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Article(id=1241102828878492163, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202405262, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1715788800000, receivedDateStr=2024-05-16, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773831572980, onlineDateStr=2026-03-18, pubDate=1724515200000, pubDateStr=2024-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773831572980, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773831572980, creator=13701087609, updateTime=1773831572980, updator=13701087609, issue=Issue{id=1241102813938380911, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='16', pageStart='2881', pageEnd='3072', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773831569418, creator=13701087609, updateTime=1773831807198, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241103811318706322, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241103811318706323, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3048, endPage=3054, ext={EN=ArticleExt(id=1241102829268562471, articleId=1241102828878492163, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Correlationstudy of H-type hypertension and chronic kidney disease, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the relationship between H-type hypertension and chronic kidney disease (CKD) and provide scientific basis for the prevention and treatment of chronic kidney disease.

Methods

From December 2021 to December 2022, 257 patients with CKD were randomly collected from the Department of Nephrology of Hunan Provincial People’s Hospital, and 257 patients were collected in the physical examination department as the control group. Data on general demographic characteristics, lifestyle habits, disease history, and clinical indicators were collected for all study subjects. The epidemic status and influencing factors of CKD, and the relationship between H-type hypertension and CKD were analyzed by univariate and multivariate analysis methods. An interaction model was constructed to analyze the interaction effect of homocysteine (Hcy) and hypertension on the onset of CKD. The effect of H-type hypertension and related influencing factors on CKD were explored by subgroup analysis.

Results

The results of univariate analysis of general demographic characteristics and clinical indicators between CKD and control groups showed: age, ethnicity, educational level, per capita income, exercise status, sleep duration, BMI, history of H-type hypertension, triglycerides (TG), High-density lipoprotein cholesterol (HDL), albumin (ALB), glomerular filtration rate (GFR), blood urea nitrogen (BUN), uric acid (UA), Hcy, total bilirubin (TBIL), direct bilirubin (DBIL), C reactive protein (CRP) levels (P<0.05). Dichotomized Logistic regression analysis showed that the risk of CKD, adjusted for age, nationality, educational level, family income, exercise, sleep duration, BMI, TG, HDL, ALB, GFR, BUN, UA, TBIL, CRP was 2.333 times higher than in those without H-type hypertension(OR=2.333, 95%CI: 1.365-3.989, P=0.002). The interaction results between hyperhomocysteinemia (HHcy) and hypertension suggested that there was a positive additive interaction between HHcy and hypertension, with no multiplicative interaction. There was an interaction between H-type hypertension and age, educational level, average annual family income, and sleep duration on the onset of CKD (P<0.05).

Conclusion

H-type hypertension is a risk factor for CKD, and there is an additive interaction between the effects of HHcy and hypertension on CKD.

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目的

探讨H型高血压与慢性肾脏病（chronic kidney disease，CKD）之间的关系，为慢性肾脏病的防治提供科学依据。

方法

2021年12月-2022年12月于湖南省人民医院肾内科随机收集CKD患者257例，体检科收集257例患者为对照组。收集所有研究对象的一般人口学特征、生活习惯、疾病史以及临床指标等数据。通过单因素及多因素分析方法分析CKD的流行现状和影响因素、H型高血压与CKD的关系。构建交互作用模型分析同型半胱氨酸（homocysteine，Hcy）、高血压对CKD发病的交互作用。通过亚组分析探索H型高血压与相关影响因素对CKD的影响。

结果

CKD组和对照组之间一般人口学特征和临床指标的单因素分析结果显示：两组的年龄、民族、文化程度、家庭人均收入、运动情况、睡眠时间、BMI、H型高血压史、甘油三酯（Triglyceride, TG）、高密度脂蛋白胆固醇（Highdensity lipoprotein cholesterol，HDL)、白蛋白（albumin，ALB）、肾小球滤过率（glomerular filtration rate，GFR）、血尿素氮（Blood urea nitrogen，BUN）、尿酸（Uric acid，UA）、Hcy、总胆红素（total bilirubin，TBIL）、直接胆红素（direct bilirubin，DBIL）、C反应蛋白（C-reactive protein，CRP）水平存在差异（P<0.05）。二分类logistic回归分析结果显示，调整调整年龄、民族、文化程度、家庭人均收入、运动情况、睡眠时间、BMI、TG、HDL、ALB、GFR、BUN、UA、TBIL、DBIL、CRP等混杂因素后，H型高血压患者发生CKD的风险是非H型高血压的2.333倍（OR=2.333，95%CI：1.365~3.989，P=0.002）。高同型半胱氨酸血症（hyperhomocysteinemia，HHcy）与高血压的交互作用结果提示：HHcy与高血压存在正向相加交互作用，无相乘交互作用。H型高血压与年龄、文化程度、家庭年均人收入、睡眠时间对CKD的发病存在交互作用（P<0.05）。

