夜尿钠钾比值与心血管事件发生风险的关系  

Relationship between overnight urinary sodium to potassium ratio and the risk of cardiovascular disease

作　　者：刘欢欢 高向民[2] 李莹[1] 吴勇[2] 周龙[1] 麦劲壮[2] 郭敏[1] 聂志强[2] 欧艳秋[2] 武阳丰[3] 刘小清[2] 赵连成[1] Liu Huanhuan, Gao Xiangmin, Li Ying, Wu Yong, Zhou Long, Mai Jinzhuang, Guo Min, Nie Zhiqiang, Ou Yanqiu, Wu Yangfeng, Liu Xiaoqing, Zhao Liancheng(Division of Prevention and Community Health, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, Chin)

机构地区：[1]中国医学科学院 北京协和医学院 国家心血管病中心 阜外医院社区防治部,100037 [2]广东省心血管病研究所 广东省医学科学院 广东省人民医院流行病研究室 [3]北京大学临床研究所

出　　处：《中华心血管病杂志》2018年第3期218-223,共6页Chinese Journal of Cardiology

基　　金：“八五”国家科技攻关计划(85-915-01-01);“九五”国家科技攻关计划(96-906-02-01);“十五”国家科技攻关计划(2001BA703B01)

摘　　要：目的探讨8 h夜尿钠钾比值与心血管事件发生风险的关系。方法从中美心肺血管疾病流行病学合作研究（前瞻性随访调查）中抽取10%小样本人群（年龄35～59岁），分别于1983至1984年秋季和1985至1986年春季进行2次连续3 d的夜尿收集，测定8 h夜尿钠和钾等指标。1987至1988年对研究对象进行第1次随访，记录心血管事件，之后每2年随访1次，随访截止到2005年12月31日。根据夜尿钠钾比值三分位数，将研究对象分为第一分位组、第二分位组和第三分位组，采用Cox比例风险回归分析探讨夜尿钠钾比值与心血管事件发生风险的关系。此外，根据8 h夜尿钠和尿钾中位数，分别将研究对象分为高低两组，并两两组合为低钠-低钾组、低钠-高钾组、高钠-低钾组和高钠-高钾组。以低钠-高钾组为参照，探讨不同尿钠钾水平与心血管事件发生风险的关系。结果最终纳入分析的研究对象共954名，其中男性459名（48.1%）。第一、二、三分位组的研究对象均为318名；低钠-低钾组和高钠-高钾组研究对象各为347名，低钠-高钾组和高钠-低钾组研究对象各为130名。研究对象的随访时间为18.6（18.3，19.3）年，共发生心血管事件81例，包括卒中64例和冠心病事件20例。多因素Cox比例风险回归分析显示，与第一分位组比较，第二和第三分位组发生心血管事件的HR分别为2.04（95%CI 1.06～3.95，P=0.034）和2.07（95%CI 1.07～4.03，P=0.032）。以低钠-高钾组为参照，低钠-低钾组发生心血管事件的风险增加24%，但差异无统计学意义（P=0.685）；而高钠-高钾组和高钠-低钾组的心血管事件风险均显著增加，HR分别为3.32（95%CI 1.26～8.76，P=0.015）和3.04（95%CI 1.05～8.83，P=0.041）。结论夜尿钠钾比值与心血管事件发生风险独立正相关；与尿钾水平相比，尿钠水平与心血管事件的关联更密切。ObjectiveTo explore the relationship between overnight urinary sodium to potassium ratio and the risk of cardiovascular disease （CVD）.MethodsA subsample of 10 percent of the participants （35-59 years old） from the People＇s Republic of China-United States Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology （prospective survey） were used. Three consecutive overnight urine samples were collected in the autumn of 1983-1984 and the spring in 1985-1986, respectively. Urinary sodium and potassium were detected and calculated for 8 hours excretion. The occurrences of cardiovascular events were recorded in 2 years interval from 1987-1988 until December 31, 2005. Participants were divided into first ratio group, second ratio group, and third ratio group based on the tertiles of sodium to potassium ratio. Cox proportional hazard regression model was used to determine the relationship between sodium to potassium ratio and risk of CVD. In addition, participants were divided into 2 subgroups by the median of overnight urinary sodium and potassium, and then combined each other for 4 subgroups including low sodium-low potassium group, low sodium-high potassium group, high sodium-low potassium group, and high sodium-high potassium group, to explore the relationship between different sodium-potassium combinations and the risk of CVD.ResultsA total of 954 participants were included in the final analysis, of whom 459 （48.1%） were males. There were 318 cases in the first, second and third ratio group, respectively. There were 347 cases in low sodium-low potassium group and high sodium-high potassium group, and 130 cases in low sodium-high potassium group and high sodium-low potassium group. After a median follow-up of 18.6 （18.3, 19.3） years, cardiovascular events occurred in 81 participants, including 64 stroke and 20 coronary heart disease events. Multivariate analysis showed that comparing with the first ratio group, the hazard ratios （HR） in the second and the third ratio groups were 2

关 键 词：冠状动脉疾病 卒中 危险因素 夜尿钠钾比值 

分 类 号：R54[医药卫生—心血管疾病]