儿童至成年期血压累积效应与成年期亚临床肾脏损害的关系：基于汉中青少年高血压队列研究

The associations between cumulative effects of blood pressure from childhood to adulthood and adult subclinical renal damage: Hanzhong adolescent hypertension cohort study

    摘要
  • 摘要: 目的 探讨从儿童到成人血压的累积效应及纵向趋势与远期亚临床肾脏损害（SRD）的关系。方法 1987年对陕西汉中农村6～15岁在校学生进行身高、体质量、血压等基线调查，并于1989、1992、1995、2005、2013及2017年进行跟踪随访。本研究共纳入了1 553名从基线开始至少接受了4次检查的个体，且于随访期进行了血尿生化指标等检测。使用随机效应模型拟合个体的收缩压及舒张压增长曲线，用曲线下面积（AUC）计算血压的累积效应及纵向趋势。笔者分别确定了收缩压及舒张压总AUC及增量AUC四分位数，并将第四分位数作为高的收缩压/舒张压累积效应组及高的收缩压/舒张压纵向趋势组。使用估算的肾小球滤过率（eGFR）和尿微量白蛋白与肌酐比值（UACR）评估肾功能。采用多因素logistic回归分析血压的累积效应及纵向趋势与远期SRD的关系。结果 血压累积效应较高组发生远期SRD的比例明显高于正常组（收缩压：20.6%比10.3%,χ2=27.619,P<0.001;舒张压：22.2%比9.8%,χ2=39.757,P<0.001）;血压纵向趋势较高组发生远期SRD的比例也高于正常组（收缩压：17.8%比11.2%,χ2=11.092,P=0.001;舒张压：19.1%比10.8%,χ2=17.685,P<0.001）。多因素logistic回归结果显示，校正性别、年龄、体质量指数（BMI）、空腹血糖、血脂、尿酸、肌酐等混杂因素后，血压累积效应较高组发生远期SRD的风险显著高于正常组（收缩压：OR=2.07,95%CI 1.45～2.96,P<0.001;舒张压：OR=2.25,95%CI 1.59～3.19,P<0.001）;血压纵向趋势较高组发生远期SRD的风险亦显著高于正常组（收缩压：OR=1.43,95%CI 1.00～2.05,P=0.049;舒张压：OR=1.50,95%CI 1.05～2.13,P=0.026）。结论 从儿童到成人血压的累积效应及纵向趋势会显著增加成人SRD的风险。从儿童时期开始监测和控制血压对于远期肾脏健康具有重要意义。

     

    Abstract: Objective To investigate the effect of cumulative effects and longitudinal trends of blood pressure（BP） from childhood to adulthood on adult subclinical renal damage（SRD）. Methods A baseline survey on height, weight and BP of 6-15 years old school students in Hanzhong, Shaanxi, was conducted in 1987. Follow-up was conducted in 1989, 1992, 1995, 2005, 2013 and 2017. A total of 1 553 individuals who had been followed at least four times since baseline were included in the study. Blood and urine biochemical indexes were detected during the follow-up period. Growth curves of systolic blood pressure（SBP） and diastolic blood pressure（DBP） were constructed using a random-effects model. The cumulative effect and longitudinal trend of BP were evaluated by area under curve（AUC）. The total and incremental AUC quartiles of SBP and DBP respectively were determined. The fourth quartile of SBP/DBP was identified as high cumulative effects or high longitudinal trends. Renal function was assessed with estimated glomerular filtration rate（eGFR） and urine albumin-to-creatinine ratio（UACR）. The logistic regression analysis was used to analyze the relationships between cumulative effects or longitudinal trends of BP and adult SRD. Results The proportion of adult SRD in the groups with high BP cumulative effects or longitudinal trends was significantly higher than that in the normal group（cumulative effects: SBP 20.6% vs 10.3%, χ~2=27.619, P＜0.001 and DBP 22.2% vs 9.8%, χ~2=39.757, P＜0.001; longitudinal trends: SBP 17.8% vs 11.2%, χ~2=11.092, P=0.001 and DBP 19.1% vs 10.8%, χ~2=17.685, P＜0.001）. Multivariate logistic regression showed that the risk of adult SRD in the group with high BP cumulative effects（SBP: OR=2.07, 95%CI 1.45-2.96, P＜0.001; DBP: OR=2.25, 95%CI 1.59-3.19, P＜0.001） or high BP longitudinal trends（SBP: OR=1.43, 95%CI 1.00-2.05, P=0.049; DBP: OR=1.50, 95%CI 1.05-2.13, P=0.026） was significantly higher than that in the normal group, after adjusting for gender, age, body mass index, blood glucose, blood lipid, uric acid and other confounding factors. Conclusions The cumulative effects and longitudinal trends of BP from children to adults significantly increase the risk of adult SRD. Monitoring and controlling blood pressure from childhood is important for long-term kidney health.

     

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