对称动态动脉硬化指数对原发性高血压患者早期肾功能损害的预测

摘要

目的:探讨对称动态动脉硬化指数(S-AASI)对原发性高血压患者早期肾功能损害的预测价值.方法:选择原发性高血压患者300例,测量患者的动态血压参数并计算S-AASI,检测尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)/肌酐(NAG/Cr),化验血清肌酐并计算Ccr.根据S-AASI的四分位数将受试者分为A、B、C、D 4组.比较4组患者各参数的差别,并行S-AASI与尿NAG/Cr等参数的多元相关回归分析.结果:①4组的年龄随S-AASI水平的增高依次增高(P＜0.05).A、B组高血压病程差异无统计学意义(P＞0.05),B、C、D组高血压病程依次延长,各组间比较差异有统计学意义(P＜0.05).②4组之间的血清肌酐比较差异无统计学意义(P＞0.05),但4组尿NAG/Cr及微量蛋白尿阳性率均依次增高,而Ccr依次降低,组间比较差异有统计学意义(P＜0.05).③多元线性回归分析显示S-AASI与尿NAG /Cr(β= 0.470,P＜0.001)、Ccr (β=-0.322,P＜0.05)具有相关性.尿NAG/Cr每增加1IU/g,S-AASI相应增加0.005;Ccr每降低1 ml/(min·1.73 m2),S-AASI相应增加0.003.结论:S-AASI可作为高血压早期肾功能损害的预测指标.%Objective: To investigate the relationship among symmetric ambulatory arterial stiffness index (S-AASI) , urine n-acetyl-β-D-glucosaminidase (NAG) and creatinine clearance rate (Ccr) in patients with essential hypertension.Methods: Three hundred patients with essential hypertension were enrolled.Ambulatory blood pressure monitoring (ABPM) was performed for S-AASI.Microproteinuria was quantified by urine NAG to creatinine ratio (NAG/Cr).Ccr was calculated with serum creatinine using Cockcroft-Gault formulation.The subjects were divided into four groups according to the S-AASI quartiles for comparison.Multivariate regression analysis was performed to confirm the association between renal impairment (using either NAG/Cr or Ccr) and S-AASI.Results: ① S-AASI increased with the age of the patients.No significant difference of the course of the essential hypertension was revealed between group A and B (P ＞ 0.05 ).However, significantly prolonged course was observed as S-AASI increased in group B, C and D (P ＜ 0.05).② Although no significant difference in serum creatinine was recorded among 4 groups, significantly successively increase and reduction were revealed in NAG/Cr and Ccr, respectively , as S-AASI increase in the 4 groups (P ＜ 0.05).③ Significantly independent correlations were revealed between S-AASI and NAG/Cr (β = 0.470, P ＜0.001) and Ccr (β = -0.322, P ＜0.05) according to multivariate regression analysis.With NAG/Cr increased by 1 IU/g, S-AASI was raised by 0.005.And with Ccr reduced by 1 ml/ (min · 1.73 m2), S-AASI was raised by 0.003.Conclusion: S-AASI is suggested as a predictive index in renal impairment of essential hypertension.