Diagnostic Value of Cystatin C and Uric Acid for Early Renal Impairment in Kazakh Patients with H-type Hypertension

doi:10.12114/j.issn.1007-9572.2018.00.035

Abstract

Abstract: Background　Cystatin C （CysC） and uric acid （UA） are closely related to renal impairment in patients with hypertension，and have become a hot research topic in recent years.Objective　To investigate the value of CysC and UA in diagnosis of early renal impairment in Kazakh patients with H-type hypertension.Methods　A total of 318 Kazakh patients with H-type hypertension who participated in the epidemiological investigation in Xinjiang between May 2014 and August 2015 were selected randomly.According to their eGFR levels，the patients were divided into a renal function impairment group〔n=174，eGFR<90 ml?min-1?（1.73 m2）-1〕 and a normal renal function group 〔n=144，eGFR≥90 ml?min-1?（1.73 m2）-1〕.Baseline data were compared between the two groups，and the correlations among CysC，UA and eGFR were analyzed.Factors influencing early renal impairment in Kazakh patients with H-type hypertension，as well as the value of CysC and UA in diagnosis of the condition，were investigated.Results　The indicators age，systolic blood pressure（SBP），diastolic blood pressure（DBP），triglyceride（TG），low density lipoprotein cholesterol（LDL-C），blood urea nitrogen（BUN），creatinine（Cr），homocysteine（Hcy），CysC and UA were higher in the renal function impairment group than in the normal renal function group（P<0.05）.CysC and UA were negatively correlated with eGFR（r=-0.791 and -0.671，P<0.05）.Multivariate Logistic regression showed that LDL-C，CysC，and UA were influencing factors for early renal impairment in Kazakh patients with H-type hypertension（P<0.05）.The areas under the ROC curve（AUC） of CysC and UA in the diagnosis of early renal impairment in these patients were 0.967〔95%CI（0.946，0.989）〕 and 0.875〔95%CI（0.837，0.913）〕.Conclusion　CysC and UA are correlated with early renal impairment in Kazakh patients with H-type hypertension and are a favorable indicator for the diagnosis of early renal impairment.

Key words: Hypertension, Kidney injury, Kazakh, Cystatin C, Uric acid, Glomerular filtration rate

摘要： 背景　胱抑素C（CysC）、尿酸（UA）与高血压患者的肾损害密切相关，已成为近年来研究的热点。目的　探讨CysC、UA对哈萨克族H型高血压患者初期肾损害的诊断价值。方法　随机抽取2014年5月—2015年8月参与新疆地区流行病学调查的哈萨克族H型高血压患者318例为研究对象，依据估算肾小球滤过率（eGFR）将患者分为肾损害组〔n=174，eGFR<90 ml?min-1?（1.73 m2）-1〕、肾功能正常组〔n=144，eGFR≥90 ml?min-1?（1.73 m2）-1〕。比较两组患者的基线资料；分析CysC、UA与eGFR的相关性，哈萨克族H型高血压患者初期肾损害的影响因素以及CysC、UA诊断哈萨克族H型高血压患者初期肾损害的价值。结果　肾损害组患者年龄、收缩压（SBP）、舒张压（DBP）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、血尿素氮（BUN）、肌酐（Cr）、同型半胱氨酸（Hcy）、CysC、UA高于肾功能正常组（P<0.05）。CysC、UA与eGFR呈负相关（r值分别为-0.791、-0.671，P<0.05）。多因素Logistic回归分析结果显示，LDL-C、CysC、UA是哈萨克族H型高血压患者初期肾损害的影响因素（P<0.05）。CysC、UA诊断哈萨克族H型高血压患者初期肾损害的受试者工作特征曲线（ROC）曲线下面积（AUC）分别为0.967〔95%CI（0.946，0.989）〕、0.875〔95%CI（0.837，0.913）〕。结论　哈萨克H 型高血压患者 CysC、UA与初期肾损害有相关性，并对其有一定的诊断价值，可作为诊断初期肾损害的重要指标。

关键词: 高血压, 肾损害, 哈萨克族, 胱抑素C, 尿酸, 肾小球滤过率

LI Ruru,CHEN Shaoze,LIU Jingjing, et al. Diagnostic Value of Cystatin C and Uric Acid for Early Renal Impairment in Kazakh Patients with H-type Hypertension[J]. Chinese General Practice, 2019, 22(6): 664-667. DOI: 10.12114/j.issn.1007-9572.2018.00.035.
李茹茹,陈少泽,刘晶晶等. 胱抑素C和尿酸对哈萨克族H型高血压患者初期肾损害的诊断价值研究[J]. 中国全科医学, 2019, 22(6): 664-667. DOI: 10.12114/j.issn.1007-9572.2018.00.035.

