原发性高血压早期肾损伤尿微量白蛋白检测的临床意义

目的探讨尿微量蛋白对原发性高血压早期肾损伤检测的临床意义。方法选取正常对照组50例及原发性高血压1、2级患者97例,采用免疫透射比浊的方法进行尿微量白蛋白(MA)、尿免疫球蛋白(IgG)、尿转铁蛋白(TRF)及尿α1-微球蛋白(α1-MG)检测。结果原发性高血压患者尿微量白蛋白的阳性率均高于正常对照组,且原发性高血压2级患者尿微量白蛋白的阳性率高于原发性高血压1级患者,差异具有显著性(P<0.05)。结论原发性高血压患者早期肾功能损伤的程度和部位在尿四项微量白蛋白检测中可较早反映,其中以α1-MG和MA最敏感,为临床早期诊断及治疗提供依据。     

ELISA法检测尿微量白蛋白的临床应用与评价

目的：评价ELISA方法检测尿微量白蛋白的准确性、可靠性及其临床意义。方法：使用ELISA一步竞争法测定尿微量白蛋白，与放免法、化学发光法进行比较。结果：ELISA测定尿微量白蛋白与放免法、化学发光法测定的结果十分接近，相关系数r值分别为0．98和0．95。测定400例健康人晨尿尿微量白蛋白正常值为18μg/ml。糖尿病、高血压、冠心病患者尿微量白蛋白的检测。阳性率分别为39．2％、42．0％和36．1％。结论：ELISA法测定尿微量白蛋白具有经济、实用的特点，与化学发光法、放免法比较有良好的相关性。对于糖尿病、高血压、冠心病早期肾脏损伤的诊断以及疾病的预测具有重要意义。     

原发性高血压患者血压变异性与尿微量白蛋白/尿肌酐比值研究

目的：探讨原发性高血压患者血压变异性（BPV）与尿微量白蛋白/尿肌酐的关系。方法：103例符合入选标准的原发性高血压患者作为高血压组,并选96例健康体检者作为对照组,予24h监测动态血压、血压变异性及尿微量白蛋白,比较两组血压变异性与尿微量白蛋白/尿肌酐的关系。结果：各组患者在年龄、性别、吸烟史、总胆固醇、甘油三酯、空腹血糖以及体重指数等指标方面比较无差异性(P>0.05),高血压组患者昼间SBPV、夜间SBPV和24h SBPV均显著高于对照组(P<0.01);高血压组尿微量白蛋白、尿微量白蛋白/尿肌酐比值显著高于对照组(P<0.05)。结论：血压变异程度与尿微量白蛋白/尿肌酐具有相关性,可预测高血压早期的肾功能损害。     

血清氧化物酶及尿微量白蛋白水平与原发性高血压颈动脉粥样硬化斑块形成的关系

目的通过检测血清氧化物酶及尿微量白蛋白水平研究其对原发性高血压病人的颈动脉斑块形成的影响。方法分别检测350例原发性高血压患者及180例健康对照组血清氧化物酶及尿微量白蛋白水平,同时通过超声检测其颈动脉粥样硬化斑块形成率,研究血清氧化物酶及尿微量白蛋白水平对原发性高血压病人的颈动脉斑块形成的影响。结果350例原发性高血压受试对象经测定确认颈动脉存在硬化斑块共为102例,为29.14%。健康对照组180例中,共有颈动脉硬化斑块形成者12例,为6.67%。高血压组与正常健康对照组高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、总胆固醇（TC）、甘油三酯（TG）之间差异无统计学意义（P〉0.05）。而高血压组血浆氧化物丙二醛（MDA）、髓过氧化物酶（MPO）及尿微量白蛋白（mALB）显著高于正常健康对照组,差异有统计学意义（P〈0.05）。以尿微量白蛋白〉19.0mg/L为尿微量白蛋白阳性,尿微量白蛋白阳性高血压组共有斑块形成62例,其颈动脉粥样硬化斑块形成率为39.2%,而尿微量白蛋白阴性高血压组有颈动脉斑块形成40例,其颈动脉粥样硬化斑块形成率为20.8%,而且其MDA、MPO浓度也显著低于尿微量白蛋白阳性组,差异有统计学意义（P〈0.01）。结论高血清氧化物丙二醛、髓过氧化物酶及尿微量白蛋白可促进颈动脉粥样硬化斑块的形成。     

