Abstract: Background　The risk factors associated with microalbuminuria in patients with obesity-related hypertension have been less studied except obesity. Objective　To investigate the prevalence and related risk factors of early renal damage in newly diagnosed obese hypertensive patients. Methods　From December 2015 to December 2017，a total of 456 newly diagnosed hypertensive outpatients from the First People's Hospital of Changde City were enrolled，including 111 with obesity，210 with overweight，and 135 with normal weight. The general demographic data，renal function indices，clinical blood pressure and ambulatory blood pressure as well as early renal function impairment were analyzed according to weight status.Then，a comparative analysis of clinical data of obese patients of MAU positive group and negative group was performed，and risk factors associated with microalbuminuria were identified by multivariate Logistic regression analysis. Results　There were significant differences in gender ratio，average BMI，HDL-C，TG，microalbuminuria prevalence，creatinine，uric acid，clinic systolic blood pressure（SBP） and diastolic blood pressure（DBP），24-hour SBP，daytime SBP and DBP，and nighttime SBP in obese，overweight and normal-weight groups（P<0.05）. Obese patients with microalbuminuria had higher average levels of fasting blood glucose，clinic SBP and DBP，24-hour SBP and DBP，daytime SBP and DBP，and nighttime SBP and DBP compared with those without；higher rate of decline in nighttime SBP compared with those without（P<0.05）. Multivariate Logistic regression analysis showed that fasting blood glucose〔OR（95%CI）=8.289（2.221，30.936）〕，daytime SBP〔OR（95%CI）=5.528（1.019，30.588）〕 and rate of decline in nighttime SBP〔OR（95%CI）=0.117（0.038，0.360）〕were the influencing factors of microalbuminuria in obese patients with hypertension（P<0.05）. Conclusion　Obese hypertensive patients are at high risk of early renal damage. Fasting blood glucose，daytime SBP and rate of decline in nighttime SBP are correlated with microalbuminuria.

Key words: Hypertension, Blood pressure determination, Overweight, Obesity, Renal damage, Root cause analysis

摘要： 背景　肥胖高血压患者出现尿微量白蛋白（MAU），除了肥胖本身这个因素外，其他相关的危险因素研究则较少。目的　探讨初诊肥胖高血压患者早期肾功能受损发生情况及其相关危险因素。方法　选择2015年12月—2017年12月在常德市第一人民医院门诊首次就诊的高血压患者456例，其中肥胖组111例，超重组210例，正常体质量组135例。比较三组患者一般资料、肾功能指标、诊室血压、动态血压，分析早期肾功能受损发生情况。然后将肥胖组患者依据尿微量白蛋白肌酐比值（ACR）分为MAU阳性组和阴性组，比较两组临床资料，并采用多因素Logistic回归分析肥胖患者发生MAU的影响因素。结果　肥胖、超重与体质量正常组患者性别、体质指数（BMI）、高密度脂蛋白胆固醇、三酰甘油、MAU阳性率、肌酐、尿酸、诊室收缩压和舒张压、24 h收缩压、白昼收缩压和舒张压、夜间收缩压比较，差异有统计学意义（P<0.05）。MAU阳性组肥胖患者的空腹血糖、诊室收缩压和舒张压、24 h收缩压和舒张压、白昼收缩压和舒张压、夜间收缩压和舒张压高于阴性组，夜间收缩压下降率低于阴性组，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，空腹血糖〔OR（95%CI）=8.289（2.221，30.936）〕、白昼收缩压〔OR（95%CI）=5.528（1.019，30.588）〕、夜间收缩压下降率〔OR（95%CI）=0.117（0.038，0.360）〕是肥胖高血压患者发生MAU的影响因素（P<0.05）。结论　肥胖高血压患者是早期肾功能损害的高危人群，空腹血糖、白昼收缩压和夜间收缩压下降率与肥胖高血压患者发生早期肾功能受损相关联。

关键词: 高血压, 血压测定, 超重, 肥胖症, 肾功能受损, 影响因素分析