中国北方农村地区人群中白蛋白尿与动脉僵硬度的关系研究  

The association between albuminuria and arterial stiffness in a rural population from Northern China

作　　者：鲍书敏[1] 黄雯[1] 杨进刚[2] 梁巧静 梁远波[3] 王宁利[4] 张国娟[1] Bao Shu-min;Huang Wen;Yang Jin-gang;Liang Qiao-jing;Liang Yuan-bo;Wang Ning-li;Zhang Guo-juan(Department of Nephrology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;State Key Laboratory of Cardiovascular Disease,Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital,Beijing 100037,China;Clinical and Epidemiological Re-search Center,t he Affiliated Eye Hospital of Wenzhou Medical University,Wenzhou 325000,China;Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Ophthal-mology and Visual Science Key Laboratory,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院肾内科,北京100730 [2]中国医学科学院北京协和医学院阜外医院心血管病国家重点实验室,北京100037 [3]温州医科大学附属眼科医院临床与流行病学研究中心,温州325000 [4]首都医科大学附属北京同仁医院眼科中心,北京市眼科与视觉科学重点实验室,北京100730

出　　处：《临床肾脏病杂志》2025年第4期297-303,共7页Journal Of Clinical Nephrology

基　　金：国家重点基础研究发展计划(973计划);中国科学技术部(Grant2007 CB 512201)。

摘　　要：目的调查中国北方农村地区人群白蛋白尿与动脉僵硬度之间的关系。方法按照分层整群多阶段抽样方法抽取中国河北省邯郸市永年区2006年10月1日至2007年10月1日13个村庄30岁以上的居民,最终纳入3694例受试者进行横断面研究。根据尿白蛋白/肌酐比值(urinary albumin-to-creatinine ratio,ACR)将受试者分为白蛋白尿组和无白蛋白尿组,比较两组受试者臂-踝脉搏波传导速度(brachial-ankle Pulse Wave Velocity,baPWV)等19个指标。再将受试者根据baPWV值由小到大分为四组,比较四组受试者之间ACR、年龄等19个指标。应用多元逻辑回归模型评估白蛋白尿和baPWV之间的关系。结果白蛋白尿组受试者的baPWV[(1689.44±430.60)cm/s比(1556.49±347.48)cm/s]、年龄[(54.56±10.49)岁比(50.96±10.80)岁]、女性占比(60.2%比53.4%)、收缩压[(146.61±24.10)mmHg比(137.99±20.98)mmHg](1 mmHg=0.133 kPa)、舒张压[(80.28±12.93)mmHg比(77.37±11.89)mmHg]、平均动脉压[(102.39±15.07)mmHg比(97.58±13.61)mmHg]、脉搏[(66.34±18.72)次/min比(60.62±15.85)次/min]、腰臀比[(0.91±0.05)比(0.90±0.05)]、高敏C反应蛋白[(1.05±0.41)mg/L比(0.82±0.37)mg/L]、总胆固醇[(4.80±1.0)mmol/L比(4.59±0.94)mmol/L]、低密度脂蛋白[(2.84±0.66)mmol/L比(2.70±0.65)mmol/L]、三酰甘油[(1.65±1.26)mmol/L比(1.50±1.04)mmol/L]显著高于无白蛋白尿组受试者(P均<0.05),而估算肾小球滤过率(estimated glomerular filtration rate,eGFR)[90.95(81.37,99.54)mL·min^(-1)·(1.73 m^(2))^(-1)比92.51(84.06,101.53)mL·min^(-1)·(1.73 m^(2))^(-1)]显著低于无白蛋白尿组受试者(P=0.002)。白蛋白尿组相比无白蛋白尿组有更多受试者患有高血压(62.1%比47.0%,P<0.001)或糖尿病(10.7%比5.6%,P<0.001)。受试者人群baPWV的增加与ACR的增加及eGFR的下降相关。进行多元Logistic回归分析提示年龄、糖尿病、血肌酐、高血压和baPWV是ACR升高的独立危险因素,相应的OR(95%CI)分别为1.018(1.008~1.028)、1.348(1.094Objective To investigate the association between albuminuria and arterial stiffness in a rural population from Northern China.Methods Using a stratified cluster multi-stage sampling method,residents over 30 years old from 13 villages in Yongnian County,Handan City,Hebei Prov⁃ince,China from October 1,2006,to October 1,2007 were selected.Finally,3694 subjects were en⁃rolled in the cross-sectional study.They were divided into the albuminuria group and non-albuminuria group according to the urinary albumin-to-creatinine ratio(ACR).Brachial-ankle pulse wave velocity(baPWV)and other 19 factors were compared between the two groups.The subjects were then divided into four groups based on the baPWV values,and albuminuria and other 19 factors were compared among the four groups.Multivariate logistic regression analysis was used to evaluate the association between al⁃buminuria and baPWV.Results BaPWV[(1689.44±430.60)cm/s vs(1556.49±347.48)cm/s],age[(54.56±10.49)years vs(50.96±10.80)years],female proportion(60.2%vs 53.4%),systolic blood pressure[(146.61±24.10)mmHg vs(137.99±20.98)mmHg,1 mmHg=0.133 kPa],diastolic blood pressure[(80.28±12.93)mmHg vs(77.37±11.89)mmHg],mean arterial pressure[(102.39±15.07)mmHg vs(97.58±13.61)mmHg],pulse[(66.34±18.72)beats/min vs(60.62±15.85)beats/min],waist-to-hip ratio[(0.91±0.05)vs(0.90±0.05)],hypersensitivity C-reactive protein[(1.05±0.41)mg/L vs(0.82±0.37)mg/L],total cholesterol[(4.80±1.0)mmol/L vs(4.59±0.94)mmol/L],low-density lipoprotein[(2.84±0.66)mmol/L vs(2.70±0.65)mmol/L],and triac⁃ylglycerol[(1.65±1.26)mmol/L vs(1.50±1.04)mmol/L]were significantly higher in the albumin⁃uria group than those of the non-albuminuria group(all P<0.05),while the estimated glomerular filtra⁃tion rate(eGFR)[90.95(81.37,99.54)mL·min^(-1)·(1.73 m^(2))^(-1) vs 92.51(84.06,101.53)mL·min^(-1)·(1.73 m^(2))^(-1)]was significantly lower in the albuminuria group(P=0.002).More subjects in the albumin⁃uria group suffered from hypertension(62.1%vs 47.0%,P<0.001)or diabetes(10.7%v

关 键 词：蛋白尿 动脉僵硬度 臂-踝脉搏波传导速度 中国 农村人口 

分 类 号：R544.1[医药卫生—心血管疾病]