妊娠期高血压疾病患者醛固酮水平及动态血压参数对早期肾损害的预测

Aldosterone levels and ambulatory blood pressure parameters for predicting early renal damage in patients with hypertensive disorders of pregnancy

摘要

目的 探讨妊娠期高血压疾病(HDP)患者醛固酮水平及动态血压参数对早期肾损害的预测价值。方法 选取2020年12月至2023年12月安徽医科大学附属巢湖医院收治的100例HDP患者为研究对象,根据HDP严重程度情况分为HDP组(n=41)、轻度子痫前期(PE)组(n=33)和重度PE组(n=26),进一步根据肾损害分为肾损伤组(n=42)和非肾损伤组(n=58)。采用多元线性回归分析醛固酮及动态血压与早期肾功能损害的关联分析,采用多元Logistic回归分析患者早期肾损伤的影响因素;采用限制性立方样条(RCS)及阈值效应分析醛固酮与早期肾损伤的关系;构建中介效应模型分析血压在醛固酮与早期肾损害间的影响。结果 HDP组、轻度PE组、重度PE组三组患者24 h平均收缩压(24hSBP)、24 h平均舒张压(24hDBP)、白天平均收缩压(dSBP)、白天平均舒张压(dDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP)依次增高,差异有统计学意义(F值介于8.973~13.505之间,P<0.05);三组患者醛固酮、胱抑素C(Cys-C)、同型半胱氨酸(Hcy)、β2-微球蛋白(β2-MG)、尿酸(UA)、24 h尿蛋白(24 h-UTP)水平依次增高,肾小球滤过率(e-GFR)、肌酐清除率(CCR)水平依次降低(F值介于12.225~852.509之间,P<0.05);重度PE组尿素氮(BUN)水平高于HDP组,尿肌酐(UCr)水平高于HDP组及轻度PE组,差异均有统计学意义(F值分别为108.901、5.141,P<0.05);多元线性回归分析结果显示醛固酮、SBP及DBP与Cys-C、BUN、UCr、Hcy、β2-MG、UA、24 h-UTP水平呈正相关(β值介于1.562~6.010之间,P<0.05),与e-GFR、CCR水平呈负相关(β值介于-2.560~-1.030之间,P<0.05);多因素Logistic回归结果显示,SBP、DBP、Cys-C、β2-MG、24 h-UTP、醛固酮、重度PE是HDP患者发生早期肾损伤的独立危险因素(OR值介于1.677~3.669之间,P<0.05),e-GFR是保护因素(OR=0.741,P<0.05);RCS样条分析及阈值效应分析结果显示,醛固酮水平分别>22.12、>25.15、>32.45 ng/dL时,HDP及轻、重度PE患者发生早期肾损伤的概率随醛固酮的升高而增加;中介效应模型分析结果显示动态血压在醛固酮和早期肾损害之间发挥中介效应(P<0.001)。结论 醛固酮水平随妊娠期高血压疾病严重程度而增加,临床可结合动态血压监测,早诊断早治疗,降低妊娠期高血压疾病患者早期肾损伤的发生风险,有效改善患者生活质量。

Abstract

Objective To investigate the predictive value of aldosterone levels and ambulatory blood pressure parameters for early renal damage in patients with hypertensive disorders of pregnancy (HDP). Methods A total of 100 patients diagnosed with HDP who were admitted to Chaohu Hospital Affiliated to Anhui Medical University between December 2020 and December 2023 were enrolled.According to disease severity,the patients were divided into an HDP group (n=41),a mild preeclampsia (PE) group (n=33),and a severe PE group (n=26).Based on the presence of renal impairment,patients were further classified into a renal damage group (n=42) and a non-renal damage group (n=58).Multivariate linear regression analysis was used to evaluate the associations between aldosterone levels,ambulatory blood pressure parameters,and early renal function impairment.Multivariate logistic regression analysis was performed to identify independent risk factors for early renal damage.Restricted cubic spline (RCS) and threshold effect analyses were conducted to explore the relationship between aldosterone levels and early renal damage.A mediation effect model was constructed to assess the mediating role of blood pressure in the association between aldosterone and early renal damage. Results The 24-hour average systolic blood pressure (24hSBP),24-hour average diastolic blood pressure (24hDBP),average systolic blood pressure during the daytime (dSBP),average diastolic blood pressure during the daytime (dDBP),average systolic blood pressure during the night (nSBP),and average diastolic blood pressure during the night (nDBP) increased progressively across the HDP,mild PE,and severe PE groups,with statistically significant differences (F values ranging from 8.973 to 13.505,P<0.05).Levels of aldosterone,cystatin C (CysC),homocysteine (Hcy),β2-microglobulin (β2-MG),uric acid (UA),and 24-hour urinary total protein (24 h-UTP) increased sequentially among the three groups,whereas estimated glomerular filtration rate (eGFR) and creatinine clearance rate (CCR) decreased progressively (F values ranging from 12.225 to 852.509,P<0.05).Blood urea nitrogen (BUN) levels in the severe PE group were higher than those in the HDP group,and urine creatinine (UCr) levels were higher in the severe PE group than in both the HDP and mild PE groups,with statistically significant differences (F=108.901 and 5.141,respectively,P<0.05).Multivariate linear regression analysis showed that aldosterone,systolic blood pressure (SBP),and diastolic blood pressure (DBP) were positively correlated with levels of CysC,BUN,UCr,Hcy,β2-MG,UA,and 24 h-UTP (β values ranging from 1.562 to 6.010,P<0.05),and negatively correlated with eGFR and CCR (β values ranging from -2.560 to -1.030,P<0.05).Multivariate logistic regression analysis demonstrated that SBP,DBP,CysC,β2-MG,24 h-UTP,aldosterone,and severe PE were independent risk factors for early renal damage in patients with HDP (OR values ranging from 1.677 to 3.669,P<0.05),whereas eGFR was identified as a protective factor (OR=0.741,P<0.05).RCS and threshold effect analyses revealed that when aldosterone levels exceeded 22.12 ng/dL,25.15 ng/dL,and 32.45 ng/dL,respectively,the probability of early renal damage increased with rising aldosterone levels in patients with HDP,mild PE,and severe PE.Mediation analysis indicated that ambulatory blood pressure exerted a significant mediating effect in the relationship between aldosterone and early renal damage (P<0.001). Conclusion Aldosterone levels increase with the severity of hypertensive disorders of pregnancy.Combined assessment of aldosterone levels and ambulatory blood pressure monitoring may facilitate early diagnosis and intervention,reduce the risk of early renal damage in patients with HDP,and ultimately improve patients' quality of life.

关键词

妊娠期高血压 / 动态血压 / 醛固酮 / 早期肾损害 / 预测

Key words

hypertensive disorders of pregnancy / ambulatory blood pressure / aldosterone / early renal damage / predict

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