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中国人高正常白蛋白尿与动脉僵硬的关系。

Relationship between high-normal albuminuria and arterial stiffness in Chinese population.

机构信息

Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.

Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.

出版信息

J Clin Hypertens (Greenwich). 2020 Sep;22(9):1674-1681. doi: 10.1111/jch.13979. Epub 2020 Aug 9.

Abstract

High-normal albuminuria is related to the morbidity and mortality of cardiovascular disease. Arterial stiffness has been regarded as a predictor of cardiovascular disease. However, the relationship between high-normal albuminuria and arterial stiffness is uncertain in Chinese population. A total of 1343 Chinese participants (aged 58.9 ± 12.1 years, 63.53% male) were included in this study. High-normal albuminuria was defined as urinary albumin-to-creatinine ratio (UACR) above the median within normal albuminuria. Based on the level of UACR, all participants were divided into low-normal albuminuria group (UACR < 6.36 mg/g, n = 580), high-normal albuminuria group (6.36 mg/g ≤ UACR < 30 mg/g, n = 581), microalbuminuria (30 mg/g ≤ UACR < 300 mg/g, n = 162), and macroalbuminuria (UACR ≥ 300 mg/g, n = 20). Arterial stiffness was assessed by measuring carotid-femoral pulse wave velocity (cfPWV). With the increment of UACR, the level of cfPWV was increased gradually (P < .001). Stepwise multiple regression analysis showed that systolic blood pressure, age, serum creatinine, heart rate, logarithmic (LG)-transformed UACR, and fasting plasma glucose were independently associated with cfPWV in all subjects (P < .001). LG-UACR was found to be related to cfPWV in high-normal albuminuria and macroalbuminuria subjects. After further stratification in the high-normal albuminuria subjects, their relation remained in male, elderly over 65 years old, or normotensives. In summary, UACR is associated with arterial stiffness in subjects with proteinuria excretion in high normal level. High-normal albuminuria might be an early indicator of arterial stiffness, especially in male, elderly, or normotensives in Chinese population. Furthermore, age and blood pressure are still observed to be the most important risk factor of arterial stiffness.

摘要

高正常白蛋白尿与心血管疾病的发病率和死亡率有关。动脉僵硬度一直被认为是心血管疾病的预测指标。然而,在中国人群中,高正常白蛋白尿与动脉僵硬度的关系尚不确定。本研究共纳入 1343 名中国参与者(年龄 58.9±12.1 岁,63.53%为男性)。高正常白蛋白尿定义为尿白蛋白/肌酐比值(UACR)高于正常白蛋白尿范围内的中位数。根据 UACR 水平,所有参与者被分为低正常白蛋白尿组(UACR<6.36mg/g,n=580)、高正常白蛋白尿组(6.36mg/g≤UACR<30mg/g,n=581)、微量白蛋白尿组(30mg/g≤UACR<300mg/g,n=162)和大量白蛋白尿组(UACR≥300mg/g,n=20)。动脉僵硬度通过测量颈-股脉搏波速度(cfPWV)来评估。随着 UACR 的增加,cfPWV 水平逐渐升高(P<0.001)。逐步多元回归分析显示,收缩压、年龄、血清肌酐、心率、对数(LG)转换后的 UACR 和空腹血糖与所有受试者的 cfPWV 独立相关(P<0.001)。在高正常白蛋白尿和大量白蛋白尿患者中,LG-UACR 与 cfPWV 相关。在高正常白蛋白尿患者进一步分层后,这种关系在男性、65 岁以上的老年人或血压正常者中仍然存在。总之,在蛋白尿排泄处于高正常水平的患者中,UACR 与动脉僵硬度相关。高正常白蛋白尿可能是动脉僵硬度的早期指标,特别是在中国人群中的男性、老年人或血压正常者。此外,年龄和血压仍然是动脉僵硬度最重要的危险因素。

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