世居高原高血压人群蛋白尿相关危险因素  

Risk factors of proteinuria in hypertensive people living at high altitude for generations

作　　者：江吉 朱小刚[2] 姜山 达哇扎巴 岑强[2] Jiang Ji;Zhu Xiaogang;Jiang Shan;Dawa Zhaba;Cen Qiang(Department of Internal Medicine,Nangqian People's Hospital,Yushu Tibetan Autonomous Prefecture,Yushu 815299,China;Department of Pediatrics,Nangqian People's Hospital,Yushu Tibetan Autonomous Prefecture,Yushu 815299,China;Department of Cardiology,Fuxing Hospital,Capital Medical University,Beijing 100038,China;Department of Spleen-Stomach-Encephalopathy,Beijing Xicheng Guangwai Hospital,Beijing 100055,China)

机构地区：[1]玉树藏族自治州囊谦县人民医院内科,青海玉树815299 [2]首都医科大学附属复兴医院心内科,北京100038 [3]北京市西城区广外医院脑病脾胃科,北京100055 [4]玉树藏族自治州囊谦县人民医院儿科,青海玉树815299

出　　处：《临床荟萃》2023年第12期1086-1090,共5页Clinical Focus

摘　　要：目的探讨世居高原的高血压患者蛋白尿的发生率及其相关危险因素。方法回顾性分析青海省玉树藏族自治州囊谦县人民医院内科病房于2017年1月至2023年3月期间收治的年龄18岁以上、世居当地的高血压患者的临床资料。根据其蛋白尿的情况,分为蛋白尿组和无蛋白尿组。比较两组基线人口学特征、血压、以及入院后24 h实验室检查的差异,应用多因素Logistic回归分析,探究世居高原高血压患者蛋白尿的相关危险因素。结果本研究共入选高血压患者695例,其中蛋白尿组148例,无蛋白尿组547例。蛋白尿组男性比例、糖尿病比例、收缩压、舒张压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、白细胞、红细胞、血红蛋白、尿酸、尿素氮和血清肌酐水平都高于无蛋白尿组,而平均年龄和血小板水平低于无蛋白尿组(P<0.05)。两组体重指数和高密度脂蛋白胆固醇水平差异无统计学意义。高原红细胞增多症共有51例(7.3%)。蛋白尿组的高原红细胞增多症发生率高于无蛋白尿组(16.2%vs 4.9%,P<0.01);蛋白尿组的高尿酸血症发生率高于无蛋白尿组(42.6%vs 30.2%,P<0.01)。多因素Logistic回归分析显示,糖尿病(OR=3.924,95%CI 2.208-6.973,P<0.01),高原红细胞增多症(OR=2.956,95%CI 1.486-5.880,P=0.002),升高的血清肌酐水平(OR=1.021,95%CI 1.010-1.031,P<0.01)与蛋白尿的发生相关,为其独立危险因素。结论糖尿病、高原红细胞增多症以及升高的血清肌酐水平,与世居高原的高血压人群发生蛋白尿明显相关,是其独立的危险因素。Objective To investigate the incidence and related risk factors of proteinuria in hypertensive patients living at high altitude for generations.Methods The clinical data of hypertension patients over 18 years old admitted in the internal medicine ward of Nangqian People's Hospital in Yushu Tibetan Autonomous Prefecture of Qinghai Province from January 2017 to March 2023 were retrospectively analyzed.The patients were assigned into albuminuria group and non-albuminuria group according to the level of proteinuria.The differences of baseline demographic characteristics,blood pressure,and 24-hour laboratory examination indexes after admission between groups were compared,and multivariate logistic regression analysis was performed to explore the risk factors of proteinuria in patients with hypertension at high altitude.Results A total of 695 patients with hypertension representing 148 in albuminuria group and 547 in non-albuminuria group were enrolled in this study.Patients of albuminuria group had significantly higher proportion of men and diabetes mellitus(DM),increased levels of systolic/diastolic blood pressure(SBP/DBP),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),white blood cell(WBC),red blood cell(RBC),hemoglobin(Hb),uric acid(UA),urea nitrogen(BUN) and serum creatinine(SCr),and had significantly decreased levels of mean age and platelets(PLT) than those of non-albuminuria group(P<0.05).Both albuminuria group and non-albuminuria group were comparable in the levels of body mass index(BMI) and high density lipoprotein cholesterol(HDL-C)(P>0.05).The total incidence of high-altitude polycythemia(HAPC) was 7.3%(51/695).The incidence of HAPC and hyperuricemia in the albuminuria group was significantly higher than that in the non-albuminuria group(16.2% vs 4.9%,42.6% vs 30.2%,both P<0.01,respectively).Multivariate Logistic regression analysis showed that DM(OR:3.924,95% confidence interval [CI]:2.208-6.973,P<0.01),HAPC(OR:2.956,95%CI:1.486-5.880,P=0.002),and elevated SCr levels(OR:

关 键 词：高血压 蛋白尿 红细胞增多症 糖尿病 肾损害 高原 

分 类 号：R544.1[医药卫生—心血管疾病]