结论

H型高血压是CKD的危险因素，且HHcy和高血压对CKD的影响具有正向的协同作用。

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洪秀琴，E-mail：
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龙田瑶（1998—），女，硕士在读，研究方向：流行病与卫生统计学

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American Journal of Hypertension, 2020, 33(12): 1127-1135., articleTitle=Hyperhomocysteinemia-Induced oxidative stress aggravates renal damage in hypertensive rats, refAbstract=null)], funds=[Fund(id=1241102837581673453, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, awardId=81773530, language=CN, fundingSource=国家自然科学基金资助项目(81773530), fundOrder=null, country=null), Fund(id=1241102837661365233, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, awardId=2020JJ4047, language=CN, fundingSource=湖南省自然科学基金(2020JJ4047), fundOrder=null, country=null), Fund(id=1241102837774611446, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, awardId=22A0078, language=CN, fundingSource=湖南省教育厅(22A0078), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241102830333915803, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, xref=1., ext=[AuthorCompanyExt(id=1241102830342304413, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, companyId=1241102830333915803, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=The First Affiliated Hospital with Hunan Normal University, Changsha, Hunan 410005, China), AuthorCompanyExt(id=1241102830346498718, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, companyId=1241102830333915803, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.湖南师范大学附属第一医院，湖南 长沙 410005)]), AuthorCompany(id=1241102830472327856, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, xref=2., ext=[AuthorCompanyExt(id=1241102830484910770, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, companyId=1241102830472327856, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.湖南师范大学医学院)])], figs=[ArticleFig(id=1241102834914096025, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, language=EN, label=Fig.1, caption=Subgroup analysis of the association between type H hypertension and CKD, figureFileSmall=pJi0KLOd4vkM1zvGE1x8Qw==, figureFileBig=Ce1ejQd3lzFKIwAq0TOUag==, tableContent=null), ArticleFig(id=1241102836394685341, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, language=CN, label=图1, caption=H型高血压与CKD相关性的亚组分析。

注：调整年龄、民族、文化程度、家庭年均人收入、运动情况、睡眠时间、BMI、TG、HDL、ALB、GFR、BUN、TBIL、DBIL、UA、CRP。

, figureFileSmall=pJi0KLOd4vkM1zvGE1x8Qw==, figureFileBig=Ce1ejQd3lzFKIwAq0TOUag==, tableContent=null), ArticleFig(id=1241102836612789167, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, language=EN, label=Table 1, caption=

Univariate analysis of the factors affecting CKD

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分组CKD(%)χ2P值
对照组CKD组
性别女181(70.43)186(72.37)0.2380.626
男76(29.57)71(27.63)
年龄（岁）≤4555(21.40)49(19.07)16.7880.001
46~5538(14.79)45(17.51)
56~6577(29.96)42(16.34)
≥6687(33.85)121(47.08)
民族汉族239(93.00)249(96.89)4.0510.044
少数民族18(7.00)8(3.11)
文化程度小学及以下85(33.07)94(36.58)13.7370.003
初中57(22.18)82(31.91)
高中78(30.35)64(24.90)
大专及以上37(14.40)17(6.61)
居住地区城市155(60.31)148(57.59)0.3940.530
农村102(39.69)109(42.41)
婚姻状况单身42(16.34)48(18.68)0.4850.486
已婚215(83.66)209(81.32)
工作情况退休117(45.53)95(36.96)8.4860.075
固定工作48(18.68)40(15.56)
兼职13(5.06)13(5.06)
自由职业者27(10.51)31(12.06)
其他52(20.23)78(30.35)
家庭人均年收入（万元）≤4102(39.69)106(41.25)14.9240.001
5~698(38.13)125(48.64)
≥757(22.18)26(10.12)
运动情况不锻炼105(40.86)125(48.64)16.178<0.001
不规律锻炼70(27.24)89(34.63)
规律锻炼82(31.91)43(16.73)
睡眠时间（h/d）≤652(20.23)85(33.07)12.2270.002
7~8185(71.98)161(62.65)
≥920(7.78)11(4.28)
吸烟是82(31.91)84(32.68)0.0360.850
否175(68.09)173(67.32)
喝酒是60(23.35)54(21.01)0.4060.524
否197(76.65)203(78.99)
饮茶是97(37.74)104(40.63)0.4470.504
否160(62.26)152(59.38)
BMI(kg/m2)≤18.417(6.61)15(5.84)8.1710.043
18.5~23.9129(50.19)148(57.59)
24.0~27.984(32.68)83(32.30)
≥28.027(10.51)11(4.28)
中心性肥胖是98(38.13)86(33.46)1.2190.270
否159(61.87)171(66.54)
H型高血压是46(17.90)123(47.86)52.268<0.001
否211(82.10)134(52.14)
), ArticleFig(id=1241102836713452469, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, language=CN, label=表1, caption=

