安庆市农村高血压患者低密度脂蛋白胆固醇与肾功能轻度下降的关系

章如山; 唐根富; 王瑞; 邹剑飞; 徐亚萍; 张旭; 陈浩; 吴谦

doi:10.16766/j.cnki.issn.1674-4152.002564

安庆市农村高血压患者低密度脂蛋白胆固醇与肾功能轻度下降的关系

doi: 10.16766/j.cnki.issn.1674-4152.002564

安徽医科大学卫生管理学院，安徽合肥 230032

基金项目:

国家自然科学基金面上项目 81773534

详细信息

通讯作者:
唐根富, E-mail: tanggenfu@163.com

中图分类号: R544.1
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- 被引次数: 0
出版历程
- 收稿日期: 2021-12-17
- 网络出版日期: 2022-09-23

The relationship between low-density lipoprotein cholesterol and mild decline of renal function in hypertensive patients of Anqing rural area

School of Health Service Management, Anhui Medical University, Hefei, Anhui 230032, China

摘要

摘要: 目的评估高血压患者血浆低密度脂蛋白胆固醇(LDL-C)与肾功能轻度下降的关系，为早期预防高血压并发慢性肾脏病提供参考。方法本研究于2020年6—9月在安庆市农村地区采用多阶段抽样方法随机抽取7个乡镇，共纳入1 959例高血压患者，获取调查对象的一般资料、血浆LDL-C水平等信息。采用logistic回归分析LDL-C与肾功能轻度下降的关系。结果 1 959例高血压患者年龄为(69.2±7.0)岁，肾功能轻度下降患者1 231例(62.8%)。调整性别等相关因素后，高血压患者LDL-C与肾功能轻度下降呈正相关，LDL-C每增加1 mmol/L，肾功能轻度下降发生的风险增加57%(OR=1.570, 95% CI: 1.359~1.813)。将LDL-C三等分，与最低三分位数(T1, ＜2.2 mmol/L)的患者比较，中三分位数(T2, 2.2~ < 2.9 mmol/L)和最高三分位数(T3, ≥2.9 mmol/L)的患者肾功能轻度下降的风险分别增加1.028倍(OR=2.028, 95% CI: 1.578~2.605)和2.721倍(OR=3.721, 95% CI: 2.814~4.920)。舒张压升高与LDL-C水平升高对增加肾功能轻度下降风险具有协同作用(舒张压＜90 mm Hg vs. ≥90 mm Hg，1 mm Hg=0.133 kPa，P_交互=0.006)。结论高血压患者LDL-C与肾功能轻度下降呈正相关关系，尤其在舒张压升高的人群中。提示控制高血压患者LDL-C和血压水平可以降低肾功能轻度下降的风险，减轻肾脏靶器官的早期损害。
- 高血压 /
- 低密度脂蛋白胆固醇 /
- 肾功能轻度下降
Abstract: Objective To evaluate the relationship between plasma low density lipoprotein cholesterol and mild decline of renal function, and provide clues for early prevention of hypertension complicated with chronic kidney disease. Methods In this study, a multi-stage random sampling method was used in seven randomly selected townships of Anqing City rural areas from June to September 2020, including 1 959 hypertensive patients. The general information and plasma low density lipoprotein cholesterol level of the subjects were obtained and logistic regression was used to analyze the relationship between LDL-C and mild decline of renal function. Results The average age of 1 959 hypertensive patients was (69.2±7.0) years, including 1 231 patients with mild renal dysfunction (62.8%). After optimizing gender and other related factors, there was a significant positive correlation between LDL-C and mild renal decline in hypertensive patients. When plasma LDL-C increased by 1 mmol/L, the risk of mild renal decline will increase 57% in patients with hypertension (OR=1.570, 95% CI: 1.359-1.813). Dividing LDL-C concentrations into 3 grades, compared with the patients with the lowest tertile of LDL-C (T1, < 2.2 mmol/L), the patients with the median tertile of LDL-C (T2, ≥2.2 and < 2.9 mmol/L) and the highest teitile of LDL-C (T3, ≥2.9 mmol/L) had a 1.028-fold (OR=2.028, 95% CI: 1.578-2.605) and 2.721-fold (OR=3.721, 95% CI: 2.814-4.920) increased risk of mild renal decline, respectively. In addition, there was a synergistic effect on increasing the risk of mild renal decline between elevated diastolic blood pressure and increased LDL-C levels (diastolic blood pressure < 90 mm Hg vs ≥ 90 mm Hg, 1 mm Hg=0.133 kPa, P for interaction=0.006). Conclusion There was a positive correlation between LDL-C and mild renal function decline in hypertensive patients, especially in those with increased diastolic blood pressure. It is suggested that controlling LDL-C and blood pressure in patients with hypertension can reduce the risk of mild renal function decline and reduce the early damage of renal target organs.
- Hypertension /
- Low density lipoprotein cholesterol /
- Mild decline in renal function

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图 1 LDL-C与肾功能轻度下降关系的曲线拟合图

Figure 1. Curve fitting diagram of the relationship between LDL-C and mild decline in renal function

