原发性高血压患者微量白蛋白尿与无症状性脑血管损害的研究

目的探讨原发性高血压(EH)患者微量白蛋白尿(MAU)与无症状性脑血管损害及颈动脉粥样硬化的关系。方法根据24h尿蛋白滤过率(UAER)测定结果,将162例EH患者分为正常白蛋白尿(NAU)组101例和MAU组61例。应用高频多普勒超声检测颈动脉内膜中层厚度(IMT)及颈动脉粥样硬化斑块;头颅MRI评价腔隙性脑梗死。采用logistic回归分析颈动脉IMT增厚和腔隙性脑梗死相关的危险因素。结果162例EH患者中MAU的阳性率为37.7%;与NAU组比较,MAU组颈动脉IMT明显增厚(1.00±0.26)mmvs(0.86±0.20)mm,P<0.01],腔隙性脑梗死的发生率明显增高(62.3%vs44.6%,P<0.05);MAU与颈动脉IMT增厚及腔隙性脑梗死的发生独立相关(OR=2.639,95%CI:1.240～5.615,P<0.05及OR=2.369,95%CI:1.156～4.856,P<0.05)。结论MAU是高血压患者发生腔隙性脑梗死和颈动脉IMT增厚的一个预测指标,可作为判断无症状性脑血管损害及颈动脉粥样硬化的早期指标。

Study of microalbuminuria and asymptomatic cerebrovascular damage in patients with essential hypertension

Objective To explore the relationship between microalbuminuria(MAU) and asymptomatic cerebrovascular damage and carotid atherosclerosis in patients with essential hypertension(EH).Methods According to 24-hour urine albumin excretion rate(UAER),162 patients were divided into two groups:normal albuminuria group(NAU) and MAU group.Carotid intima-media thickness(IMT) and atherosclerotic plaque were measured by high-frequency Doppler ultrasound,lacunar infarction was assessed by MRI.Logistic regression analysis was used to identify the risk factors concerned with thickening of carotid IMT and incidence of lacunar infarction.Results The prevalence of MAU in 162 patients was 37.7%.Compared with NAU group,carotid IMT was significantly thicker (1.00±0.26) mm vs(0.86±0.20) mm,P< 0.01 ] and the incidence of lacunar infarction(62.3% vs 44.6%,P<0.05) was significantly higher in MAU group.Logistic regression analysis showed that MAU was independently associated with the thickening of carotid IMT and lacunar infarction,the OR was 2.639(95%CI:1.240-5.615,P<0.05) and 2.369(95%CI:1.156-4.856,P<0.05) respectively when other risk factors were controlled.Conclusion MAU is an indicator for lacunar infarction and thickening of carotid IMT,and can be used as an early index to identify asymptomatic cerebrovascular damage and carotid atherosclerosis.