超重肥胖和血浆醛固酮水平联合与原发性高血压患者系统性炎症的关联  

Association of overweight/obesity,aldosterone levels,and systemic inflammation in patients with essential hypertension

作　　者：汪驰 邹宇婷 兰丽花 黄建翔 葛振 薛浩 WANG Chi;ZOU Yuting;LAN Lihua;HUANG Jianxiang;GE Zhen;XUE Hao(Department of Cardiology,the Sixth Medical Center of Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]中国人民解放军总医院第六医学中心心内科,北京100048

出　　处：《中国分子心脏病学杂志》2025年第1期6568-6574,共7页Molecular Cardiology of China

基　　金：国家自然科学基金(82070433);解放军总医院青年自主创新科学基金项目(22QNFC064,22BJZ38)。

摘　　要：目的探究超重肥胖和醛固酮水平联合与原发性高血压患者系统性炎症的关联,并探讨醛固酮水平在超重肥胖与系统性炎症之间的中介作用。方法连续纳入2022年7月至2024年4月在中国人民解放军总医院第六医学中心住院的340例原发性高血压患者。超重肥胖定义为体重指数(body mass index,BMI)≥24 kg/m2。根据人群中位数将醛固酮水平分为高醛固酮、低醛固酮。将研究对象分为4组:正常体重+低醛固酮组、正常体重+高醛固酮组、超重肥胖+低醛固酮组、超重肥胖+高醛固酮组。系统性炎症定义为高敏C反应蛋白≥1 mg/L。使用多元logistic回归模型检验BMI-醛固酮分组与系统性炎症之间的关联。使用中介效应分析探究醛固酮在超重肥胖与系统性炎症之间的中介作用。结果340例患者的平均年龄为(53.91±15.26)岁,男性比例为60.29%(n=205)。正常体重+低醛固酮组、正常体重+高醛固酮组、超重肥胖+低醛固酮组和超重肥胖+高醛固酮组系统性炎症的发生率分别为41.67%、36.59%、52.46%和62.79%。与正常体重+低醛固酮组相比,超重肥胖+高醛固酮组发生系统性炎症的比值比和95%置信区间为2.23(1.10~4.54),正常体重+高醛固酮组为0.79(0.32~1.95),超重肥胖+低醛固酮组为1.70(0.84~3.45)。根据中介效应分析,醛固酮水平并不是超重肥胖导致系统性炎症的中介效应因素。结论超重肥胖和醛固酮升高与原发性高血压患者发生系统性炎症累积相关,醛固酮并未介导超重肥胖与系统性炎症之间的关联。Objective To examine the joint association of overweight/obesity and aldosterone with systemic inflammation in patients with essential hypertension and explored the mediated role of aldosterone level between overweight/obesity and systemic inflammation.Methods This cross-sectional study was conducted in Sixth Medical Center of Chinese PLA General Hospital.A total of 340 patients with essential hypertension,who were hospitalized between July 2022 and April 2024 were included.Overweight/obesity was defined as body mass index(BMI)≥24 kg/m~2.Serum aldosterone was categorized according to the median value.Study patients were categorized into 4 groups:normal weight+low aldosterone(NW/LA)group,normal weight+high aldosterone(NW/HA)group,overweight/obesity+low aldosterone(OW/LA)group,and overweight/obesity+high aldosterone(OW/HA)group.Systemic inflammation was defined as high-sensitivity C-reactive protein≥1 mg/L.Multivariate Logistic regression model was used to examine the association between BMI-aldosterone groups and systemic inflammation.Mediation analysis was used to determine the role of aldosterone as a mediator.Results Of 340 patients included in the current study,the mean age was(53.91±15.26)years,60.29%(n=205)were men.The percentages of patients with systemic inflammation were 41.67%,36.59%,52.46%,and 62.79%for NW/LA,NW/HA,OW/LA,and OW/HA group,respectively.Relative to NW/LA group,the odds ratios and 95%confidence intervals of systemic inflammation were 2.23(1.10-4.54)for OW/HA group,0.79(0.32-1.95)for NW/HA group,and 1.70(0.84-3.45)for OW/LA group.According to the mediation analysis,the aldosterone level did not mediate the associationbetween overweight/obesity and systemic inflammation.Conclusions Overweight/obesity and elevated aldosterone are additivelyassociated with systemic inflammation in patients with essential hypertension.Aldosterone does not mediate the association betweenoverweight/obesity and systemic inflammation.

关 键 词：超重肥胖 醛固酮 原发性高血压 系统性炎症 

分 类 号：R544.1[医药卫生—心血管疾病]