120例顽固性高血压合并微量白蛋白尿的疗效观察及危险因素分析

目的 回顾性分析顽固性高血压(RH)合并微量白蛋白尿的临床特点、患病率、相关危险因素,为老年RH合并微量白蛋白尿的防治提供理论依据.方法 选择120例RH患者(RH组)和100例原发性高血压非RH患者(对照组),比较两组患者的靶器官损害情况、治疗前后尿白蛋白及血脂改善情况,并对RH合并微量白蛋白尿的危险因素进行单因素和多因素分析.结果 RH组微量白蛋白尿的患病率为30.0%(36/120),对照组为19.0%(19/100).单因素分析显示,年龄、外周动脉疾病、高脂血症、肾脏疾病、冠心病与RH合并微量白蛋白尿相关;多因素分析显示,外周动脉疾病及高脂血症是RH合并微量白蛋白尿的独立危险因素(P值分别为0.010、0.020).结论 年龄、外周动脉疾病、高脂血症、肾脏疾病、冠心病是RH合并微量白蛋白尿的潜在危险因素,外周动脉疾病及高脂血症为RH合并微量白蛋白尿的独立危险因素.RH原因多样,临床医师通过合理的思维方法,可降低误诊率,配合适宜的个体化治疗,常可获得较好的疗效.     

原发性高血压患者脉搏波传导速度与尿微量白蛋白相关性研究

目的：探讨原发性高血压患者脉搏波传导速度与尿微量白蛋白之间的相关性。方法：人选在本院住院原发性高血压患者112例,同时人选在本院体检的健康人群109例,两组人群均检测脉搏波传导速度、尿微量白蛋白。比较两组人群各种临床指标,并分析脉搏波传导速度与尿微量白蛋白之间的相关性。结果：高血压组患者PwV和尿微量白蛋白分别为（9．74±1．38）m／s、（49．78±11．35）mg／L,与非高血压组的（8．36±1．49）m／s、（38．34±10．36）mg／L相比,差异具有统计学意义（P〈O．05）;高血压患者PwV与尿微量白蛋白Pearson相关分析显示,两者之间存在显著相关性（r=-O．521,P〈O．05）;尿微量白蛋白的多元线性回归显示,PwV是尿微量白蛋白的主要危险因素。结论：原发性高血压患者脉搏波传导速度与尿微量白蛋白存在显著相关性,是影响尿微量白蛋白的主要危险因素之一。     

尿MA检测在高血压肾病早期诊断中的意义

目的探讨尿微量白蛋白定量检测在高血压肾病早期诊断中的意义。方法70例原发性高血压患者根据用药情况分为问断用降压药治疗组（A组,35例）和坚持用降压药治疗组（B组,35例）,同时选取40例健康者为正常对照组（c组）。对上述观察对象分别进行24h尿微量白蛋白定量检测和尿蛋白定性检查,统计检测结果后比较两种方法的精确性。结果高血压各组尿MA定性和定量结果均明显高于健康对照组,其差异有统计学意义（P〈0．01）,且A组尿MA水平和阳性率明显较B组高（P〈0．05）。尿微量蛋白检测阳性率明显高于尿蛋白定性（p〈0．05）。结论尿微量蛋白定量检测是一种判断原发性高血压早期肾损害程度的有效方法。     

尿MA检测在高血压肾病早期诊断中的意义

目的探讨尿微量白蛋白定量检测在高血压肾病早期诊断中的意义。方法 70例原发性高血压患者根据用药情况分为间断用降压药治疗组(A组,35例)和坚持用降压药治疗组(B组,35例),同时选取40例健康者为正常对照组(C组)。对上述观察对象分别进行24h尿微量白蛋白定量检测和尿蛋白定性检查,统计检测结果后比较两种方法的精确性。结果高血压各组尿MA定性和定量结果均明显高于健康对照组,其差异有统计学意义(P<0.01),且A组尿MA水平和阳性率明显较B组高(P<0.05)。尿微量蛋白检测阳性率明显高于尿蛋白定性(P<0.05)。结论尿微量蛋白定量检测是一种判断原发性高血压早期肾损害程度的有效方法。     

