我国北方人群24 h尿钠排泄量与全因死亡的相关性分析  

Associations between 24-hour urinary sodium excretion and all-cause mortality in adults living in north China

作　　者：刘小云 刘之光 邓卿[3] 成小如[3] 胡泊[3] 刘力生[4] 王兴河 Liu Xiaoyun;Liu Zhiguang;Deng Qing;Cheng Xiaoru;Hu Bo;Liu Lisheng;Wang Xinghe;on behalf of PURE-China Investigators(Department of PhaseⅠClinical Trial Center,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Pharmacy,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;State Key Laboratory of Cardiovascular Disease,Fuwai,Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 102300,China;Beijing Hypertension League Institute,Beijing 100039,China;不详)

机构地区：[1]首都医科大学附属北京世纪坛医院药物Ⅰ期临床试验研究室,北京100038 [2]首都医科大学附属北京安贞医院药事部,北京100029 [3]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院医学统计部,北京102300 [4]北京高血压联盟研究所,北京100039

出　　处：《中华心血管病杂志》2022年第12期1220-1228,共9页Chinese Journal of Cardiology

摘　　要：目的探讨我国北方人群24 h尿钠排泄量(24hUNaE)与全因死亡风险的关系。方法本研究基于前瞻性城乡流行病学研究中国队列的随访调查,纳入我国北方人群数据。由经过培训的研究人员采用面对面形式记录所有参与者的基线信息,并收集其清晨空腹尿标本,估算24hUNaE和24 h尿钾排泄量(24hUKE)以衡量钠、钾摄入量。采用多元脆弱Cox回归模型分析24hUNaE(<3.00、3.00~3.99、4.00~4.99、5.00~5.99和≥6.00 g/d)与全因死亡的关系。结果本研究共纳入27310名研究对象。24hUNaE为(5.84±1.73)g/d。中位随访时间8.8年,全因死亡共发生1024例(3.7%),其中心血管相关死亡390例,非心血管相关死亡591例,其余患者死亡原因无法确定。以24hUNaE 4.00~4.99 g/d为参照组,校正其他影响因素后,当24hUNaE≥6 g/d时全因死亡(HR=1.24,95%CI:1.02~1.49)和心血管相关死亡(HR=1.39,95%CI:1.02~1.88)的发生风险显著增加;当24hUNaE<3.00 g/d时,全因死亡的发生风险增加(HR=1.38,95%CI:0.96~1.99),但无显著相关性。24hUNaE与非心血管相关死亡的发生风险无显著相关性。以24hUNaE 4.00~4.99 g/d伴24hUKE≥2.11 g/d为参照组,全因死亡和心血管相关死亡的发生风险在低尿钠(24hUNaE<3.00 g/d)伴低尿钾(24hUKE<2.11 g/d)组最高。结论我国北方人群的24hUNaE过低(<3 g/d)或过高(≥6 g/d)与全因死亡和心血管相关死亡风险增加有关。适度的钠摄入同时增加钾摄入可能对机体健康更有益。Objective To investigate the associations between 24-hour urinary sodium excretion(24hUNaE)and all-cause mortality in adult Northern Chinese population.Methods Data from this study were derived from the prospective urban and rural epidemiology(PURE)study in north China.Baseline information of all participants were obtained by face to face interview through trained research staffs based on questionnaires,and morning fasting urine samples of participants were collected to estimate 24hUNaE and 24-hour potassium excretion(24hUKE).Multivariable frailty Cox regression models were used to explore the association between 24hUNaE(<3.00,3.00-3.99,4.00-4.99,5.00-5.99 and≥6 g/d)and all-cause death.Results A total of 27310 participants were included in this study.The mean 24hUNaE was(5.84±1.73)g/d.After a median follow-up of 8.8 years,1024 participants died(3.7%),including 390 cardiovascular related deaths and 591 non-cardiovascular related deaths.The cause of death of the remaining patients could not be determined.Using 24hUNaE level of 4.00-4.99 g/d as the reference group,after fully adjustment,24hUNaE≥6.00 g/d was associated with an increased risk of all-cause death(HR=1.24,95%CI:1.02-1.49)and cardiovascular related death(HR=1.39,95%CI:1.02-1.88).24hUNaE<3.00 g/d was associated with increased risk of all-cause mortality(HR=1.38,95%CI:0.96-1.99).There was no significant association between 24hUNaE and non-cardiovascular related death.Furthermore,using the combination of 24hUNaE 4.00-4.99 g/d and 24hUKE≥2.11 g/d as the reference group,the highest risk occurred in participants with the combination of low sodium(<3.00 g/d)and low potassium(<2.11 g/d).Conclusion 24hUNaE equal or higher than 6 g/d or lower than 3 g/d is associated with increased risk of all-cause mortality and cardiovascular related death in Northern Chinese population.Besides,moderate sodium intake in combination with increased potassium intake might reduce the risk of all-cause death.

关 键 词：钠 钾 尿液 全因死亡 心血管相关死亡 

分 类 号：R195[医药卫生—卫生统计学]