原发性高血压伴慢性肾脏病与动脉硬化的关系  

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

作　　者：左君丽[1] 常桂丽[1] 葛茜[2] 初少莉[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院北院高血压科,上海201800 [2]上海交通大学医学院附属瑞金医院高血压科,上海200025

出　　处：《上海交通大学学报（医学版）》2015年第11期1619-1624,共6页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海交通大学医学院科技基金(14XJ10057)~~

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(cf PWV)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(e GFR)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-f PWV显著高于高血压组(P<0.05)。随着e GFR的降低,两组cf PWV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,cf PWV与e GFR呈负相关(r=-0.085 1,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:cf PWV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cf PWV明显增高。cf PWV可作为高血压发生慢性肾脏病风险的预测指标之一。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（Cl 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=-0.085 1,P=0.02）.Taken the primary hypertension combined with C KD as a binary categorical variable,multiple logistic analysis showed that the risk of C KD 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 C KD of primary hypertensive patients.

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 

分 类 号：R544.14[医药卫生—心血管疾病] R543.5[医药卫生—内科学]