尿微量白蛋白检测在早期肾损伤诊断中的临床应用研究

目的探讨尿微量白蛋白检测对高血压及糖尿病患者早期肾损伤的诊断价值。方法采用免疫透射比浊法,使用全自动生化分析仪进行尿微量白蛋白的测定,并对检测结果进行对比分析。结果高血压、糖尿病患者的尿微量白蛋白检测值和阳性率均明显高于正常健康人群,差异均有统计学意义(P<0.01)。结论尿微量白蛋白的检测是早期发现肾病最敏感、最可靠的指标,定期对高血压及糖尿病患者进行尿微量白蛋白的检测,对发现早期肾损伤有重要的诊断价值。     

尿微量蛋白分析对原发性高血压早期肾损害的诊断价值探讨

目的探讨尿微量蛋白分析对原发性高血压早期肾损害的诊断价值。方法选取来该院进行诊治的原发性高血压患者60例,同时选取60例健康体检者作为对照组,两组患者均进行尿微量白蛋白、血尿素氮、肌酐、总胆固醇等数值进行测定,分析对比两组患者的检测结果。结果经分析对比得知,分析组60例患者,出现尿微量白蛋白者52例(86.7%),对照组出现尿微量白蛋白者7例(11.7%);分析组患者的尿微量白蛋白水平明显高于对照组,两组结果比较差异具有统计学意义(P<0.05)。结论及时对高血压患者采取尿微量蛋白检测,可早期预防高血压肾损害,对治疗疾病具有一定的临床应用价值。     

老年原发性高血压合并微量白蛋白尿患者的高胰岛素血症

目的研究老年原发性高血压 (EH)合并微量白蛋白尿 (MAU)患者的胰岛素水平及胰岛素敏感性指数的变化。方法选择不伴有糖尿病及原发性肾脏疾病的老年 EH患者 60例 ,所有病人按是否合并微量白蛋白尿 ,将其分为MAU组和正常 MAU组 ,测定空腹血糖 (FBG)、胰岛素 (FINS)、血脂 ,同时计算胰岛素敏感性指数 (ISI)。结果老年 EH合并 MAU患者与不合并 MAU的 EH患者比较 ,前者伴有高胰岛素血症 ,ISI显著低于不合并 MAU患者 (P<0 .0 5)。结论老年 EH患者合并 MAU与不合并 MAU的 EH患者比较 ,前者存在高胰岛素血症和胰岛素抵抗     

老年原发性高血压合并微量白蛋白尿患者的高胰岛素血症

目的　研究老年原发性高血压 (EH)合并微量白蛋白尿 (MAU)患者的胰岛素水平及胰岛素敏感性指数的变化。方法　选择不伴有糖尿病及原发性肾脏疾病的老年EH患者 60例 ,所有病人按是否合并微量白蛋白尿 ,将其分为MAU组和正常MAU组 ,测定空腹血糖 (FBG)、胰岛素 (FINS)、血脂、胰岛素敏感性指数 (ISI) ,并进行分析。结果　老年EH患者合并MAU患者伴有高胰岛素血症 ,ISI显著低于不合并MAU患者 (P <0 .0 5)。结论　老年EH患者合并MAU时存在高胰岛素血症和胰岛素抵抗     

18～69岁人群微量白蛋白尿与体重指数的相关性研究

目的 分析18～69岁人群微量白蛋白尿（microalbuminuria,MAU）与体重指数（body mass index, BMI）的相关性。方法 在山东省和江苏省4个项目县,采用多阶段整群随机抽样的方法,抽取18～69岁调查对象进行问卷调查、体格测量和24 h尿液收集。采用多因素logistic回归分析MAU和BMI的关系。结果 最终纳入分析的2 265名研究对象24 h尿微量白蛋白为12.5（9.6～17.4）mg/d,MAU的检出率为9.0%。随着BMI水平升高,尿微量白蛋白水平和MAU检出率均呈上升趋势（P＜0.001）。多因素logistic回归分析结果显示,调整年龄、性别、教育程度、吸烟、饮酒、身体活动、高血压和糖尿病后,BMI与MAU发生相关,其中肥胖组发生MAU的风险高于正常组,OR值（95% CI）为1.76(1.19～2.60),而超重组发生MAU风险与正常组差异无统计学意义（P = 0.235）。结论 BMI与MAU发生相关,肥胖人群是MAU发生的高危人群。     

Prospective study of cataract extraction and risk of coronary heart disease in women

