世居高原高血压人群蛋白尿相关危险因素

doi:10.3969/j.issn.1004-583X.2023.12.005

摘要/Abstract

摘要：

目的探讨世居高原的高血压患者蛋白尿的发生率及其相关危险因素。方法回顾性分析青海省玉树藏族自治州囊谦县人民医院内科病房于2017年1月至2023年3月期间收治的年龄18岁以上、世居当地的高血压患者的临床资料。根据其蛋白尿的情况,分为蛋白尿组和无蛋白尿组。比较两组基线人口学特征、血压、以及入院后24 h实验室检查的差异,应用多因素Logistic回归分析,探究世居高原高血压患者蛋白尿的相关危险因素。结果本研究共入选高血压患者695例,其中蛋白尿组148例,无蛋白尿组547例。蛋白尿组男性比例、糖尿病比例、收缩压、舒张压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、白细胞、红细胞、血红蛋白、尿酸、尿素氮和血清肌酐水平都高于无蛋白尿组,而平均年龄和血小板水平低于无蛋白尿组( $P$ <0.05)。两组体重指数和高密度脂蛋白胆固醇水平差异无统计学意义。高原红细胞增多症共有51例(7.3%)。蛋白尿组的高原红细胞增多症发生率高于无蛋白尿组(16.2% vs 4.9%, $P$ <0.01); 蛋白尿组的高尿酸血症发生率高于无蛋白尿组(42.6% vs 30.2%, $P$ <0.01)。多因素Logistic回归分析显示,糖尿病( $O R$ =3.924, 95% $C I$ 2.208-6.973, $P$ <0.01), 高原红细胞增多症( $O R$ =2.956, 95% $C I$ 1.486-5.880, $P$ =0.002), 升高的血清肌酐水平( $O R$ =1.021, 95% $C I$ 1.010-1.031, $P$ <0.01)与蛋白尿的发生相关,为其独立危险因素。结论糖尿病、高原红细胞增多症以及升高的血清肌酐水平,与世居高原的高血压人群发生蛋白尿明显相关,是其独立的危险因素。

关键词: 高血压, 蛋白尿, 红细胞增多症, 糖尿病, 肾损害, 高原

Abstract:

Objective To investigate the incidence and related risk factors of proteinuria in hypertensive patients living at high altitude for generations. Methods The clinical data of hypertension patients over 18 years old admitted in the internal medicine ward of Nangqian People's Hospital in Yushu Tibetan Autonomous Prefecture of Qinghai Province from January 2017 to March 2023 were retrospectively analyzed. The patients were assigned into albuminuria group and non-albuminuria group according to the level of proteinuria. The differences of baseline demographic characteristics, blood pressure, and 24-hour laboratory examination indexes after admission between groups were compared, and multivariate logistic regression analysis was performed to explore the risk factors of proteinuria in patients with hypertension at high altitude. Results A total of 695 patients with hypertension representing 148 in albuminuria group and 547 in non-albuminuria group were enrolled in this study. Patients of albuminuria group had significantly higher proportion of men and diabetes mellitus (DM), increased levels of systolic/diastolic blood pressure (SBP/DBP), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), white blood cell (WBC), red blood cell (RBC), hemoglobin (Hb), uric acid (UA), urea nitrogen (BUN) and serum creatinine (SCr), and had significantly decreased levels of mean age and platelets (PLT) than those of non-albuminuria group ( $P$ <0.05). Both albuminuria group and non-albuminuria group were comparable in the levels of body mass index (BMI) and high density lipoprotein cholesterol (HDL-C) ( $P$ >0.05). The total incidence of high-altitude polycythemia (HAPC) was 7.3%(51/695). The incidence of HAPC and hyperuricemia in the albuminuria group was significantly higher than that in the non-albuminuria group (16.2% vs 4.9%, 42.6% vs 30.2%, both $P$ <0.01, respectively). Multivariate Logistic regression analysis showed that DM ( $O R$ : 3.924, 95% confidence interval [ $C I$ ]: 2.208-6.973, $P$ <0.01), HAPC ( $O R$ : 2.956, 95% $C I$ : 1.486-5.880, $P$ =0.002), and elevated SCr levels ( $O R$ : 1.021, 95% $C I$ : 1.010-1.031, $P$ <0.01) were the independent associations of proteinuria. Conclusion Diabetes mellitus, HAPC and elevated SCr are significant independent associations of proteinuria in hypertensive people living at high altitude for generations.

