限盐饮食对一级原发性高血压合并2型糖尿病患者心血管风险的影响  

Effects of Modest Salt Reduction on Cardiovascular Risk in Patients with Mild Hypertensives and Type 2 Diabetes Mellitus

作　　者：张进[1] 丁立群[1] 范洁[1] 张曦[1] ZHANG Jin;DING Li-qun;FAN Jie;ZHANG Xi(The Department of Cardiology,the First People's Hospital of Yunnan Province,the Affiliated Hospital of Kunming University of Science and Technology,Kunming 650032,Yunnan,China)

机构地区：[1]云南省第一人民医院、昆明理工大学附属医院心内科,云南昆明650032

出　　处：《广东医学》2018年第23期3477-3481,共5页Guangdong Medical Journal

基　　金：国家自然科学基金资助项目(编号:81360039)

摘　　要：目的探讨限盐饮食对一级高血压合并2型糖尿病患者心血管风险(血压、尿白蛋白、血浆肾素及醛固酮)的影响。方法入选152例未使用药物治疗的一级原发性高血压合并2型糖尿病患者,分为限盐饮食组及常规饮食组,各76例。建议限盐饮食组患者限盐(5 g/d)。入组前检测诊室血压、动态血压,24 h尿钠、24 h尿白蛋白排泄率,肝肾功能、空腹血糖、餐后2 h血糖、糖化血红蛋白、血电解质、血浆肾素活性及醛固酮。12周观察期结束时复查上述指标,并比较上述指标组内及组间差异有无统计学意义。另外,通过多元线性回归分析筛选出影响24 h尿白蛋白排泄率的独立危险因子。结果 76例限盐饮食组患者限盐饮食12周后,尿钠由(182±13) mmo L/24 h降至(110±16) mmo L/24 h;尿白蛋白排泄率由(87±7) mg/24 h降至(46±5)mg/24 h;诊室血压:收缩压由(147±9) mm Hg降至(139±7) mm Hg,舒张压由(94±6) mm Hg降至(90±7)mm Hg,平均动脉压由(111±3) mm Hg降至(106±6) mm Hg;动态血压:24 h平均收缩压血压由(142±7) mm Hg降至(134±6) mm Hg,24 h平均舒张压由(89±4) mm Hg降至(85±9) mm Hg;日间收缩压由(148±5) mm Hg降至(140±7) mm Hg,日间舒张压由(91±7) mm Hg降至(86±9) mm Hg;夜间收缩压由(126±6) mm Hg降至(120±8) mm Hg,夜间舒张压由(78±4) mm Hg降至(71±7) mm Hg;组内比较差异均有统计学意义(P <0. 05)。与常规饮食组组间比较,上述指标差异均有统计学意义(P <0. 05)。常规饮食组12周前后上述指标组内比较差异均无统计学意义(P> 0. 05)。限盐饮食对血糖、血电解质、血肌酐、血浆肾素活性及醛固酮无影响。以24 h尿白蛋白量为因变量,24 h尿钠、血钠、诊室平均动脉压、空腹血糖、体质指数及年龄为自变量,通过多元线性回归方程,筛选出24 h尿钠、诊室血平均动脉压及空腹血糖是引起24 h尿白蛋白量升高的独立危险因素(P <0. 01)。结论适当减少钠盐摄入,能�Objective To investigate the effect of modest salt reduction on cardiovascular risk (blood pressure, urinary albumin,renin and aldosterone)in patients with mild hypertensives and type 2 diabetes mellitus (T2DM).Methods A total of 152 patients with mild hypertensives and T2DM without drug treatment were recruited.They were assigned into reduced salt diet and usual diet groups.Participants in reduced salt diet group were given with detailed dietary advice to reduce salt intake to 5g/d.Measurements were performed at baseline and at the end of 12-week study.Office blood pressure,24-hour ambulatory blood pressure monitoring,24-hour urines albumin excretion,blood biochemistry, plasma renin activity and aldosterone,fasting blood glucose,2-hour postprandial blood glucose and HbA1c were examined at baseline and after intervention for comparison.The independent risks of 24h urinary albumin were revealed by multiple linear regression analyses.Results In reduced salt diet group,24-hour urinary sodium was reduced from 182 hou mmoL/24h to 110h t mmoL/24h;urinary albumin was reduced from 87na mg/24h to 46g/mg/24h;office SBP was reduced from 147ce mmHg to 139Hg mmHg;office DBP was reduced from 94fi mmHg to 90Hg mmHg;mean arterial pressure (MAP)was reduced from 111P)mmHg to 106g mmHg after treatment.The 24h SBP was reduced from 142s mmHg to 134Hg mmHg;24h DBP was reduced from 89±4mmHg to 85mH mmHg;day SBP was reduced from 148SB mmHg to 140g mmHg;day DBP was reduced from 91D mmHg to 86Hg mmHg;nocturnal SBP was reduced from 126P mmHg to 120g mmHg;nocturnal DBP was reduced from 78BP mmHg to 71mH mmHg after intervention.All these reductions were with significant differences (P <0.05).Above these variables,there were also significant differences compared between the usual diet and reduced salt diet groups at the end of 12-week study (P <0.05).But there was no significant difference in blood glucose,hemoglobin A1c,renin activity or aldosterone after intervention.Multiple linear regression analyses showed that 24-hour urinary sodium,of

关 键 词：限盐饮食 原发性高血压 2型糖尿病 尿白蛋白 血浆肾素 醛固酮 

分 类 号：R544.11[医药卫生—心血管疾病] R587.2[医药卫生—内科学]