CKD影响因素的单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分组CKD(%)χ2P值
对照组CKD组
性别女181(70.43)186(72.37)0.2380.626
男76(29.57)71(27.63)
年龄（岁）≤4555(21.40)49(19.07)16.7880.001
46~5538(14.79)45(17.51)
56~6577(29.96)42(16.34)
≥6687(33.85)121(47.08)
民族汉族239(93.00)249(96.89)4.0510.044
少数民族18(7.00)8(3.11)
文化程度小学及以下85(33.07)94(36.58)13.7370.003
初中57(22.18)82(31.91)
高中78(30.35)64(24.90)
大专及以上37(14.40)17(6.61)
居住地区城市155(60.31)148(57.59)0.3940.530
农村102(39.69)109(42.41)
婚姻状况单身42(16.34)48(18.68)0.4850.486
已婚215(83.66)209(81.32)
工作情况退休117(45.53)95(36.96)8.4860.075
固定工作48(18.68)40(15.56)
兼职13(5.06)13(5.06)
自由职业者27(10.51)31(12.06)
其他52(20.23)78(30.35)
家庭人均年收入（万元）≤4102(39.69)106(41.25)14.9240.001
5~698(38.13)125(48.64)
≥757(22.18)26(10.12)
运动情况不锻炼105(40.86)125(48.64)16.178<0.001
不规律锻炼70(27.24)89(34.63)
规律锻炼82(31.91)43(16.73)
睡眠时间（h/d）≤652(20.23)85(33.07)12.2270.002
7~8185(71.98)161(62.65)
≥920(7.78)11(4.28)
吸烟是82(31.91)84(32.68)0.0360.850
否175(68.09)173(67.32)
喝酒是60(23.35)54(21.01)0.4060.524
否197(76.65)203(78.99)
饮茶是97(37.74)104(40.63)0.4470.504
否160(62.26)152(59.38)
BMI(kg/m2)≤18.417(6.61)15(5.84)8.1710.043
18.5~23.9129(50.19)148(57.59)
24.0~27.984(32.68)83(32.30)
≥28.027(10.51)11(4.28)
中心性肥胖是98(38.13)86(33.46)1.2190.270
否159(61.87)171(66.54)
H型高血压是46(17.90)123(47.86)52.268<0.001
否211(82.10)134(52.14)
), ArticleFig(id=1241102836797338556, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, language=EN, label=Table 2, caption=

