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目的了解存在多重心血管危险因素的人群中尿微量白蛋白(MA)与冠状动脉粥样硬化程度的关系。方法共入选患者208名,平均年龄为(65.4±10.6)岁,其中高血压患者149人(71.6%),冠心病患者125人(60.1%)。进行回顾性横断面研究,入选因怀疑或为排除冠心病而行冠脉造影的患者,并排除大量蛋白尿的患者。于静息状态下留取随机尿标本测白蛋白和肌酐,并计算二者之比值(ACR),ACR>30mg/g且<300mg/g判断为MA阳性。并采用修正的Gensini评分系统评价冠脉粥样硬化的严重程度。结果尿MA阳性和阴性组在年龄、性别、收缩压、糖化血红蛋白(HbA1c)、高敏C-反应蛋白(hsCRP)上的差别具有显著性。冠脉病变程度不同的患者间性别、年龄、高血压、糖尿病、高密度脂蛋白胆固醇(HDL-C)、空腹血糖、餐后2-h血糖、HbA1c、hsCRP、ACR、血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂及他汀类的使用差别有显著性。相关分析发现ACR与Gensini评分间呈显著正相关(r=0.232,P=0.001)。以Gensini评分为因变量,性别、年龄、吸烟、高血压、体重指数、腰臀比、LDL-C、HDL-C、HbA1c、hsCRP、ACR为自变量建立多元逐步线性回归模型,显示性别、ACR、LDL-C为Gensini评分的独立预测因子(B值分别为-25.0,0.3,9.2;P值分别为0.002,0.006,0.041)。结论MA与冠状动脉粥样硬化病变程度呈正相关,ACR、性别、LDL-C均为Gensini评分的独立预测因子。
Objective To investigate the relationship between urinary albumin (MA) and coronary atherosclerosis in populations with multiple cardiovascular risk factors. METHODS: A total of 208 patients were selected, with a mean age of (65.4 ± 10.6) years, of whom 149 (71.6%) were hypertensive patients and 125 (60.1%) were coronary heart disease patients. A retrospective cross-sectional study was performed in patients who had coronary angiography for suspected or exclusion of coronary heart disease and who had extensive proteinuria excluded. Urine albumin and creatinine were collected at rest and ACR> 30 mg / g and <300 mg / g were evaluated as positive for MA. The severity of coronary atherosclerosis was assessed using a modified Gensini scoring system. Results The differences of urine MA positive and negative groups in age, sex, systolic blood pressure, HbA1c and hsCRP were significant. Age, hypertension, diabetes mellitus, high-density lipoprotein cholesterol (HDL-C), fasting blood glucose, postprandial 2-h blood glucose, HbA1c, hsCRP, ACR, angiotensin converting enzyme inhibition There was a significant difference in the use of agents / angiotensin receptor blockers and statins. Correlation analysis showed a significant positive correlation between ACR and Gensini score (r = 0.232, P = 0.001). A multiple stepwise linear regression model was established with Gensini as dependent variable, sex, age, smoking, hypertension, body mass index, waist-hip ratio, LDL-C, HDL-C, HbA1c, hsCRP and ACR. Gender, ACR , LDL-C was an independent predictor of Gensini score (B values were -25.0,0.3,9.2; P values were 0.002,0.006,0.041, respectively). Conclusions MA is positively correlated with the severity of coronary atherosclerosis. ACR, sex and LDL-C are all independent predictors of Gensini score.