糖尿病合并高血压患者摄盐量与早期肾损害的相关性研究

发布时间：2018-05-19 04:39

本文选题：高血压 + 糖尿病　；参考：《第三军医大学》2016年硕士论文

【摘要】：背景和目的:随着人们的生活方式发生巨大转变,人类的疾病谱也悄然发生变化。流行病学研究发现,肿瘤、糖尿病、心血管疾病、呼吸系统疾病等非传染性疾病已成为全球死亡率增高的主要病因。糖尿病、高血压是导致心、脑、肾等一系列靶器官功能衰竭的重要病因;早期发现靶器官损害及其危险因素,并进行积极的早期干预能有效预防和延缓靶器官衰竭。因此,糖尿病和高血压早期管理就显得尤其重要。我国糖尿病、高血压患病率高,知晓率低,控制率低,两者常常合并存在,在疾病进展过程中相互影响,导致靶器官损害的加重。如何有效防控疾病的进展,避免并发症发生已成为糖尿病、高血压防治工作中亟待解决的问题。糖尿病合并高血压发病机制复杂,是遗传与环境相互作用的结果,其中不健康的生活方式是其重要原因。既往流行病学调查显示,高盐摄入与心血管疾病发病率的增高明确相关,相关研究报道高盐膳食与血压升高有着密不可分的联系,且日均摄盐量与血压存在一定剂量效应关系。根据24小时钠盐排泄量评估日均摄盐量是目前世界上公认最准确的方法,因此临床研究通常选用24小时尿钠排泄总量进行换算后计算日均摄盐量。临床上尿微量白蛋白、血肌酐与肾小球滤过率是评估肾脏损害的指标,而24小时尿微量蛋白定量作为评估早期糖尿病肾病的有效指标,同时也是早期肾损害与影响心血管病预后的重要标志物。既往众多临床研究发现高盐增加糖尿病肾病及高血压肾损害风险,但针对高盐是否引起糖尿病合并高血压早期肾损害风险,研究报道尚不多。故本研究以24小时尿钠排泄作为评估日均摄盐量标准,并观察糖尿病患者合并高血压时摄盐量(24小时尿钠)与尿蛋白排泄量(早期肾损害)是否具有相关性,用以评估糖尿病合并高血压早期肾损害的潜在危险因素。研究对象:入选人群为第三军医大学大坪医院高血压内分泌科住院2014年1月~2016年1月在2型糖尿病合并原发性高血压患者345例,其中男性188例,女性157例;2型糖尿病患者159例(男性91例,女性68例);原发性高血压患者373例(男性183例,女性190例)。所有患者年龄20~75岁。2型糖尿病的诊断标准:依照2013年版《中国2型糖尿病防治指南》的定义:排除1型糖尿病、特殊类型糖尿病及妊娠糖尿病。原发性高血压的诊断标准:依据2010年《中国高血压防治指南》的定义:排除继发性高血压。本研究的排除标准:肾小球滤过率(e GFR)小于60ml/min/1.73m2患者,e GFR计算公式采用2006年全国e G FR课题协作组的改良MDRD方程(e GFR=175×[Scr(μmol/L)/88.4]-1.234×Age-0.179×(0.79女性)。方法:采集入选患者年龄、用药史、家族史、糖尿病病程、高血压病程、性别、既往疾病等一般资料;测量身高、体重、计算体重指数[BMI=体重(kg)/身高2(m2)],腰围、收缩压(SBP),舒张压(DBP),收集24小时尿液。检测总胆固醇(Total cholesterol,TC)、血清钠、低密度脂蛋白胆固醇(Low-density lipoprotein cholesterol,LDL-c)、糖化血红蛋白(Hb A1c)、甘油三酯(Triglyceride,TG)、空腹血糖、血肌酐、高密度脂蛋白胆固醇(High-density lipoprotein cholesterol,HDL-c)、尿微量白蛋白(Microalbumin)、24小时尿量、尿钠、尿钾、尿肌酐。根据24小时尿钠排泄量换算为摄盐量的计算公式为:日均食盐摄入量(g/d)=(24h尿钠排泄量(mmol/d)×58.5/103)。根据摄盐量的四分位数将入选人群345例糖尿病合并高血压患者分为4组,分别为:低摄盐组(1.92 g/d≤摄盐量≤7.11g/d)、中摄盐组(7.12 g/d≤摄盐量≤10.05g/d)、中高摄盐组(10.07 g/d≤摄盐量≤12.93 g/d)与高摄盐组(12.95 g/d≤摄盐量≤23.46g/d)。将所有数据利用SPSS 17.0软件分析,四分位分组的组间计量资料采用单因素方差分析,卡方检验用以分析组间计数资料。两变量的线性相关性采用Pearson相关分析。多元线性回归分析影响尿微量白蛋白的危险因素。P0.05为差异具有统计学意义。结果:1.糖尿病合并高血压患者高摄盐组、中高摄盐组、中摄盐组及低摄盐组患者的BMI、腰围、尿酸、尿微量白蛋白、肾小球滤过率组间比较有统计学意义(P0.05)。高摄盐组腰围显著高于低摄盐组(P0.05),血尿酸水平显著高于低摄盐组和中低摄盐组(P0.05),24h尿微量白蛋白显著高于低摄盐组((P0.05),体重指数显著高于低摄盐组((P0.05)。2.糖尿病合并高血压患者收缩压、尿酸、24h尿钠、腰围、总胆固醇和低密度脂蛋白胆固醇与24 h尿微量白蛋白呈正相关。3.糖尿病合并高血压患者日均摄盐量、收缩压、糖化血红蛋白及尿酸是24h尿微量白蛋白增高的危险因素。4.原发性高血压患者日均摄盐量与24 h尿微量白蛋白呈正相关。5.糖尿病合并高血压患者的日均摄盐量显著低于、而24 h尿微量白蛋白显著高于单纯2型糖尿病组与原发性高血压组。结论:1.糖尿病合并高血压患者高盐摄入是早期肾脏损害的危险因素,且日均摄盐量越高早期肾脏损害越重。2.收缩压、糖化血红蛋白及尿酸是糖尿病合并高血压患者早期肾脏损害的独立危险因素。3.高盐摄入与原发性高血压患者24 h尿微量白蛋白呈剂量相关性。4.糖尿病合并高血压患者比2型糖尿病或原发性高血压患者更容易出现早期肾脏损害。
[Abstract]:Background and purpose: as people's lifestyle changes dramatically, the spectrum of human disease has also changed. Epidemiological studies have found that noncommunicable diseases, such as cancer, diabetes, cardiovascular disease, respiratory diseases, have become the main cause of global mortality. Diabetes, high blood pressure is a series of targets for heart, brain, kidney and so on. The early detection of target organ damage and its risk factors and active early intervention can effectively prevent and delay target organ failure. Therefore, the early management of diabetes and hypertension is especially important. In the course of the disease, the mutual influence of the disease causes the aggravation of the target organ damage. How to prevent and control the progress of the disease and avoid the complications has become the urgent problem in the prevention and treatment of hypertension. The pathogenesis of diabetes complicated with