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表 1 不同肾功能状态的高血压患者基本特征描述

Table 1. Basic characteristics of hypertensive patients with different renal function status

项目	总体(n=1 959)	肾功能正常(n=728)	肾功能轻度下降(n=1 231)	统计量	P值
男性[例(%)]	976(49.8)	345(47.4)	631(51.3)	2.739^a	0.098
年龄(x±s，岁)	69.2±7.0	66.0±6.4	71.1±6.7	16.735^b	< 0.001
BMI(x±s)	22.9±3.5	22.7±3.3	23.0±3.6	1.698^b	0.090
收缩压(x±s，mm Hg)	150.7±19.2	149.9±18.4	151.1±19.7	1.338^b	0.181
舒张压(x±s，mm Hg)	91.2±13.2	91.4±11.0	91.0±14.4	-0.698^b	0.485
现在吸烟[例(%)]	626(32.0)	228(31.3)	398(32.3)	0.216^a	0.642
现在饮酒[例(%)]	563(28.7)	214(29.4)	349(28.4)	0.244^a	0.621
空腹血糖(x±s，mmol/L)	5.2±1.5	5.4±1.6	5.1±1.5	-2.960^b	0.003
TC(x±s，mmol/L)	4.3±1.1	4.3±1.2	4.3±1.0	-0.173^b	0.863
TG[M(P₂₅, P₇₅), mmol/L]	1.00(0.75, 1.39)	1.03(0.73, 1.47)	0.99(0.76, 1.36)	0.321^c	0.748
HDL-C(x±s，mmol/L)	1.3±0.4	1.4±0.4	1.2±0.4	-3.695^b	< 0.001
LDL-C(x±s，mmol/L)	2.7±1.1	2.5±1.3	2.8±1.0	5.196^b	< 0.001
注：^a为χ²值, ^b为t值, ^c为Z值。

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表 2 LDL-C与肾功能轻度下降的logistic回归分析

Table 2. Logistic regression analysis of LDL-C and mild decline in renal function

变量	肾功能轻度下降[例(%)]	未调整模型					调整模型I
变量	肾功能轻度下降[例(%)]	β	SE	Wald χ²	OR(95% CI)	P值	β	SE	Wald χ²	OR(95% CI)	P值
LDL-C(mmol/L)	1 231(62.8)	0.344	0.060	32.429	1.411(1.253~1.588)	< 0.001	0.451	0.075	37.799	1.570(1.359~1.813)	< 0.001
LDL-C三分位(mmol/L)
T1(< 2.2)^a	328(50.3)
T2(2.2~＜2.9)	418(64.5)	0.585	0.113	26.592	1.795(1.437~2.242)	< 0.001	0.707	0.128	30.557	2.028(1.578~2.605)	< 0.001
T3(≥2.9)	485(73.6)	1.013	0.118	73.566	2.753(2.184~3.470)	< 0.001	1.314	0.144	84.943	3.721(2.814~4.920)	< 0.001
趋势检验P值						< 0.001					< 0.001
高LDL-C血症
否^a	1 167(62.2)
是	64(77.1)	0.716	0.266	7.271	2.046(1.216~3.444)	0.007	0.802	0.300	7.149	2.229(1.239~4.013)	0.008
注：调整模型I调整变量为性别、年龄、BMI、吸烟、饮酒、收缩压、舒张压、空腹血糖、TC、TG、HDL-C。因变量赋值：肾功能正常=0，肾功能轻度下降=1。自变量赋值为LDL-C三分位：T1=0，T2=1，T3=2；高LDL-C血症：否=0，是=1。^a为对照组。

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表 3 不同人群中LDL-C与肾功能轻度下降的关系

Table 3. The relationship between LDL-C and mildly decreased renal function in different populations

变量	肾功能轻度下降[例(%)]	模型		P值(交互)
变量	肾功能轻度下降[例(%)]	OR(95% CI)	P值	P值(交互)
性别				0.331
男性	631(64.7)	1.470(1.211~1.785)	< 0.001
女性	600(61.0)	1.694(1.371~2.083)	< 0.001
年龄(岁)				0.055
< 65	116(39.9)	1.231(0.892~1.701)	0.207
≥65	1 115(66.8)	1.645(1.411~1.918)	< 0.001
BMI				0.566
< 24	741(60.2)	1.553(1.295~1.862)	< 0.001
≥24	490(67.3)	1.643(1.288~2.097)	< 0.001
收缩压(mm Hg)				0.117
< 140	329(62.7)	1.322(1.028~1.702)	0.029
≥140	902(62.9)	1.732(1.452~2.066)	< 0.001
舒张压(mm Hg)				0.006
< 90	595(65.3)	1.351(1.107~1.650)	0.003
≥90	636(60.7)	1.858(1.512~2.283)	< 0.001
注：调整变量为性别、年龄、BMI、吸烟、饮酒、收缩压、舒张压、空腹血糖、TC、TG、HDL-C。

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