原发性高血压早期肾损害患者血清白脂素水平的临床意义

doi:10.11958/20231349

摘要/Abstract

摘要：

目的探讨原发性高血压早期肾损害患者血清白脂素（ASP）水平变化及临床意义。方法 160例原发性高血压患者根据尿白蛋白/肌酐比值（UACR）分为单纯高血压组78例和早期肾损害组82例。另选择60例健康体检者为对照组。比较各组间血清ASP、白细胞介素-6（IL-6）、UACR水平。分析ASP与血压、IL-6及UACR的相关性。Logistic回归分析原发性高血压早期肾损害的影响因素。受试者工作特征（ROC）曲线分析各指标对早期肾损害的预测价值。结果早期肾损害组血清ASP、IL-6、UACR水平高于对照组和单纯高血压组（均P<0.05），随着血压升高，血清ASP、IL-6水平呈递增趋势。原发性高血压患者ASP与SBP、DBP及IL-6水平呈正相关（均P<0.05），早期肾损害组血清ASP与UACR、IL-6水平呈正相关（均P<0.05）。Logistic回归分析显示，较高水平的SBP、ASP和IL-6是早期肾损害的独立危险因素。ROC曲线显示，单项指标检测曲线下面积（AUC）最大的是ASP，为0.972（95%CI：0.950~0.993）。ASP+IL-6+SBP联合检测的AUC为0.986（95％CI：0.972~0.999）。结论原发性高血压早期肾损害患者血清ASP水平升高，是早期肾损害良好的预测指标，ASP+IL-6+SBP联合检测优于单独检测。

关键词: 原发性高血压, 肾疾病, 白细胞介素6, 白蛋白尿, ROC曲线, 白脂素

Abstract:

Objective To investigate the clinical significance and serum changes of asprosin (ASP) levels in patients with essential hypertension and early renal damage. Methods According to urinary albumin / creatinine ratio (UACR), 160 patients with essential hypertension were divided into the simple hypertension group (78 cases) and the early renal damage group (82 cases). Another 60 healthy subjects were selected as the control group. The differences of serum ASP, interleukin-6 (IL-6) and UACR levels were compared between groups. The correlation between ASP and blood pressure, IL-6 and UACR was analyzed. Logistic regression analysis was used to analyze the factors influencing early renal damage in essential hypertension. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of each index for early renal injury. Results The serum levels of ASP, IL-6 and UACR were higher in the early renal damage group than those in the control group and the simple hypertension group (all P<0.05). The serum levels of ASP and IL-6 showed an increasing trend with the increase of blood pressure. ASP was positively correlated with systolic blood pressure (SBP), diastolic blood pressure (DBP) and IL-6 levels in patients with essential hypertension (all P<0.05). Serum ASP was positively correlated with SBP, UACR and IL-6 levels in essential hypertension patients (P<0.05), and serum ASP was positively correlated with UACR and IL-6 levels in the early renal damage group (P<0.05). Logistic regression analysis showed that higher levels of SBP, ASP and IL-6 were independent risk factors for early renal damage. ROC curve showed that ASP had the largest area under the curve (AUC) of 0.972 (95%CI: 0.950-0.993). The AUC of combined detection of ASP+IL-6+SBP was 0.986 (95%CI:0.972-0.999). Conclusion The increased serum ASP level in patients with early renal damage in essential hypertension is a good predictor of early renal damage. The combined detection of ASP+IL-6+SBP is better than single detection.

Key words: essential hypertension, kidney diseases, interleukin-6, albuminuria, ROC curve, asprosin

中图分类号:

R544.11，R692

图/表 9

参考文献 19

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组别	n	年龄/ 岁	性别（男/女）	吸烟	BMI/ （kg/m²）
对照组	60	53.52±11.64	35/25	17（28.33）	26.00±2.83
单纯高血压组	78	49.44±11.01	53/25	21（26.92）	26.38±3.23
早期肾损害组	82	51.66±10.86	54/28	22（26.83）	26.76±3.08
F、χ²或Z		2.231	1.468	0.132	1.064

组别	n	年龄/ 岁	性别（男/女）	吸烟	BMI/ （kg/m²）
对照组	60	53.52±11.64	35/25	17（28.33）	26.00±2.83
单纯高血压组	78	49.44±11.01	53/25	21（26.92）	26.38±3.23
早期肾损害组	82	51.66±10.86	54/28	22（26.83）	26.76±3.08
F、χ²或Z		2.231	1.468	0.132	1.064

组别	n		BUN/(mmol/L)		SCr/ (mmol/L)		TC/(mmol/L)	TG/ (mmol/L)
对照组	60		5.75±1.06		69.11±9.03		4.60±0.71	1.55（1.29，2.05）
单纯高血压组	78		5.97±1.58		71.23±7.56		4.84±0.90	1.67（1.30，2.24）
早期肾损害组	82		6.22±1.58		72.50±10.63		4.87±0.84	1.68（1.24，2.49）
F或Z			1.766		1.754		2.271	0.003
组别		LDL-C/ (mmol/L)		FBG/ (mmol/L)		SBP/ mmHg			DBP/ mmHg
对照组		2.42±0.66		5.25±0.42		118.55±9.55			68.80±7.16
单纯高血压组		2.72±0.78		5.28±0.44		143.23±11.74^a			91.35±11.28^a
早期肾损害组		2.65±0.80		5.23±0.34		149.82±13.40^ab			101.39±10.05^ab
F		2.910		0.202		128.229^＊＊			193.832^＊＊

组别	n		BUN/(mmol/L)		SCr/ (mmol/L)		TC/(mmol/L)	TG/ (mmol/L)
对照组	60		5.75±1.06		69.11±9.03		4.60±0.71	1.55（1.29，2.05）
单纯高血压组	78		5.97±1.58		71.23±7.56		4.84±0.90	1.67（1.30，2.24）
早期肾损害组	82		6.22±1.58		72.50±10.63		4.87±0.84	1.68（1.24，2.49）
F或Z			1.766		1.754		2.271	0.003
组别		LDL-C/ (mmol/L)		FBG/ (mmol/L)		SBP/ mmHg			DBP/ mmHg
对照组		2.42±0.66		5.25±0.42		118.55±9.55			68.80±7.16
单纯高血压组		2.72±0.78		5.28±0.44		143.23±11.74^a			91.35±11.28^a
早期肾损害组		2.65±0.80		5.23±0.34		149.82±13.40^ab			101.39±10.05^ab
F		2.910		0.202		128.229^＊＊			193.832^＊＊

组别		n	高血压分级（1/2/3级）	高血压病程/年		降压药物应用时间/年
单纯高血压组		78	20/26/32	5.46±2.61		4.00（2.00，6.00）
早期肾损害组		82	21/28/33	7.01±2.88^a		5.00（3.00，7.25）
t、χ²或Z			0.014	3.565^＊＊		1.998^＊
组别	β受体阻滞剂		CCB	ACEI/ARB	ARNI	利尿剂
单纯高血压组	21（26.92）		43（55.13）	45（57.69）	11（14.10）	5（6.41）
早期肾损害组	20（24.39）		45（54.88）	47（57.32）	11（13.41）	6（7.31）
χ²	0.135		0.045	0.446	1.240	1.019