原发性高血压患者中心舒张压、血浆醛固酮和尿酸与微量白蛋白尿相关：一项病例对照研究。
Central diastolic blood pressure, plasma aldosterone and uric acid are associated with microalbuminuria in essential hypertension: a case-control study.
机构信息
Department of Hypertension, Clinical School of Cardiovascular Disease, Tianjin Medical University, Tianjin, 300457, China.
Department of Hypertension, TEDA International Cardiovascular Hospital, Tianjin, 300457, China.
出版信息
BMC Cardiovasc Disord. 2023 Oct 17;23(1):511. doi: 10.1186/s12872-023-03515-1.
OBJECTIVE
To study the development of microalbuminuria (MAU) in essential hypertension (EHT), we investigated the association of MAU with central blood pressure (CBP), direct renin concentration (DRC), plasma aldosterone (PA), and uric acid (UA).
METHOD
We determined 24 h-urinary albumin excretion (24 h-UAE) in patients with EHT who were hospitalized at TEDA International Cardiovascular Hospital from June 2020 to May 2022. We defined MAU as 24 h-UAE in the range of 30 mg/24 h to 300 mg/24 h. Univariate and multivariate analyses were conducted to determine the associations of MAU with CBP, DRC, PA, and UA in EHT, considering demographic and clinical information. We also plotted receiver operating characteristic curves (ROCs) for predicting MAU using these results.
RESULTS
More than a quarter of patients (26.5%, 107/404, 95% CI: 22.2-31.1%) were diagnosed with MAU in EHT. A higher body mass index (BMI), longer duration of hypertension, and higher severity were associated with MAU. Also, nearly 10% more creatinine levels were recorded in the MAU group than in the control group (69.5 ± 18.7 µmol/L vs. 64.8 ± 12.5 µmol/L, P = 0.004). The increase was also observed for PA (15.5, 9.7-20.6 ng/dL vs. 12.3, 9.0-17.3 ng/dL, P = 0.024) and UA (419.8 ± 105.6 µmol/L vs. 375.1 ± 89.5 µmol/L, P < 0.001) in the MAU group compared to that in the control group. Several variables were associated with MAU, including central diastolic blood pressure (CDBP) (OR = 1.017, 95% CI: 1.002-1.032, P = 0.027), PA (OR = 1.043, 95% CI: 1.009-1.078, P = 0.012) and UA (OR = 1.005, 95% CI: 1.002-1.008, P < 0.001). For MAU prediction, the area under the curve (AUC) was 0.709 (95% CI: 0.662-0.753; P < 0.001) when CDBP, PA, and UA were used in combination, and the optimal probability of the cut-off value was 0.337.
CONCLUSION
We found that CDBP, PA, and UA, used for MAU prediction, might be associated with its development during EHT.
目的
为了研究原发性高血压（EHT）中微量白蛋白尿（MAU）的发展，我们研究了 MAU 与中心血压（CBP）、直接肾素浓度（DRC）、血浆醛固酮（PA）和尿酸（UA）的关系。
方法
我们在 2020 年 6 月至 2022 年 5 月期间在泰达国际心血管病医院住院的 EHT 患者中测定了 24 小时尿白蛋白排泄量（24 h-UAE）。我们将 MAU 定义为 24 h-UAE 在 30 mg/24 h 至 300 mg/24 h 的范围内。我们进行了单变量和多变量分析，以确定 MAU 与 EHT 中 CBP、DRC、PA 和 UA 的关系，同时考虑了人口统计学和临床信息。我们还使用这些结果绘制了预测 MAU 的受试者工作特征曲线（ROC）。
结果
超过四分之一的 EHT 患者（26.5%，107/404，95%CI：22.2-31.1%）被诊断为 MAU。较高的体重指数（BMI）、高血压持续时间较长和严重程度较高与 MAU 有关。此外，MAU 组的肌酐水平比对照组高近 10%（69.5±18.7 μmol/L 比 64.8±12.5 μmol/L，P=0.004）。PA（15.5，9.7-20.6 ng/dL 比 12.3，9.0-17.3 ng/dL，P=0.024）和 UA（419.8±105.6 μmol/L 比 375.1±89.5 μmol/L，P<0.001）也在 MAU 组中比对照组有所增加。与 MAU 相关的变量包括中心舒张压（CDBP）（OR=1.017，95%CI：1.002-1.032，P=0.027）、PA（OR=1.043，95%CI：1.009-1.078，P=0.012）和 UA（OR=1.005，95%CI：1.002-1.008，P<0.001）。对于 MAU 预测，当 CDBP、PA 和 UA 联合使用时，曲线下面积（AUC）为 0.709（95%CI：0.662-0.753；P<0.001），最佳截断值的概率为 0.337。
结论
我们发现，用于 MAU 预测的 CDBP、PA 和 UA 可能与 EHT 期间其发展有关。
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