hypertension is complex, which is the result of the interaction between the heredity and the environment, and the unhealthy life is in it. The previous epidemiological survey showed that high salt intake was clearly associated with the increase in the incidence of cardiovascular diseases. The related studies reported that the high salt diet had an inseparable relationship with the increase of blood pressure, and the daily average salt intake and blood pressure had a certain dose effect relationship. The daily salt intake was assessed according to the 24 hour sodium salt excretion. It is currently recognized as the most accurate method in the world. Therefore, clinical studies usually use the total amount of sodium excretion in 24 hours to calculate daily average daily salt intake. Clinical urine microalbuminuria, serum creatinine and glomerular filtration rate are the indicators for evaluating renal damage, and the 24 hour urine microamount of egg white determination is effective as an effective assessment of early diabetic nephropathy. The index is also an important marker for early renal damage and the prognosis of cardiovascular disease. Many previous clinical studies have found that high salinity increases the risk of diabetic nephropathy and hypertensive renal damage. However, there are not many studies on whether high salt causes the risk of early renal damage in diabetes with hypertension. Therefore, the 24 hour urine sodium excretion is used in this study. To assess the daily salt uptake standard, and to observe the correlation between the amount of salt intake (24 hours urine sodium) and urine protein excretion (early renal damage) in diabetic patients with hypertension, to assess the potential risk factors for early renal damage in diabetes combined with hypertension. Subjects were selected as hypertension in Daping Hospital of Third Military Medical University. The Department of endocrinology was hospitalized in 345 cases of type 2 diabetes with primary hypertension in January ~2016 January 2014, including 188 males and 157 females, 159 cases of type 2 diabetes (91 males and 68 females); 373 cases of primary hypertension (183 males and 190 females). The diagnostic criteria of type.2 diabetes in all patients aged 20~75 years: according to 20 13 year edition of China's guidelines for the prevention and control of type 2 diabetes: excluding type 1 diabetes, special type diabetes and gestational diabetes. Diagnostic criteria for essential hypertension: according to the definition of Chinese hypertension prevention guide in 2010: exclusion of secondary hypertension. The exclusion criteria of this study: glomerular filtration rate (e GFR) less than 60ml/min/1.73m2 patients The e GFR formula uses the modified MDRD equation (E GFR=175 x [Scr (mu mol/L) /88.4]-1.234 x Age-0.179 x (0.79 women) of the 2006 National e G FR project cooperation group. Methods: collect the general data of patients' age, history of medicine, family history, the course of diabetes, the course of diabetes, the course of hypertension, the sex, and the past diseases; measure the height, weight, and calculate the body mass index. MI= weight (kg) / height 2 (M2)], waist circumference, systolic pressure (SBP), diastolic pressure (DBP), collected 24 hours of urine. Test total cholesterol (Total cholesterol, TC), serum sodium, low