Oxidative damage to proteins in the human lens is believed to be important in the etiology of age-related cataract. Because free radical-mediated oxidative damage to lipoproteins may accelerate atherosclerosis, the authors hypothesized that the development of cataract might be a marker for such damage and therefore might be associated with future risk of coronary heart disease (CHD). The authors followed 60,657 women aged 45--63 years and without known coronary disease, stroke, or cancer in 1984. During 10 years of follow-up (674,283 person-years), the authors documented 887 incident cases of CHD and 2,322 deaths. After adjustment for age, smoking, and other coronary risk factors, cataract extraction was significantly associated with higher risk of CHD (relative risk (RR) = 1.88, 95% confidence interval (CI): 1.41, 2.50) for total CHD, 2.44 (95% CI: 1.54, 3.89) for fatal CHD, and 1.63 (95% CI: 1.14, 2.34) for nonfatal myocardial infarction). The positive association between cataract extraction and total CHD was stronger among women with a history of diabetes (RR = 2.80, 95% CI: 1.77, 4.42) than among those without reported diabetes (RR = 1.51, 95 percent CI: 1.04, 2.18). In multivariate analyses, cataract extraction was associated with significantly increased overall mortality (RR = 1.37, 95 percent CI: 1.13, 1.66), which was entirely explained by the increased mortality from cardiovascular disease (RR = 1.84, 95% CI: 1.29, 2.64). These findings are compatible with current hypotheses relating oxidative damage and tissue aging to the development of cataract and CHD.     

微量白蛋白尿与代谢综合征及其组分的关联性研究

目的 分析微量白蛋白尿(microalbuminuria, MAU)与代谢综合征及其组分的关系。方法 2017年,在江苏省和山东省的4个调查点开展减盐防控高血压项目终末调查,调查对象通过多阶段整群随机抽样的方式抽取,年龄为18～75岁的常住人口。通过24 h尿白蛋白测定法测算MAU,并使用logistic回归分析模型分析MAU与代谢综合征(metabolic syndrome, MS)及其组分的关联。结果 共纳入研究对象1 193名,年龄(49.4±12.6)岁,其中男性558人,占46.8%,MAU检出人数为112人,占9.4%,MS者375人,占31.4%。logistic回归分析模型校正相关混杂因素后,与非MS组相比,MS组MAU患病风险更高(OR=3.188, 95%CI:2.123～4.790),且MS各组分中心性肥胖、血压升高和GLU升高均与MAU患病风险呈正相关。在对相关因素校正后,与不具有MS组分者相比,具有3、4和5个MS组分者MAU患病风险更高(OR=4.839, 95%CI:2.134～10.976;OR=5.185, 95%CI:2.153～12.487;OR=...     

A prospective study of microalbuminuria and incident coronary heart disease and its prognostic significance in a British population: the EPIC-Norfolk study

Microalbuminuria is associated with an increased risk of cardiovascular and renal disease in patients with diabetes and hypertension. The role of microalbuminuria as a predictor of coronary heart disease (CHD) has not been examined in large general-population cohorts, and its prognostic significance in persons with established CHD is uncertain. The authors examined the relation between microalbuminuria and incident CHD (1993-2002) in a population-based British cohort of 22,368 men and women aged 40-79 years without prevalent baseline CHD and evaluated its prognostic significance in 1,596 participants with baseline CHD. Participants were members of the Norfolk, United Kingdom, component of the European Prospective Investigation into Cancer and Nutrition (the EPIC-Norfolk Study). At baseline, participants were categorized into normoalbuminuria, microalbuminuria, and macroalbuminuria groups. During an average of 6.4 years of follow-up, 800 primary CHD events were registered. The age-adjusted incidence of CHD increased significantly across ordered categories of albuminuria (4.3, 4.4, and 5.6/1,000 person-years across tertiles of normoalbuminuria, 7.1/1,000 person-years for microalbuminuria, and 12.2/1,000 person-years for macroalbuminuria; p for trend < 0.001). The multivariate hazard ratio for incident primary CHD was 1.36 (95% confidence interval (CI): 1.12, 1.64) for microalbuminuria and 1.59 (95% CI: 1.10, 2.37) for macroalbuminuria. Among participants with established baseline CHD, the independent risk of all-cause mortality associated with microalbuminuria was 1.61 (95% CI: 1.19, 2.07). Microalbuminuria may be useful in identifying persons at increased risk of CHD and subsequent death in the general population.     

