原发性高血压患者利用点尿钠估测24h尿钠水平准确性的验证  

Evaluation of Estimating 24-hour Urinary Sodium Excretion from Spot Urine in Chinese Primary Hypertension Patients

作　　者：孙星河 汪洋 康俊萍 刘小慧 SUN Xinghe;WANG Yang;KANG Junping;LIU Xiaohui(Department of Cardiology,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]北京大学国际医院心内科,北京市102206

出　　处：《中国全科医学》2024年第6期685-691,共7页Chinese General Practice

摘　　要：背景通过24 h尿钠测定计算原发性高血压患者的钠盐摄入量对指导治疗具有重要意义,但检测过程繁琐。已有的通过点尿钠估测24 h尿钠水平公式在我国原发性高血压患者中的估测价值尚不清楚。目的评价在我国原发性高血压患者中,应用Kawasaki、INTERSALT、Tanaka公式(以下分别简称K法、I法、T法)以点尿钠估测24 h尿钠水平的准确性。方法纳入2018年3月—2021年3月于北京大学国际医院心内科住院的原发性高血压患者为研究对象,收集患者的一般资料,测量24 h尿钠排泄量,通过点尿钠估测24 h尿钠排泄量。采用配对t检验评估3种公式24 h尿钠排泄量估测值与实测值差异的显著性,并采用Spearman秩相关分析两者的相关性。绘制Bland–Altman图对24 h尿钠排泄量实测值与估测值进行一致性分析。计算3种方法24 h尿钠排泄量估测值与实测值的相对偏差。评估在不同钠盐摄入水平、患有糖尿病、临床蛋白尿患者中3种估测公式的准确性。结果最终纳入患者196例,平均实测24 h尿钠排泄量(165.04±78.53)mmol/d,相当于钠盐摄入量(9.65±4.59)g/d。女性患者年龄、微量蛋白尿比例、临床蛋白尿比例高于男性患者,BMI、入院舒张压、24 h平均舒张压、吸烟比例、点尿钠、实测24 h尿钠排泄量低于男性患者(P<0.05)。患者24 h尿钠排泄量实测值低于K法24 h尿钠排泄量估测值(t配对=-8.008,P<0.001),Bland-Altman散点图显示有94.90%的点在95%CI之内。患者24 h尿钠排泄量实测值高于I法24 h尿钠排泄量估测值(t配对=4.167,P<0.001),Bland-Altman散点图显示有94.39%的点在95%CI之内。患者24 h尿钠排泄量实测值与T法24 h尿钠排泄量估测值比较,差异无统计学意义(t配对=-0.547,P>0.05),Bland-Altman散点图显示有96.43%的点在95%CI之内。K法、I法、T法24 h尿钠排泄量估测值的相对偏差分别为-31.82%、12.94%、-1.90%。根据钠盐摄入量进行分组后,估测值与�Background It is important to estimate the sodium intake of primary hypertension patients through 24-hour urine sodium excretion,but the collection and testing processes are complicated.It is not clear whether the existing equation for estimating 24-hour urinary sodium excretion from spot urine sample is valid in Chinese primary hypertension patients.Objective To evaluate the validity of the Kawasaki,INTERSALT,and Tanaka equations using spot urine samples to estimate 24-hour urinary sodium excretion among Chinese primary hypertension patients.Methods This study retrospectively selected hospitalized primary hypertension patients from Department of Cardiology Peking University International Hospital from March 2018 to March 2021.General data were collected.The 24-hour urinary sodium extraction in the 24-hour urine sample was measured.The 24-hour urinary sodium extraction from spot urine sample was estimated.Paired t-test was used to measure the significance of difference between the 24-hour urine sodium excretion from spot urine samples predicted using Kawasaki,INTERSALT or Tanaka equation and measured 24-hour urinary sodium excretion from 24-hour urine collections,and the correlation and agreement between them were analyzed using the Spearman correlation coefficient and Bland-Altman plots,respectively.Relative deviation was calculated.The accuracy of the three equations were also evaluated in patients with different levels of salt intake,diabetes or proteinuria.Results One hundred and ninety-six patients were finally included for analysis.The average 24-hour urinary sodium excretion level was(165.04±78.53)mmol/d,which was equivalent to daily NaCl intake of(9.65±4.59)g/d.Female patients were older,had higher ratios of microalbuminuria and proteinuria,while lower BMI,diastolic blood pressure on admission,24-hour average diastolic blood pressure compared with male patients(P<0.05).Moreover,female patients were less likely to be smokers,and had lower spot urine sodium,as while as lower 24-hour urinary sodium excreti

关 键 词：原发性高血压 钠尿增多 膳食 限钠 诊断 一致率 

分 类 号：R544.1[医药卫生—心血管疾病]