尿酸与肾素-血管紧张素系统激活和中青年非勺型高血压关系  

Uric Acid,Renin-Angiotensin System Activation and Nondipping Hypertension in Young and Middle-age

作　　者：黄裕立[1] 麦炜颐[2] 宋元彬[2] 胡允兆[1] 邝健[2] 吴焱贤[1] 

机构地区：[1]南方医科大学附属顺德第一人民医院心内科,广东佛山528300 [2]中山大学附属第一医院心血管内科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2010年第6期817-821,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：2010年佛山市卫生局医学科研立项(2010385);2009年广东省自然科学基金(8151008901000157);2009年广东省科技计划项目(2009A030301004)

摘　　要：【目的】探索血清尿酸水平与肾素-血管紧张素系统(RAS)激活和非勺型高血压关系。【方法】入选中青年(18～60岁)原发性高血压患者187例,行24h动态血压监测,根据收缩压昼夜差值百分比将患者分为勺型高血压组(126例,67.4%)和非勺型高血压组(61例,32.6%),并抽血测定尿酸、肝功能、肾功能及血浆卧位肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)等,分析尿酸与肾素-血管紧张素系统(RAS)活性、非勺型高血压之间的关系。【结果】两组患者在年龄、性别、吸烟史、酗酒史、高血压病家族史、体质量指数(BMI)、血脂谱、空腹血糖、糖化血红蛋白、肌酐、尿素氮、总胆红素等无明显差异(P>0.05),非勺型高血压患者血清尿酸、PRA、AngⅡ高于勺型高血压患者(P<0.05)。单因素Logistic回归分析提示血浆尿酸、PRA、AngⅡ水平为非勺型血压危险因素,相关分析提示患者血尿酸水平与PRA(r=0.349,P<0.05)和AngⅡ(r=0.296,P<0.05)呈线性正相关。PRA与AngⅡ水平呈线性正相关(r=0.464,P<0.01)。多因素Logistic回归分析提示尿酸(OR=3.136;95%CI,1.897-5.403;P<0.01)、PRA(OR=1.451;95%CI,1.127-2.389;P<0.05)、AngⅡ(OR=2.343;95%CI,1.804-4.076;P<0.01)升高增加非勺型高血压发生。【结论】血尿酸、PRA与AngⅡ升高增加非勺型血压发生风险,血尿酸水平升高促进非勺型血压的发生可能与其激活RAS有关。【Objective】 To explore the relationship of serum uric acid,renin-Angiotensin System and nondipping hypertension in young and middle-age. 【Methods】 A total of 187 essential hypertension patients （aged 18 -60 years） were enrolled,and defined as dippers （126 patients,67.4% ） or nondippers （61 patients,32.6% ） by ambulatory blood pressure monitoring. Uric acid,hepatic and renal function,fasting blood glucose,lipid profile,plasma renin activity （PRA）,and angiotensin Ⅱ （Ang Ⅱ） were measured. The relationship of serum uric acid,activity of RAS,nondipping Hypertension was analyzed. 【Results】 The basic data in the two groups had no difference. Uric acid,PRA,and Ang Ⅱ levels were higher in nondippers than in dippers and positively correlated with the risk of nondipping hypertension,which revealed by univariate logistic regression （P 0.05）. Pearson r coefficient analysis showed that uric acid was positively correlated with PRA （r = 0.349,P 0.05） and Ang Ⅱ （r = 0.296,P 0.05）,the logistic regression model improved by principal component analysis showed that serum uric acid levels （OR = 3.136; 95% CI,1.897 -5.403;P 0.01）,PRA （OR = 1.451; 95% CI,1.127 -2.389,P 0.05） and Ang Ⅱ （OR = 2.343; 95% CI,1.804 -4.076; P 0.01） were associated with the nondipping pattern. 【Conclusion】 Serum uric acid level increase the risk of nondipping hypertension. This may corrrelate with its activation of RAS.

关 键 词：高血压病 非勺型高血压 尿酸 动态血压 

分 类 号：R54[医药卫生—心血管疾病]