何效应修饰因素。

方法

本研究共纳入中国脑卒中一级预防试验肾亚研究中估计肾小球滤过率（eGFR）≥60 ml/min/1.73 m2 的 12549 例高血压患者。主要结局为肾功能快速下降，定义为 eGFR 每年平均下降≥5 ml/min/1.73 m2。

结果

中位治疗时间为 4.4 年。在充分调整 TC、TG、HDL-C 和其他主要混杂因素后，与 TG<150 mg/dl 的患者相比，TG≥150 mg/dl（7.7% vs. 5.5%；比值比（OR）：1.27；95%置信区间（CI）：1.06-1.51）、TG:HDL-C 比值≥2.7（中位数）（7.7% vs. 5.0%；OR：1.39；95% CI：1.14-1.71）、TC≥200 mg/dl（6.0% vs. 7.0%；OR：0.79；95% CI：0.67-0.93）或 LDL-C 水平≥130 mg/dl（6.1% vs. 7.0%；OR：0.79；95% CI：0.67-0.94）的患者发生肾功能快速下降的风险显著升高。此外，与 TG 升高相关的主要结局风险增加在总同型半胱氨酸水平较低的患者中更为明显（[12.4（中位数） vs. ≥ 12.4 μmol/L；P 交互=0.036]）。