Effects of an angry temperament on coronary heart disease risk : The Atherosclerosis Risk in Communities Study

The objective of the study was to determine which component of an anger-prone personality more strongly predicts coronary heart disease (CHD) risk. Proneness to anger, as assessed by the Spielberger Trait Anger Scale, is composed of two distinct subcomponents-anger-temperament and anger-reaction. Participants were 12,990 middle-aged Black men and women and White men and women from the Atherosclerosis Risk in Communities Study who were followed for the occurrence of acute myocardial infarction (MI)/fatal CHD, silent MI, or cardiac revascularization procedures (average = 53 months; maximum = 72 months) through December 31, 1995. Among normotensive persons, a strong, angry temperament (tendency toward quick, minimally provoked, or unprovoked anger) was associated with combined CHD (acute MI/fatal CHD, silent MI, or cardiac revascularization procedures) (multivariate-adjusted hazard ratio = 2.10, 95% confidence interval: 1.34, 3.29) and with 'hard" events (acute MI/fatal CHD) (multivariate adjusted hazard ratio = 2.28, 95% confidence interval: 1.29, 4.02). CHD event-free survival among normotensives who had a strong, angry temperament was not significantly different from that of hypertensives at either level of anger. These data suggest that a strong, angry temperament rather than anger in reaction to criticism, frustration, or unfair treatment places normotensive, middle-aged persons at increased risk for cardiac events and may confer a CHD risk similar to that of hypertension.     

24 h尿钠、尿钾及钠钾比与微量白蛋白尿的关联分析

  目的  分析我国普通人群24 h尿钠、尿钾以及钠钾比与微量白蛋白尿(microalbuminuria, MAU)的关系。  方法  2018年在黑龙江省、河北省、四川省、湖南省、江西省、青海省的12个区县开展基线调查,采用问卷调查、体格测量以及24 h尿液收集的方法对抽取的18~75岁对象进行调查。采用多因素logistic回归分析模型分析24 h尿钠、尿钾以及钠钾比和MAU的相关性。  结果  最后纳入分析的研究对象共2 604名,年龄为(47.32±12.78)岁,男性有1 287人(49.42%),MAU者共231人(8.87%)。24h尿量为(1 614.80±645.16)mL/d,尿钠为(193.07±78.87)mmol/d,尿钾为(40.18±16.59)mmol/d,钠钾比为(5.18±2.19)。随着24 h尿钠和钠钾比的增长,MAU的检出率均呈上升趋势(P_趋势 < 0.05)。多因素logistic回归分析模型分析结果显示,较高的24 h尿钠排泄量(Q5)与最低五分位数组(Q1)相比,MAU发生的风险增加(OR=2.211, 95% CI: 1.359~3.597)。较高的尿钠钾比水平(Q5)与最低五分位数组(Q1)相比,MAU发生的风险增加(OR=2.498,95% CI: 1.546~4.038)。  结论  24 h尿钠、钠钾比与MAU的发生呈正向关联,而24 h尿钾与MAU的发生无关。     

Meticillin-resistant Staphylococcus aureus carriage among district nurse patients and medical admissions in a UK district

We studied the prevalence of meticillin-resistant Staphylococcus aureus (MRSA) carriage in two defined community populations and assessed risk factors associated with MRSA colonization. The study was designed as a population prevalence survey and was carried out in the medical assessment unit (MAU) of the local hospital and the district nurse patient (DNP) population in Huntingdonshire. In all, 162 participants were recruited, 91 were from MAU and 71 from the DNP population. MRSA was found in 21.1% [confidence interval (CI): 11.6-30.4] of the DNP study population and 6.6% (CI 1.5-11.7) of the MAU study population. Factors found to be significantly associated with MRSA colonization were age (76.6 years, P=0.008), presence of wound/ulcer (P=0.012), hospital admission in the past year (P=0.017), past history of MRSA (P<0.001), and antibiotic use in the preceding six months (P=0.016). The only independent predictor for MRSA colonization was found to be past history of MRSA (adjusted odds ratio: 8.53; CI: 2.11-34.43; P=0.003). The DNP population are a significant reservoir for MRSA in the community and policies on screening high-risk patients need to reflect this.