density lipoprotein cholesterol (Low-density lipoprotein cholesterol, LDL-c), glycosylated hemoglobin, triglyceride, blood creatinine, high density fat High-density lipoprotein cholesterol (HDL-c), urine microalbuminuria (Microalbumin), 24 hour urine, urine sodium, urinary potassium, and urine creatinine. The formula for the conversion of 24 hour urine sodium excretion into salt intake is: daily average salt intake (g/d) = (24h urine sodium excretion (mmol/d) * 58.5/103). According to the four digits of salt intake 345 patients with diabetes combined with hypertension were divided into 4 groups: low salinity group (1.92 g/d or less 7.11g/d), medium salt group (7.12 g/d < < 10.05g/d), high salinity group (10.07 g/d < < 12.93 g/d) and high salinity group (12.95 g /d < /d < < 23.46g/d). All data were divided into SPSS 17 software. Analysis, the inter group measurement data of the four sub group were analyzed by one-way ANOVA, and the chi square test was used to analyze the inter group count data. The linear correlation of the two variables was analyzed by Pearson correlation analysis. The multivariate linear regression analysis of the risk factors for urinary microalbuminuria was of the difference of.P0.05. Results: 1. diabetes combined with hypertension The BMI, waist circumference, uric acid, urine microalbuminuria and glomerular filtration rate were statistically significant (P0.05) in the high intake salt group, middle high salt group and low salt intake group. The waist circumference of the high intake salt group was significantly higher than that of the low salinity group (P0.05). The serum uric acid level was significantly higher than the low salinity group and the low middle salt group (P0.05), and the 24h urine trace white eggs. The white show was higher than the low salinity group (P0.05), the body mass index was significantly higher than the low salinity group (P0.05).2. diabetes combined with hypertension, the uric acid, 24h urine sodium, waist circumference, total cholesterol and low density lipoprotein cholesterol were positively correlated with 24 h urine microalbuminuria,.3. glucurauria and hypertension patients with daily salt intake, systolic pressure, glycosylated blood red Protein and uric acid are the risk factors for the increase of 24h urine microalbuminuria in.4. primary hypertension patients, the daily average salt intake and 24 h urine microalbuminuria are positively correlated with the daily average salt intake in.5. diabetic patients with hypertension, while 24 h urine microalbuminuria is significantly higher than that of the simple type 2 glycan group and the primary hypertension group. High salt intake in patients with hypertension and hypertension is a risk factor for early renal damage, and the higher the daily salt intake is, the higher the early renal damage is.2. systolic pressure, glycated hemoglobin and uric acid are independent risk factors for early renal damage in patients with diabetes and hypertension,.3. high salt intake and 24 h urine trace white eggs in patients with essential hypertension White dose related.4. diabetes and hypertension patients are more prone to early renal damage than type 2 diabetes or essential hypertension.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R544.1;R587.2

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