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

    • 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 m2-1比92.51(84.06,101.53)mL·min-1·(1.73 m2-1]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(1.094~1.660)、1.548(1.137~2.107)、0.986(0.978~0.004)和1.0004(1.000~1.001)。结论 在一般人群中,白蛋白尿与baPWV具有显著相关性。

       

      Abstract: Objective 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 Province, China from October 1, 2006, to October 1, 2007 were selected. Finally, 3694 subjects were enrolled 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 albuminuria 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 triacylglycerol [(1.65 ±1.26)mmol/L vs (1.50 ±1.04)mmol/L] were significantly higher in the albuminuria group than those of the non-albuminuria group (all P<0.05), while the estimated glomerular filtration rate (eGFR) [90.95(81.37,99.54)mL·min-1·(1.73 m2-1 vs 92.51(84.06,101.53)mL·min-1·(1.73 m2-1] was significantly lower in the albuminuria group (P=0.002). More subjects in the albuminuria group suffered from hypertension (62.1% vs 47.0%, P<0.001) or diabetes (10.7% vs 5.6%, P<0.001). The increase in baPWV was associated with the increase in ACR and the decrease in eGFR. Multivariate Logistic regression analysis showed that age, diabetes, blood creatinine, hypertension and baPWV were independent risk factors for elevated ACR, and the corresponding odds ratios (95% CI) were 1.018 (1.008-1.028), 1.348 (1.094-1.660), 1.548 (1.137-2.107), 0.986 (0.978-0.004) and 1.0004 (1.000-1.001), respectively.Conclusion In the general population, there is a significant correlation between albuminuria and baPWV.

       

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