尿NGAL、KIM-1、UACR在原发性高血压早期心血管损伤中的临床意义  

Clinical Significance of Urinary NGAL,KIM-1 and ACR in Early Cardiovascular Injury of Patients with Essential Hypertension

作　　者：曾艳[1] 匡文俐 蒋青 李秋月[1] Zeng Yan;Kuang Wenli;Jiang Qin(Department of Nephrology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院肾内科

出　　处：《华中科技大学学报（医学版）》2019年第3期311-316,共6页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：江西省科技厅科技支撑计划资助项目(No.20161BBG70165);江西省教育厅重点项目计划资助(No.GJJ150039)

摘　　要：目的 通过分析尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子1(KIM-1)、尿白蛋白肌酐比(UACR)与高血压患者心脏、颈动脉血管病变相关指标的相关性,探讨尿NGAL、KIM-1水平及UACR在早期高血压脏器损伤中的意义。方法以原发性高血压患者为研究对象,根据UACR将其分为正常蛋白尿组(NA)、微量蛋白尿组(MA)、临床蛋白尿组(CA),检测各组的生化指标、血压和尿NGAL、KIM-1水平,超声检查心脏和血管。结果①CA组的舒张末期左室后壁厚度(LVPWT)、舒张末期室间隔厚度(IVST)均明显大于MA组和NA组(均 P <0.05);CA组、MA组左室重量指数(LVMI)高于NA组(均 P <0.05);CA组右室内径(RV)及左室肥厚(LVH)、颈动脉斑块形成检出比例均显著高于NA组(均 P <0.05)。②MA组尿NGAL/Cr明显高于NA组( P <0.01),尿KIM-1/Cr高于NA组( P <0.05);CA组NGAL/Cr、KIM-1/Cr均明显高于MA组(均 P <0.01)。③相关性分析:尿NGAL/Cr在NA组与LVPWT、IVST、LVMI、肺动脉内径(PA)呈正相关,在MA组与LVMI呈正相关,在CA组与舒张期末左室内径(LVIDd)、LVPWT、IVST、LVMI、升主动脉内径(AO)、PA呈正相关;尿KIM-1在NA组与各心脏指标均无相关性,在MA组与LVMI呈正相关,在CA组与LVPWT、IVST、LVMI、AO、RV呈正相关;UACR在NA组与LVIDd呈正相关,在MA组与LVMI呈正相关,在CA组与LVIDd、IVST、LVMI、RV呈正相关;④二元Logistic回归分析:尿NGAL/Cr是左心室肥厚和颈动脉斑块形成的独立危险因素。结论尿NGAL相比UACR和KIM-1,在预测心血管健康方面有更大的优势,能早期评估高血压心脏损伤,是左心室肥厚和颈动脉斑块形成的独立危险因素。Objective To investigate the relationship between urinary NGAL,KIM-1,urinary albumin creatinine ratio(UACR)and heart,carotid vascular markers in patients with hypertension,and to explore the clinical significance of urinary NGAL,KIM-1 and UACR in early hypertensive cardiovascular injury. Methods Patients with essential hypertension were divided into normal proteinuria group(NA),microalbuminuria group(MA)and clinical proteinuria group(CA)according to UACR.The biochemical indexes,blood pressure,urinary NGAL and KIM-1 were detected,heart and blood vessels were examined by echocardiography for each group. Results The left ventricular posterior wall thickness(LVPWT)and interventricular septal thickness at the end of diastole(IVST)of CA group were significantly higher than those of MA and NA groups( P <0.05).The left ventricular mass index(LVMI)was significantly higher in the CA and MA groups than in the NA group( P <0.05).The right ventricular diameter(RV),left ventricular hypertrophy(LVH)and carotid plaque of CA group were significantly higher than those in NA group( P <0.05).The urinary NGAL/Cr in MA group was significantly higher than that in NA group( P <0.01);the urinary KIM-1/Cr in MA group was significantly higher than that in NA group( P <0.05);the NGAL/Cr and KIM-1/Cr in the CA group were significantly higher than those in MA group( P <0.01).Correlation analysis showed that urinary NGAL/Cr was positively correlated with LVPWT,IVST,LVMI and pulmonary artery diameter(PA)in NA group,positively correlated with LVMI in MA group,and positively correlated with left ventricular diameter at the end of diastole(LVIDd),LVPWT,IVST,LVMI,ascending aortic diameter(AO),and PA in CA group;urinary KIM-1 was not associated with each cardiac index in the NA group,but positively correlated with LVMI in the MA group and positively correlated with LVPWT,IVST,LVMI,AO and RV in MA group;UACR was positively correlated with LVIDd in NA group,positively correlated with LVMI in MA group,and positively correlated with LVIDd,IVST,LVMI and

关 键 词：心脏 中性粒细胞明胶酶相关脂质运载蛋白 肾损伤分子1 尿白蛋白肌酐比 颈动脉斑块 

分 类 号：R541.3[医药卫生—心血管疾病]