Abstract: Background　Kidney injury is one of the most common target organ damages in essential hypertension. Early detection and intervention will possibly reverse or even eliminate underlying renal damage. Previous studies have shown that plasma renin activity（PRA）plays an important role in appropriate treatment and prognosis evaluation of essential hypertensive patients，but it is unclear whether PRA can predict early hypertensive renal damage. Objective　To investigate the relationship of PRA with early renal damage in essential hypertensive patients. Methods　A total of 1 614 Han Chinese inpatients with essential hypertension were recruited between January 2007 and October 2014 from Department of Hypertension，People's Hospital of Xinjiang Uygur Autonomous Region. Data including gender，age，BMI，course of hypertension，blood pressure，fasting blood glucose，blood lipid，plasma aldosterone（PAC），and renal function indicators（urea nitrogen，creatinine，Cyst C，24-hour urine protein，24-hour urine microalbuminuria）were compared between sitting PRA quartiles 〔low renin（Q1，<0.44 μg?L-1?h-1），medium renin 1（Q2，0.44-1.07 μg?L-1?h-1），medium renin 2（Q3，1.08 -2.36 μg?L-1?h-1）and high renin（Q4，>2.36 μg?L-1?h-1）〕. Multivariate Logistic regression was used to explore factors associated with early hypertensive renal function damage. Results　Q1 group had lower male proportion，and lower levels of mean DBP，PRA and TG，and greater mean age and ARR ratio than other groups（P<0.05）. This group also showed lower levels of mean PAC，TC and LDL-C and longer mean course of hypertension than Q3 and Q4 groups（P<0.05）. Q2 group had greater mean age and longer mean course of hypertension as well as lower mean level of PRA than Q3 group（P<0.05）. Q2 group had lower male proportion，and lower mean DBP，greater mean age and longer mean course of hypertension，lower mean PRA and PAC，and higher mean ARR ratio than Q4 group（P<0.05）. Q3 group had lower male proportion，and lower mean DBP，PRA and PAC as well as greater mean age than Q4 group（P<0.05）. Q1 group had lower mean level of creatinine than Q2 and Q3 groups（P<0.05）. Q1 group showed lower mean levels of creatinine and Cyst C than Q4 group，so did Q3 group（P<0.05）. Multivariate Logistic regression analysis showed that gender，course of hypertension，BMI，SBP，DBP and PRA level were associated with early renal damage（P<0.05）. Conclusion　In Xinjiang Han Chinese people with essential hypertension，female，overweight，longer course of hypertension，higher blood pressure and higher PRA were risk factors for early renal damage.

Key words: Essential hypertension, Plasma renin activity, Early renal damage, Cyst C, Root cause analysis

摘要： 背景　高血压肾损伤是高血压常见靶器官损害，若能及早识别并干预，有可能延缓甚至逆转肾功能损伤。有研究显示，肾素活性（PRA）对原发性高血压患者的合理治疗及预后评估有非常重要的指导价值，但PRA是否对原发性高血压早期肾功能损伤有预测作用尚不清楚。目的　探讨PRA对原发性高血压早期肾功能损伤的影响。方法　选取2007年1月—2014年10月在新疆维吾尔自治区人民医院高血压科住院的原发性高血压汉族患者1 614例为研究对象。根据所有入选患者PRA水平按四分位法将其分为低肾素组（Q1组，<0.44 μg?L-1?h-1）、等肾素1组（Q2组，0.44~1.07 μg?L-1?h-1）、等肾素2组（Q3组，1.08~2.36 μg?L-1?h-1）、高肾素组（Q4组，>2.36 μg?L-1?h-1）。收集患者性别、年龄、BMI、病程、血压、空腹血糖、肾功能、血脂、PRA、血浆醛固酮（PAC）、肾脏功能〔尿素氮、肌酐、胱抑素C（Cyst C）、24 h尿蛋白、24 h微量白蛋白〕等资料。采用多因素Logistic回归分析探讨原发性高血压患者早期肾功能损伤的影响因素。结果　Q1组男性占比、舒张压、PRA、TG小于Q2组、Q3组、Q4组，年龄、ARR比值大于Q2组、Q3组、Q4组，PAC、TC、LDL-C小于Q3组、Q4组，病程大于Q3组、Q4组（P<0.05）；Q2组男性占比、舒张压小于Q4组，年龄、病程大于Q3组、Q4组，PRA小于Q3组、Q4组，PAC小于Q4组，ARR比值大于Q4组（P<0.05）；Q3组男性占比、舒张压、PRA、PAC小于Q4组，年龄大于Q4组（P<0.05）。Q1组肌酐小于Q2组、Q3组、Q4组，Cyst C小于Q4组（P<0.05）；Q3组肌酐、Cyst C小于Q4组（P<0.05）。多因素Logistic回归分析结果显示，性别、病程、BMI、收缩压、舒张压、PRA水平是原发性高血压患者早期肾功能损伤的影响因素（P<0.05）。结论　女性、超重、病程长，血压高、高PRA是原发性高血压患者早期肾功能损伤的危险因素。

关键词: 原发性高血压, 肾素活性, 早期肾功能损伤, 胱抑素C, 影响因素分析