高血压患者24 h尿钠钾比值对同型半胱氨酸水平的影响研究

摘要

目的 探索高血压患者24 h尿钠钾比值对同型半胱氨酸(Hcy)水平的影响.方法 选取2015年1月-2016年12月在新疆医科大学第一附属医院心血管内科住院确诊的高血压患者958例为研究对象.根据病历详细收集患者一般资料.所有患者按照要求留取24 h尿液标本,检测24 h尿钾、尿钠水平和尿钠钾比值,并在同一天抽取血液标本检测血清钠、血清钾、Hcy、三酰甘油(TG)、总胆固醇(TC)等指标.根据所有入选患者24 h尿钠钾比值水平按三分位法将其分为3组:尿钠钾比值≤4.05(T1组,n=320);4.06~6.16(T2组,n=319)和>6.16(T3组,n=319).采用多元线性回归分析探讨高血压患者24 h尿钠钾比值对Hcy水平的影响.结果 3组患者24 h尿钠水平为130~260 mmol/24 h,中位水平为182.90(107.79)mmol/24 h;24 h尿钾水平为25~100 mmol/24 h,中位水平为35.73(18.37)mmol/24 h;24 h尿钠钾比值中位水平为4.99(3.33).3组患者24 h尿钠、尿钾、尿钠钾比值及Hcy水平比较,差异有统计学意义(P<0.05).多元线性回归分析结果显示,24 h尿钠钾比值是Hcy的影响因素〔b=0.409,95%CI(0.053,0.765),P<0.05〕.控制患者血清钠钾水平、性别、年龄、BMI、血压等多个混杂因素后,24 h尿钠钾比值仍是Hcy的影响因素〔b=0.461,95%CI(0.063,0.859),P<0.05〕. 结论 高血压患者24 h尿钠钾比值是Hcy的影响因素.通过减少钠摄入、增加钾摄入等改善不良饮食习惯是高血压非药物治疗的重要组成部分,应当引起广大高血压患者及临床医生的重视.%Objective To explore the relationship between 24-hour urinary sodium/potassium ratio and homocysteine in hypertension patients.Methods A total of 958 patients diagnosed hypertension were recruited from January 2015 to December 2016 at Vasculocardiology Department in the First Affiliated Hospital of Xinjiang Medical University.According to requirements,24-hour urine specimens were collected to detect the content of urinary sodium,urinary potassium and urinary sodium/potassium ratio.And on the same day,blood samples were collected to detect the content of serum sodium,serum potassium,homocysteine,triglyceride(TG),total cholesterol(TC) and so on.According to the trichotomy,the 24-hour urinary sodium/potassium ratios were divided into three groups:group T1 (urinary sodium/potassium ratio ≤4.05 ,n=320),group T2(4.06-6.16,n=319) and group T3 (urinary sodium/ potassium ratio> 6.16,n=319).The effect of 24-hour urinary sodium/potassium ratio on the content of homocysteine in blood samples of hypertensive patients was investigated by multiple linear regression analysis.Results The 〔M(QR)〕 of 24-hour urinary sodium,urinary potassium,and urinary sodium/potassium ratio of three groups were 182.90(107.79)mmol/24 h(130-260 mmol/24 h),35.73(18.37)mmol/24 h (25-100 mmol/24 h) and 4.99(3.33).The 24-hour urinary sodium, urinary potassium, urinary sodium/potassium ratio,and homocysteine differed significantly among the three groups(P<0.05).Multiiple linear regression analysis showed that the 24-hour urinary sodium/potassium ratio was the influencing factor of homocysteine〔b =0.409,95%CI (0.053,0.765),P<0.05〕.After adjusting for the levels of serum sodium and potassium,sex distribution,age distribution,BMI,blood pressure and other confounding factors,the 24-hour urinary sodium/potassium ratio was still the significant associated factor for the homocysteine〔b=0.461,95%CI(0.063,0.859),P<0.05〕.Conclusion 24-hour urinary sodium/potassium ratio is the influencing factor of homocysteine.Reducing the sodium intake and increasing potassium intake is an important part of non-drug treatments,which should draw high attention of hypertensive patients and clinicians.