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目的探讨原发性高血压(EH)患者低水平微量白蛋白尿(LGAU)[晨尿白蛋白浓度(MUAC)≥10 mg/L,而<30 mg/L]与左心室质量指数(LVMI)、左室构型、颈动脉内膜中层厚度(I MT)、颈动脉硬化斑块指数(PI)及斑块发生率、肾小球滤过率(GFR)的关系。方法未系统治疗的EH患者301例按MUAC水平分为3组:正常组(MUAC<10 mg/L)107例;LGAU组(10≤MUAC<30 mg/L)127例;微量白蛋白尿(MAU)组(MUAC≥30 mg/L)67例。分别测量血压、身高、体质量及生化指标,包括血肌酐、尿素氮、尿酸、空腹血糖、OGTT餐后2 h血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C),进行心脏超声扇扫、颈部血管超声检查,测量舒张末期左室内径(LVDd),舒张末期左室后壁厚度(LVPWT),舒张末期室间隔厚度(IVST),I MT及斑块发生率,根据公式计算LVMI、左室壁相对厚度(RWT)、GFR、体质量指数(BMI),比较各组LVMI、左室构型、I MT、PI、斑块发生率及GFR。结果以MUAC≥10 mg/L为切点,采用Logistic多元回归分析,结果显示BMI(OR=1.098,P=0.037)、收缩压(OR=1.100,P<0.01)、空腹血糖(OR=2.323,P<0.01)、总胆固醇(OR=2.159,P=0.003)、HDL-C(OR=0.539,P=0.014)与EH患者发生LGAU独立相关。LGAU组与正常组比较,IVST、LVPWT、RWT、LVMI水平显著升高,左室向心性肥厚发生率升高,GFR下降,I MT、PI升高(P<0.01),左室向心性重构发生率、颈动脉斑块发生率升高(P<0.05),均有统计学差异。直线相关分析显示,LVMI、I MT与Lg MUAC(晨尿白蛋白浓度的对数)呈正相关(r分别为0.43,0.39,均P<0.01),GFR与Lg MUAC呈负相关(r=-0.28,P<0.01)。结论EH患者即使合并LGAU就与亚临床靶器官损害密切相关,提示临床高血压、糖尿病医师应当常规检查MAU,并及时给予标准化治疗。
Objective To investigate the relationship between low-level microalbuminuria (LGAU) [morning urine albumin concentration (MUAC) ≥10 mg / L and <30 mg / L] and left ventricular mass index (LVMI) in patients with essential hypertension , Left ventricular configuration, carotid artery intima-media thickness (I MT), carotid plaque index (PI) and plaque incidence, glomerular filtration rate (GFR). Methods 301 patients with untreated EH were divided into 3 groups according to the level of MUAC: 107 in the normal group (MUAC <10 mg / L), 127 in the LGAU group (10≤MUAC <30 mg / L), microalbuminuria MAU) group (MUAC ≥30 mg / L) in 67 cases. Blood pressure, height, body weight and biochemical parameters were measured, including serum creatinine, urea nitrogen, uric acid, fasting blood glucose, OGTT blood glucose, total cholesterol, triglyceride, low density lipoprotein cholesterol (HDL-C). The patients underwent echocardiography and cervical ultrasonography. The left ventricular end-diastolic diameter (LVDd), left ventricular posterior wall thickness (LVPWT), end-diastolic interventricular septum thickness LVMI, RWT, GFR and body mass index (BMI) were calculated according to the formula, LVMI, left ventricular configuration, I MT, PI, plaque Incidence and GFR. Results MUAC≥10 mg / L was used as the cut-off point. Logistic multivariate regression analysis showed that BMI (OR = 1.098, P = 0.037), systolic blood pressure (OR = 1.100, Total cholesterol (OR = 2.159, P = 0.003) and HDL-C (OR = 0.539, P = 0.014) were independently associated with LGAU in patients with EH. Compared with normal group, the levels of IVST, LVPWT, RWT and LVMI in LGAU group were significantly increased, the incidence of left ventricular concentric hypertrophy increased, GFR decreased, I MT and PI increased (P <0.01) Incidence, carotid plaque incidence increased (P <0.05), there was a statistically significant difference. Linear correlation analysis showed that there was a positive correlation between LVMI, I MT and Lg MUAC (r = -0.28, r = -0.28, P <0.01, respectively) , P <0.01). Conclusions EH patients with LGAU are closely related to the damage of subclinical target organs, suggesting that clinical hypertension and diabetic physicians should routinely check MAU and give standardized treatment promptly.