原发性高血压微量白蛋白尿与颈动脉粥样硬化的相关性研究

发布时间：2018-08-12 13:19

【摘要】：背景高血压在慢性心血管疾病中较为普遍,长期血压维持在较高水平极易引发动脉硬化,进而导致一系列由动脉硬化病变而产生的心脑血管疾病。目前对于动脉硬化的评估主要基于颈动脉超声、动脉血管造影及无创外周动脉硬化检测等检查,一旦出现阳性结果提示病理结局已经形成。近些年,随着对MAU进一步深入研究发现,多数高血压患者可并发MAU,MAU出现提示高血压已造成早期血管损伤,其在动脉硬化的早期即可出现。对高血压MAU水平与血管动脉硬化指标进行比较分析,将有助于揭示MAU在早期预测动脉硬化中的价值,具有重要的临床意义。目的通过对原发性高血压MAU与颈动脉硬化评分进行相关性分析,探究高血压MAU与动脉硬化之间的联系,促使临床医生重视对高血压MAU的检测,早期采取有效防治措施,降低动脉硬化性心脑血管疾病的致死、致残风险。方法选取玉溪市人民医院心内科从20 16年2月到2016年10月住院经明确诊断的原发性高血压患者359例,除外继发性高血压,并排除患者存在同样能够导致尿白蛋白升高的疾病,诸如:糖尿病、肾功能不全、感染性性疾病、免疫性疾病、肿瘤等。研究对象于入院次日清晨采集清洁中段尿送检,行ACR测定;采集空腹静脉血测定空腹Glu、TC、TG、HDL-C、LDL-C、Hcy、Cys-C、hs-CRP、CREA、UA 水平;择期通过超声检测仪测定颈动脉内膜中层厚度,观察是否有斑块及斑块的厚度、数目,斑块是否导致管腔阻塞及阻塞的程度,计算Crouse总积分、等级评分。根据ACR值分为MAU阴性组266例(ACR30mg/g)和MAU阳性组73例(30mg/g≤ACR≤300mg/g),临床蛋白尿组20例(ACR300mg/g,因样本量偏少未纳入研究)。分别对两组研究对象进行一般资料(性别、吸烟史、BMI、是否合并冠心病)、血生化指标(Glu、TC、TG、HDL-C、LDL-C、Hcy、Cys-C、hs-CRP、CREA、UA)、ACR、Crouse 总积分、等级评分、近期3月发生心脑血管事件率进行统计分析。结果1.所有入选研究对象均按要求完成一般资料收集及ACR水平、血生化指标、颈动脉硬化指标测定。2.近期3月随访无失访现象。3.①MAUp阳性组73例,平均年龄(64.48±8.76)岁,其中含35名男性,38名女性,平均 BMI(25.09±3.75),57 例吸烟,合并冠心病 49 例;Glu(5.07±0.52)mmol/L、TC(4.08±0.75)mmol/L、TG(2.25±2.06)mmol/L、HDL-C(1.12±0.19)mmol/L、LDL-C(2.08 ±0.66)mmol/L、Cys-C(1.22 ± 0.29)mg/L、hs-CRP(2.67±3.09)mg/L、Hcy(16.36±8.22)μmol/L、CREA(81.67± 22.73)μmol/L、UA(352.49±82.88)μmol/L、ACR(76.84±57.69)、Crouse总积分(5.85± 1.11)、等级评分(4.27± 1.26)、斑块数目(4.53±1.00)、近期3月发生心脑血管事件27例;②MAU阴性组266例,平均年龄(65.39±11.53)岁,其中含157名男性,109名女性,平均 BMI(24.49±3.46),73 例吸烟,合并冠心病 126 例;Glu(5.13±0.56)mmol/L、TC(4.29± 1.10)mmol/L、TG(2.02±1.80)mmol/L、HDL-C(1.22±0.04)mmol/L、LDL-C(2.38± 1.31)mmol/L、Cys-C(1.26±0.45)mg/L、hs-CRP(2.36±3.36)mg/L、Hcy(17.83 ± 10.69)μmol/L、CREA(85.78 ±21.82)μmol/L、UA(364.76±95.38)μmol/L、ACR(5.75±6.17)、Crouse 总积分(2.09± 1.40)、等级评分(2.16± 1.12)、斑块数目(1.31±0.90)、近期3月发生心脑血管事件41例。4.两组之间在年龄、性别、BMI、吸烟史、Glu、TC、TG、HDL-C、LDL-C、Cys-C、hs-CRP、Hcy、CREA、UA方面的比较差异均无统计学意义(P0.05);ACR、Crouse总积分、等级评分、斑块数目、合并冠心病、近期心脑血管事件的比较差异均有统计学意义(P0.05)。5.分别以Crouse总积分、等级评分、斑块数目为因变量,以ACR为自变量进行单因素相关分析,ACR与Crouse总积分、等级评分、斑块数目呈正相关(r=0.784、0.733、0.787),进一步以ACR为自变量分别对其行回归分析,线性回归方程分别为y=2.058+0.040x,y=2.060+0.026x,y=1.332+0.032x。6.两组内分别以Crouse总积分、等级评分、斑块数为因变量,以TC、TG、LDL-C、LDL-C为自变量行单因素相关性分析,血脂水平(TC、TG、LDL-C)与Crouse总积分、等级评分、斑块数呈正相关,HDL-C与Crouse总积分、等级评分、斑块数呈负相关。7.据胆固醇水平分为高胆固醇血症组(TC≥5.2mmmol/L)56人(发生近期血脑血管事件11人)和非高胆固醇血症组(TC5.2mmmol/L)283人(发生近期心脑血管事件57人);两组在发生近期血脑血管事件方面的比较差异无统计学意义(P0.05)。另外,据甘油三酯水平分为高甘油三酯血症组(TG≥1.7mmmol/L)148人(发生近期血脑血管事件30人)和非高甘油三脂血症组(TG1.7mmmol/L)191人(发生近期心脑血管事件38人);两组在发生近期血脑血管事件方面的比较差异无统计学意义(P0.05)。结论原发性高血压MAU与颈动脉硬化、合并冠心病、发生近期心脑血管事件有关,且MAU水平与颈动脉硬化程度呈正相关,提示高血压患者MAU在一定水平上能早期预测动脉硬化、靶器官血管损害及近期心脑血管事件风险,且血脂异常促成并加速了动脉硬化的进程,对高血压患者早期进行MAU及血脂水平检测,尽早采取有效防治手段,将有助于降低高血压并发心脑血管疾病的致死、致残风险。
