肾功能正常高血压患者血清胱抑素C与动脉硬化早期指标的关系  

Relationship between serum cystatin C and early indicators of arteriosclerosis in hypertensive patients with normal renal function

作　　者：张杰梅 商黔惠 王晓春 ZHANG Jie-mei;SHANG Qian-hui;WANG Xiao-chun(Clinical Medicine Institute,Cardiovascular Disease Institute,Hypertension Research Institute of Zunyi Medical College,Cardiovascular Department of Affiliated Hospital of Zunyi Medical College,Zunyi Guizhou 563003,China;不详)

机构地区：[1]遵义医科大学附属医院临床医学研究所,心血管病研究所,高血压研究室,贵州遵义563003 [2]遵义医科大学附属医院心内科

出　　处：《中华高血压杂志》2020年第10期933-940,共8页Chinese Journal of Hypertension

基　　金：国家自然科学基金(81160041,81460077);贵州省优秀科技教育人才省长专项基金项目[黔省专合字(2012)15号]。

摘　　要：目的探讨肾功能正常高血压患者血清胱抑素C与臂踝动脉脉搏波传导速度(baPWV)、颈股动脉脉搏波传导速度(cfPWV)、踝臂血压指数(ABI)、反射波增强指数(AIx)等动脉硬化早期指标的关系。方法选取2017年1月至2019年5月于遵义医科大学附属医院高血压门诊就诊且肾功能正常的高血压患者2486例为研究对象,根据胱抑素C四分位、年龄、血压水平和服用降压药情况进行分组,采用方差分析、χ2检验、Pearson相关及多因素logistic回归分析胱抑素C与动脉硬化早期指标的关系。结果随着胱抑素C水平的增高,baPWV≥1.4及cfPWV>10 m/s的发生率逐渐增加(P<0.05),而胱抑素C四分位组间ABI和AIx的差异无统计学意义(P>0.05);随着年龄和血压分级的增加,baPWV≥1.4、cfPWV>10 m/s的发生率逐渐增加,ABI和AIx逐渐增高(P<0.05);服用降压药组的cfPWV>10 m/s发生率和AIx高于未服用降压药组(P<0.05)。Pearson相关分析结果显示,胱抑素C与baPWV、cfPWV呈弱正相关(r=0.334,0.283,均P<0.05),与ABI、AIx相关性无统计学意义(r=0.013,-0.005,均P>0.05)。多因素logistic回归分析校正年龄、性别等混杂因素后,相对于胱抑素C第一分位组,第四分位组发生baPWV≥1.4 m/s的OR值(95%CI)为2.51(1.47~4.31)、第二、三分位组差异无统计学意义(P>0.05),而第二、三、四分位组发生cfPWV>10 m/s的OR值(95%CI)分别为1.60(1.03~2.48)、1.96(1.25~3.08)、2.11(1.30~3.43);胱抑素C每增加一个标准差,发生baPWV≥1.4、cfPWV>10 m/s的OR值(95%CI)分别为1.25(1.04~1.51)、1.31(1.10~1.56)。结论胱抑素C是肾功能正常高血压患者baPWV、cfPWV增高的独立预测因子。Objective To explore the relationship between serum cystatin C(CysC)and arteriosclerotic indicators such as brachial ankle pulse wave velocity(baPWV),carotid femoral pulse wave velocity(cfPWV),ankle brachial index(ABI)and augmentation index(AIx)in hypertensive patients with normal renal function.Methods From January 2017 to May 2019,2486 hypertensive patients with normal renal function were selected from the clinic of hypertension in the Affiliated Hospital of Zunyi Medical University.The patients were grouped according to CysC quartile,age,blood pressure level and the situation of taking antihypertensive drugs.Analysis of variance,χ~2 test,Pearson correlation and multivariate logistic regression analysis were used to clarify the relationship between CysC and arteriosclerosis indicators.Results With the increase of CysC level,the incidence of baPWV≥1.4 m/s and cfPWV>10 m/s increased gradually(P<0.05),while the difference of ABI and AIx was not statistically significant among quartile group of CysC(P>0.05).With the increase of age and blood pressure classification,the incidence of baPWV≥1.4 m/s and cfPWV>10 m/s gradually increased,and ABI and AIx gradually increased(P<0.05);The incidence of cfPWV>10 m/s and AIx in the patients taking antihypertensive drugs were higher than those in the patients not taking antihypertensive drugs(P<0.05).Pearson correlation analysis showed that CysC was weakly correlated with baPWV and cfPWV(r=0.334,0.283,P<0.05),and had no significant correlation with ABI and AIx(r=0.013,-0.005,P>0.05).After adjusting for various factors,the multivariate logistic regression analysis showed that compared with quartile 1,OR(95%CI)of baPWV≥1.4 m/s in quartile 4 group was 2.51(1.47-4.31),OR(95%CI)of cfPWV>10 m/s in quartile 2,3 and 4 group were 1.60(1.03-2.48),1.96(1.25-3.08)and 2.11(1.30-3.43),respectively.In contrast,the difference of baPWV≥1.4 m/s in the quartile 2 and 3 group were no statistically significant(P>0.05).For per standard deviation the CysC increased,the OR(95%CI)of baPWV≥1.4

关 键 词：高血压患者 肾功能正常 血清胱抑素C 臂踝动脉脉搏波传导速度 颈股动脉脉搏波传导速度 

分 类 号：R544.1[医药卫生—心血管疾病] R543.5[医药卫生—内科学]