Key words: high blood pressure, proteinuria, polycythemia, diabetes mellitus, kidney damage, plateau

中图分类号:

R544.1

江吉, 朱小刚, 姜山, 达哇扎巴, 岑强. 世居高原高血压人群蛋白尿相关危险因素[J]. 临床荟萃, 2023, 38(12): 1086-1090.

Jiang Ji, Zhu Xiaogang, Jiang Shan, Dawa Zhaba, Cen Qiang. Risk factors of proteinuria in hypertensive people living at high altitude for generations[J]. Clinical Focus, 2023, 38(12): 1086-1090.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.12.005

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I12/1086

图/表 3

表1 两组患者人口学、基线特征

Tab.1 Comparison of demography and baseline in the two groups

指标	总人群( $n$ =695)	蛋白尿组( $n$ =148)	无蛋白尿组( $n$ =547)	$t$ /χ²值	$P$ 值
男性[例(%)]	307(44.2)	89(60.1)	218(39.9)	9.440	0.002
年龄(岁)	65.2±11.2	63.3±12.2	65.8±10.8	-2.260	0.009
BMI(kg/m²)	27.4±4.5	27.7±4.6	27.4±4.9	0.798	0.496
DM[例(%)]	80(11.5)	35(23.6)	45(8.2)	411.835	<0.01
SBP(mmHg)	158±26	163±27	157±25	2.273	0.024
DBP(mmHg)	97±16	100±18	96±15	2.375	0.018
WBC(×10⁹/L)	6.5±2.1	6.9±2.5	6.4±2.0	2.113	0.033
RBC(×10¹²/L)	5.5±0.9	5.8±1.1	5.4±0.8	4.796	<0.01
Hb(g/L)	161.6±26.3	172.8±29.9	158.6±24.4	5.310	<0.01
PLT(×10⁹/L)	232.2±66.5	222.6±74.3	234.8±64.0	-1.821	0.035
TC(mmol/L)	4.8±1.3	4.9±1.7	4.7±1.1	0.929	<0.01
TG(mmol/L)	1.5±0.9	1.6±1.1	1.4±0.9	1.574	0.003
LDL-C( mmol/L)	2.9±0.9	3.0±1.2	2.9±0.8	0.596	<0.01
HDL-C(mmol/L)	1.2±0.5	2.2±0.8	1.2±0.4	-0.041	0.078
UA(μmol/L)	355.5±120.0	387.9±129.8	346.7±115.8	3.503	0.049
BUN(mmol/L)	5.1±3.2	6.0±5.4	4.8±2.2	2.516	<0.01
SCr(μmol/L)	73.6±23.7	85.9±29.5	70.3±20.6	6.072	<0.01

表1 两组患者人口学、基线特征

Tab.1 Comparison of demography and baseline in the two groups

指标	总人群( $n$ =695)	蛋白尿组( $n$ =148)	无蛋白尿组( $n$ =547)	$t$ /χ²值	$P$ 值
男性[例(%)]	307(44.2)	89(60.1)	218(39.9)	9.440	0.002
年龄(岁)	65.2±11.2	63.3±12.2	65.8±10.8	-2.260	0.009
BMI(kg/m²)	27.4±4.5	27.7±4.6	27.4±4.9	0.798	0.496
DM[例(%)]	80(11.5)	35(23.6)	45(8.2)	411.835	<0.01
SBP(mmHg)	158±26	163±27	157±25	2.273	0.024
DBP(mmHg)	97±16	100±18	96±15	2.375	0.018
WBC(×10⁹/L)	6.5±2.1	6.9±2.5	6.4±2.0	2.113	0.033
RBC(×10¹²/L)	5.5±0.9	5.8±1.1	5.4±0.8	4.796	<0.01
Hb(g/L)	161.6±26.3	172.8±29.9	158.6±24.4	5.310	<0.01
PLT(×10⁹/L)	232.2±66.5	222.6±74.3	234.8±64.0	-1.821	0.035
TC(mmol/L)	4.8±1.3	4.9±1.7	4.7±1.1	0.929	<0.01
TG(mmol/L)	1.5±0.9	1.6±1.1	1.4±0.9	1.574	0.003
LDL-C( mmol/L)	2.9±0.9	3.0±1.2	2.9±0.8	0.596	<0.01
HDL-C(mmol/L)	1.2±0.5	2.2±0.8	1.2±0.4	-0.041	0.078
UA(μmol/L)	355.5±120.0	387.9±129.8	346.7±115.8	3.503	0.049
BUN(mmol/L)	5.1±3.2	6.0±5.4	4.8±2.2	2.516	<0.01
SCr(μmol/L)	73.6±23.7	85.9±29.5	70.3±20.6	6.072	<0.01