References

［1］胡大一，徐西平.有效控制“H型”高血压——预防卒中的新思路［J］．中华内科杂志，2008，47（12）：976-977．DOI：10.3321/j.issn：0578-1426.2008.12.005.
［2］高向阳，杨春显，周紫燕，等．胱抑素C在原发性高血压早期肾损害诊断中的临床意义［J］．中国卫生检验杂志，2015，25（23）：4090-4091，4094.
GAO X Y，YANG C X，ZHOU Z Y，et al．The clinical significance of serum cystatin C in the diagnosis of patients with essential hypertension early renal damage［J］．Chinese Journal of Health Laboratory Technology，2015，25（23）：4090-4091，4094.
［3］莫新玲，杨锡恒，谢婷，等．H型高血压患者Hcy、Cyst-C、UACR与早期肾损害的关系［J］．广东医学，2015，36（23）：3623-3626.
MO X L，YANG X H，XIE T，et al．Relationship of homocysteine，cystain C，urinary albumin to creatinine ratio with early renal injury in H-type hypertension patients［J］．Guangdong Medical Journal，2015，36（23）：3623-3626.
［4］GUO S，PANG H，GUO H，et al．Ethnic differences in the prevalence of high homocysteine levels among low-income rural Kazakh and Uyghur adults in far western China and its implications for preventive public health［J］．Int J Environ Res Public Health，2015，12（5）：5373-5385．DOI：10.3390/ijerph120505373.
［5］中国高血压防治指南修订委员会.中国高血压防治指南2010［J］．中华高血压杂志，2011，19（8）：701-706.
Writing Group of 2010 Chinese Guidelines for the Management of Hypertension.2010 Chinese guidelines for the management of hypertension［J］．Chin J Hypertens，2011，19（8）：701-706.
［6］全国eGFR课题协作组.MDRD方程在我国慢性肾脏病患者中的改良和评估［J］．中华肾脏病杂志，2006，22（10）：589-595．DOI：10.3760/j.issn：1001-7097.2006.10.002.
Chinese eGFR Investigation Collaboration.Modification and evaluation of MDRD estimating equation for Chinese patients with chronic kidney disease［J］．Chinese Journal of Nephrology，2006，22（10）：589-595．DOI：10.3760/j.issn：1001-7097.2006.10.002.
［7］梁海峰，杨明，刘瑜，等．血浆同型半胱氨酸水平对非ST段抬高急性冠脉综合征患者围术期心肌梗死及预后的影响研究［J］．中国全科医学，2017，20（7）：823-827．DOI：10.3969/j.issn.1007-9572.2017.07.013.
LIANG H F，YANG M，LIU Y，et al．Effect of plasma homocysteine level on the myocardial infarction during perioperative period and prognosis of patients with non-ST segment elevation acute coronary syndrome［J］．Chinese General Practice，2017，20（7）：823-827．DOI：10.3969/j.issn.1007-9572.2017.07.013.
［8］ILHAN N，KUCUKSU M，KAMAN D，et al．The 677 C/T MTHFR polymorphism is associated with essential hypertension，coronary artery disease，and higher homocysteine levels［J］．Arch Med Res，2008，39（1）：125-130．DOI：10.1016/j.arcmed.2007.07.009.
［9］MALDONADO C，SONI C V，TODNEM N D，et al．Hyperhomocysteinemia and sudden cardiac death：potential arrhythmogenic mechanisms［J］．Curr Vasc Pharmacol，2010，8（1）：64-74．
［10］李瑞瑞，庞晓．血同型半胱氨酸与高血压患者脑出血的关系［J］．中华高血压杂志，2014，22（2）：181-183．
［11］左希宏，张会珍，王景俊.H型高血压与早期肾损害的相关性分析［J］．中华临床医师杂志（电子版），2015，9（7）：27-29．DOI：10.3877/cma.j.issn.1674-0785.2015.07.008.
ZUO X H，ZHANG H Z，WANG J J.Correlation analysis of H type hypertension and the early renal damage［J］．Chinese Journal of Clinicians （Electronic Edition），2015，9（7）：27-29．DOI：10.3877/cma.j.issn.1674-0785.2015.07.008.
［12］李小雷，王忠，陈少泽，等．哈萨克族H型高血压患者血清同型半胱氨酸水平与临床特征的关系［J］．山东医药，2016，56（5）：13-15．DOI：10.3969/j.issn.1002-266X.2016.05.005.
LI X L，WANG Z，CHEN S Z，et al．Serum homocysteine level in H-type hypertensive patients of Kazakh and its relationships with clinical features［J］．Shandong Pharmaceutical，2016，56（5）：13-15．DOI：10.3969/j.issn.1002-266X.2016.05.005.
［13］魏丽丽，徐新娟，珠勒皮亚?司马义，等．血清胱抑素C在高血压患者肾功能评价中的应用［J］．中华高血压杂志，2014，22（1）：79-81．DOI：10.16439/j.cnki.1673-7245.
2014.01.019.
［14］ORTUNO-ANDERIZ F，CABELLO-CLOTET N，VIDART-SIMON N，et al．Cystatin C as an early marker of acute kidney injury in septic shock［J］．Rev Clin Esp，2015，215（2）：83-90．DOI：10.1016/j.rce.2014.09.010.
［15］黄国秀，余文珊.2型糖尿病患者动态脉压与胱抑素C及尿微量蛋白的相关性［J］．广东医学，2011，32（3）：367-368．DOI：10.3969/j.issn.1001-9448.2011.03.040.
［16］刘华，林娜.高尿酸血症患者早期肾损害特点［J］．中国老年学杂志，2015，35（12）：3312-3313．DOI：10.3969/j.issn.1005-9202.2015.12.057.
［17］寇惠娟，韩振华，董新，等．高血压高尿酸血症患者与肾损害的关系［J］．陕西医学杂志，2016，45（4）：415-416．DOI：10.3969/j.issn.1000-7377.2016.04.015.
［18］KANG D H，NAKAGAWA T，FENG L，et al．A role for uric acid in the progression of renal disease［J］．J Am Soc Nephrol，2002，13（12）：2888-2897.
［19］ANAND N N，PADMA V，PRASAD A，et al．Serum uric acid in new and recent onset primary hypertension［J］．J Pharm Bioallied Sci，2015，7（Suppl 1）：S4-8．DOI：10.4103/0975-7406.155763.
［20］NAKANISHI N，OKAMOTO M，YOSHIDA H，et al．Serum uric acid and risk for development of hypertension and impaired fasting glucose or type Ⅱ diabetes in Japanese male office workers［J］．Eur J Epidemiol，2003，18（6）：523-530.

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