上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

原发性高血压伴慢性肾脏病与动脉硬化的关系

左君丽1，常桂丽1，葛茜2，初少莉1   

  1. 上海交通大学 医学院 1.附属瑞金医院北院高血压科, 上海 201800; 2.附属瑞金医院高血压科, 上海 200025
  • 出版日期:2015-11-28 发布日期:2016-01-13
  • 通讯作者: 初少莉, 电子信箱: shaolichu@163.com。
  • 作者简介:左君丽（1975—）， 女， 副主任医师， 博士; 电子信箱: zuo-junli@163.com。
  • 基金资助:

    上海交通大学医学院科技基金（14XJ10057）

Correlation between chronic kidney disease and arterial stiffness of primary hypertensive patients

ZUO Jun-li1, CHANG Gui-li1, GE Qian2, CHU Shao-li1   

  1. 1.Department of Hypertension, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai 201800, China; 1.Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2015-11-28 Published:2016-01-13
  • Supported by:

    Science and Technology Foundation of Shanghai Jiao Tong University School of Medicine, 14XJ10057

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摘要：

目的   探讨动脉僵硬度无创性检测指标对原发性高血压伴慢性肾脏病风险的预测价值。方法  以541例原发性高血压患者作为研究对象，其中单纯原发性高血压患者330例（高血压组），原发性高血压合并慢性肾脏病211例（高血压+肾病组）。采用动脉僵硬度无创性检测方法，对颈动脉-股动脉脉搏波传导速度（cfPWV）及大、小动脉弹性（C1、C2）进行测定，同时行脉搏波分析(PWA)，并经颈动脉超声检查测定内膜中层厚度（IMT）。结果  与高血压组比较，高血压+肾病组患者高龄、高血压病程长、尿白蛋白与肌酐比值较高（P<0.01），而估测的肾小球滤过率（eGFR）较低（P<0.05）。在调整年龄、心率、病程、吸烟和服用降压药物情况及肱动脉收缩压之后，高血压+肾病组动脉僵硬度指标中的c-fPWV显著高于高血压组(P<0.05)。随着eGFR的降低，两组cfPWV和IMT均逐渐增高（P<0.01），C2降低（P<0.01）；调整心血管危险因素之后，cfPWV与eGFR呈负相关(r=－0.0851，P=0.02)。将原发性高血压伴慢性肾脏病作为二分类变量，进一步的多元Logistic回归分析发现：cfPWV每增加1个SD(3 m/s), 单纯原发性高血压患者发生慢性肾脏病的危险度增加1.50倍。结论  原发性高血压伴慢性肾脏病时cfPWV明显增高。cfPWV可作为高血压发生慢性肾脏病风险的预测指标之一。

关键词: 动脉僵硬度, 原发性高血压, 慢性肾脏病, 颈动脉-股动脉脉搏波传导速度, 动脉弹性, 内膜中层厚度

Abstract:

Objective To investigate the value of noninvasive arterial stiffness indexes for predicting the risk of primary hypertensive patients with chronic kidney disease (CKD). Methods  A total of 541 patients with primary hypertensive were selected and 330 of them were simple primary hypertensive patients (hypertension group) and 211 of them were primary hypertensive patients with CKD (hypertension+CKD group). The carotid-femoral pulse wave velocity (cfPWV) and large and small artery elasticity indexes (C1 and C2) were measured by noninvasive test method of arterial stiffness. The pulse wave analysis (PWA) was performed and inter-media thickness (IMT) was measured by carotid ultrasonography. Results  Compared with the hypertension group, patients of the hypertension+CKD group were older, and had longer duration of hypertension, higher urine protein/creatinine ratio (P<0.01), and lower estimated glomerular filtration rate (eGFR) (P<0.05). After age, heart rate, duration, smoking, use of antihypertensive drugs, and brachial systolic blood pressure were adjusted, the cfPWV of the hypertension+CKD group was significantly higher than that of hypertension group (P<0.05). With the decrease of eGFR, cfPWV and IMT of two groups gradually increased (P<0.01) and C2 decreased (P<0.01). After cardiovascular risk factors were adjusted, cfPWV negatively correlated with the eGFR (r=-0.0851, P=0.02). Taken the primary hypertension combined with CKD as a binary categorical variable, multiple logistic analysis showed that the risk of CKD of patients with simple primary hypertension increased by 1.50 times with the increase of cfPWV by 1 SD (3 m/s). Conclusion  The cfPWV of primary hypertensive patients with CKD significantly increases, which can be used as a index for predicting the risk of CKD of primary hypertensive patients.

Key words: arterial stiffness, primary hypertension；chronic kidney disease, carotid-femoral pulse wave velocity； artery elasticity, inter-media thickness