表2 两组HAPC、HUA发生率比较[例(%)]

Tab.2 Comparison of the incidence of HAPC、HUA in the two groups(n[%])

组别	例数	HAPC	HUA
总人群	695	51(7.3)	228(32.8)
蛋白尿组	148	24(16.2)	63(42.6)
无蛋白尿组	547	27(4.9)	165(30.2)
$t$ /χ²值		505.970	82.188
$P$ 值		<0.01	<0.01

表2 两组HAPC、HUA发生率比较[例(%)]

Tab.2 Comparison of the incidence of HAPC、HUA in the two groups(n[%])

组别	例数	HAPC	HUA
总人群	695	51(7.3)	228(32.8)
蛋白尿组	148	24(16.2)	63(42.6)
无蛋白尿组	547	27(4.9)	165(30.2)
$t$ /χ²值		505.970	82.188
$P$ 值		<0.01	<0.01

表3 高血压患者蛋白尿的多因素Logistic回归分析

Tab.3 Multivariate Logistic regression analysis of albuminuria in hypertensive patients

指标	回归系数	标准误	χ²值	$P$ 值	$O R$ 值	95% $C I$
指标	回归系数	标准误	χ²值	$P$ 值	$O R$ 值	下限	上限
男性	0.197	0.241	0.669	0.413	1.218	0.759	1.954
年龄	-0.016	0.010	2.921	0.087	0.984	0.965	1.002
糖尿病	1.367	0.293	21.717	<0.01	3.924	2.208	6.973
SBP	0.000	0.005	0.004	0.947	1.000	0.989	1.010
DBP	0.009	0.009	1.198	0.274	1.009	0.993	1.027
WBC	0.084	0.048	3.014	0.083	1.088	0.989	1.196
PLT	-0.002	0.002	0.789	0.375	0.998	0.995	1.002
TC	0.014	0.160	0.008	0.931	1.014	0.741	1.388
TG	0.013	0.121	0.012	0.912	1.013	0.800	1.284
LDL-C	-0.052	0.219	0.057	0.811	0.949	0.618	1.457
BUN	-0.001	0.030	0.001	0.975	0.999	0.942	1.059
SCr	0.020	0.005	15.727	<0.01	1.021	1.010	1.031
HAPC	1.084	0.351	9.539	0.002	2.956	1.486	5.880
HUA	0.147	0.229	0.408	0.523	1.158	0.739	1.815
常数项	-3.285	1.150	8.164		0.037

表3 高血压患者蛋白尿的多因素Logistic回归分析

Tab.3 Multivariate Logistic regression analysis of albuminuria in hypertensive patients

指标	回归系数	标准误	χ²值	$P$ 值	$O R$ 值	95% $C I$
指标	回归系数	标准误	χ²值	$P$ 值	$O R$ 值	下限	上限
男性	0.197	0.241	0.669	0.413	1.218	0.759	1.954
年龄	-0.016	0.010	2.921	0.087	0.984	0.965	1.002
糖尿病	1.367	0.293	21.717	<0.01	3.924	2.208	6.973
SBP	0.000	0.005	0.004	0.947	1.000	0.989	1.010
DBP	0.009	0.009	1.198	0.274	1.009	0.993	1.027
WBC	0.084	0.048	3.014	0.083	1.088	0.989	1.196
PLT	-0.002	0.002	0.789	0.375	0.998	0.995	1.002
TC	0.014	0.160	0.008	0.931	1.014	0.741	1.388
TG	0.013	0.121	0.012	0.912	1.013	0.800	1.284
LDL-C	-0.052	0.219	0.057	0.811	0.949	0.618	1.457
BUN	-0.001	0.030	0.001	0.975	0.999	0.942	1.059
SCr	0.020	0.005	15.727	<0.01	1.021	1.010	1.031
HAPC	1.084	0.351	9.539	0.002	2.956	1.486	5.880
HUA	0.147	0.229	0.408	0.523	1.158	0.739	1.815
常数项	-3.285	1.150	8.164		0.037

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