[Abstract]:Background Hypertension is common in chronic cardiovascular diseases. Long-term maintenance of high blood pressure can easily lead to atherosclerosis, which leads to a series of cardiovascular and cerebrovascular diseases. In recent years, with the further study of MAU, most patients with hypertension can be complicated with MAU. MAU indicates that hypertension has caused early vascular injury, which can occur in the early stage of atherosclerosis. Objective To explore the relationship between hypertensive MAU and atherosclerosis by analyzing the correlation between MAU and carotid atherosclerosis score in essential hypertension, so as to urge clinicians to pay attention to the detection of hypertensive MAU and take effective measures in the early stage. Methods From February 2016 to October 2016, 359 patients with essential hypertension were admitted to the Department of Cardiology of Yuxi People's Hospital. Except for secondary hypertension, the patients were excluded from having diseases that could also lead to elevated urinary albumin. For example, diabetes mellitus, renal insufficiency, infectious diseases, immune diseases, tumors and so on. The subjects were collected in the morning of admission clean middle urine for examination, ACR measurement; Fasting venous blood was collected to determine fasting Glu, TC, TG, HDL-C, LDL-C, Hcy, Cys-C, hs-CRP, CREA, UA levels; Choosing ultrasonic detector to determine the carotid intima-media thickness, and so on. The total Crouse score and grade score were calculated. According to ACR value, 266 cases were classified as MAU negative group (ACR30mg/g) and 73 cases were classified as MAU positive group (30mg/g < ACR < 300mg/g). 20 cases were classified as clinical proteinuria group (ACR300mg/g, not included in the study because of the small sample size). General data (gender, smoking history, BMI, whether coronary heart disease was associated), blood biochemical indicators (Glu, TC, TG, HDL-C, LDL-C, Hcy, Cys-C, hs-CRP, CREA, UA), ACR, Crouse total score, ranking score, the incidence of cardiovascular and cerebrovascular events in recent March were statistically analyzed. Results 1. All the selected subjects completed general information as required. Data were collected and ACR levels, blood biochemical indices and carotid atherosclerosis indices were measured. 2. There was no missing follow-up in recent 3 months. 3. 6.06mmol/L, HDL-C (1.12 (+ 0.19) mmol/L, HDL-C (1.12 (+ 0.19) mmol/L, LDL-C (2.08 (+ 0.66) mmol/L, Cys-C (1.22 (+ 0.29) mg/L, hs-CRP (2.67 (2.67 (+ 3.09) mg/L), hs-CRP (2.67 (2.67 (2.67 (+ 3.09) mg/L), Hcy (16.36 (+ 16.36 [8.22.22.22.22) mmol/L, CREA (81.67 (+ 81.67 [22.73 [22.73 (+ 352 85 + 1.11, grade score (4.27 + 1.26), number of plaques (4.53 + 1.00), recent occurrence in March 27 cases of cardiovascular and cerebrovascular events; 2 266 cases in MAU negative group, with an average age of (65.39 + 11.53) years, including 157 maleand 109 females, 157 males and 109 females, with an average BMI (24.49 + 3.46), 73 smok, and 126 patients with coronary heart disease; Glu (5.13 + 0.56) mmol / L, Glu (5.13 + 0.56) mmol / L, TC (4.29 + 1.10) mmol / L, TG (2.02 + 1.80) mmol / L, HDL-C (1.22 + 0.04) mmol / L, L-C (1.22 [0.04) mmol / L, L-L (2.22 [(2.04) L-L (L, Cys-C(1.26+0) 45 mg/L, hs-CRP (2.36 (+ 3.36) mg/L, hs-CRP (2.36 (+ 3.36) mg/L, Hcy (17.83 (+ 10.69) micromol/L, CREA (85.78 (+ 21.82) micromol/L, UA (364.76 (+ 95.38) micromol/L, ACR (5.75 (+ 6.17), ACR (5.75 (+) 17), Crouse total score (2.09 (+ 1.40), grade score (2.16 (+ 1.12), number of PLA (1.31 (+ 0.31 (+ 0.90), 41 recent cardiovascular and cerebrovascular events (4.4.4.4.4) between the two groups in March, u, TC There were no significant differences in TG, HDL-C, LDL-C, Cys-C, hs-CRP, Hcy, CREA, UA (P 0.05); ACR, Crouse total score, grade score, plaque number, coronary heart disease, and recent cardiovascular and cerebrovascular events (P 0.05). Univariate correlation analysis showed that ACR was positively correlated with the total score of Rouse, grade score and the number of plaques (r = 0.784, 0.733, 0.787). Further regression analysis was performed with ACR as independent variables. The linear regression equations were y = 2.058 + 0.040x, y = 2.060 + 0.026x, y = 1.332 + 0.032x.6. Crouse total score, grade score, plaque number were used in the two groups respectively. TC, TG, LDL-C and LDL-C were used as independent variables for univariate correlation analysis. The total score of serum lipid (TC, TG, LDL-C) was positively correlated with the total score of Rouse, grade score and plaque number. HDL-C was negatively correlated with the total score of Rouse, grade score and plaque number. There was no significant difference between the two groups (P 0.05). In addition, 148 patients were divided into hypertriglyceridemia group (TG < 1.7 mmmol/L) and non-hypercholesterolemia group (TC5.2 mmmol/L) according to the level of triglyceride (TG < 1.7 mmmol/L). There was no significant difference between the two groups in the occurrence of recent cardiovascular and cerebrovascular events (P 0.05). Conclusion MAU in essential hypertension is associated with carotid atherosclerosis, coronary heart disease and recent cardiovascular and cerebrovascular events. Positive correlation was found between MAU and carotid atherosclerosis, suggesting that MAU can predict early atherosclerosis, target organ vascular damage and the risk of recent cardiovascular and cerebrovascular events, and abnormal blood lipid contributes to and accelerates the process of atherosclerosis. Early detection of MAU and blood lipid levels in patients with hypertension, and effective prevention and treatment as soon as possible. It will help reduce the risk of death and disability of hypertension complicated with cardiovascular and cerebrovascular diseases.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.11

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