Correlation between clinical indicators and CKD

, figureFileSmall=null, figureFileBig=null, tableContent=
变量CKD分组t/UP值
对照组(n=257)CKD组(n=257)
TC(mmol/L)4.62±0.914.48±1.001.7020.089
TG(mmol/L)1.63±0.861.83±0.87-2.6090.009
HDL(mmol/L)1.26±0.271.20±0.322.4960.013
LDL(mmol/L)2.73±0.752.66±0.900.9820.327
ALB(g/L)42.36±4.2841.04±5.303.1120.002
GLB(g/L)26.80±4.2926.99±4.58-0.4840.629
GFR(ml/min)93.42±21.2425.93±26.3028.171<0.001
BUN(mmol/L)5.23±2.7416.90±15.98-11.541<0.001
Scr(μmol/L)67.82±19.5567.81±48.770.0050.996
UA(μmol/L)309.76±67.28407.61±98.92-10.872<0.001
CRP(mg/L)1.77±0.822.44±1.16-1.757<0.001
TBIL(μmol/L)10.70(8.70,13.70)10.40(7.90,12.80)29 397.0000.031
DBIL(μmol/L)3.70(2.80,4.80)3.50(2.40,4.50)29 338.5000.029
IBIL(μmol/L)7.20(5.30,9.20)6.60(5.30,8.50)30 291.0000.104
TP(g/L)68.80(64.60,74.10)68.80(62.20,74.20)30 841.0000.195
ALT(U/L)17.00(12.00,25.40)19.00(13.00,25.30)29 845.5000.059
), ArticleFig(id=1241102836893807555, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, language=CN, label=表2, caption=

临床指标与CKD的相关性

, figureFileSmall=null, figureFileBig=null, tableContent=
变量CKD分组t/UP值
对照组(n=257)CKD组(n=257)
TC(mmol/L)4.62±0.914.48±1.001.7020.089
TG(mmol/L)1.63±0.861.83±0.87-2.6090.009
HDL(mmol/L)1.26±0.271.20±0.322.4960.013
LDL(mmol/L)2.73±0.752.66±0.900.9820.327
ALB(g/L)42.36±4.2841.04±5.303.1120.002
GLB(g/L)26.80±4.2926.99±4.58-0.4840.629
GFR(ml/min)93.42±21.2425.93±26.3028.171<0.001
BUN(mmol/L)5.23±2.7416.90±15.98-11.541<0.001
Scr(μmol/L)67.82±19.5567.81±48.770.0050.996
UA(μmol/L)309.76±67.28407.61±98.92-10.872<0.001
CRP(mg/L)1.77±0.822.44±1.16-1.757<0.001
TBIL(μmol/L)10.70(8.70,13.70)10.40(7.90,12.80)29 397.0000.031
DBIL(μmol/L)3.70(2.80,4.80)3.50(2.40,4.50)29 338.5000.029
IBIL(μmol/L)7.20(5.30,9.20)6.60(5.30,8.50)30 291.0000.104
TP(g/L)68.80(64.60,74.10)68.80(62.20,74.20)30 841.0000.195
ALT(U/L)17.00(12.00,25.40)19.00(13.00,25.30)29 845.5000.059
), ArticleFig(id=1241102836990276555, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, language=EN, label=Table 3, caption=

Association between type H-type hypertension and CKD in different models

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量模型1模型2模型3
OR值(95%CI)P值OR值(95%CI)P值OR值(95%CI)P值
H型高血压
否1.0001.0001.000
是3.688（2.540~5.354）<0.0013.491（2.340~5.208）<0.0012.333（1.365~3.989）0.002
), ArticleFig(id=1241102837086745554, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, language=CN, label=表3, caption=

不同模型中H型高血压与CKD的关系

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量模型1模型2模型3
OR值(95%CI)P值OR值(95%CI)P值OR值(95%CI)P值
H型高血压
否1.0001.0001.000
是3.688（2.540~5.354）<0.0013.491（2.340~5.208）<0.0012.333（1.365~3.989）0.002
), ArticleFig(id=1241102837187408853, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, language=EN, label=Table 4, caption=

Relation between Hcy, hypertension and CKD under different interaction models

, figureFileSmall=null, figureFileBig=null, tableContent=
交互类型变量对照组[n(%)]CKD组[n(%)]OR值（95%CI）aP值
相加无HHcy且无高血压110(42.80)19(7.39)1.000-
有HHcy且无高血压25(7.73)31(12.06)8.891（3.249~18.219）<0.001
无HHcy且有高血压56(21.79)63(24.51)2.512（1.373~4.596）<0.001
有HHcy且有高血压66(25.68)144(56.03)17.868（10.124~31.534）<0.001
相乘HHcy--7.476（2.737~20.421）<0.001
高血压--5.471（2.152~13.911）<0.001
HHcya高血压--0.428（0.067~1.078）0.180
), ArticleFig(id=1241102837296460763, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, language=CN, label=表4, caption=

不同交互作用模型下HHcy、高血压与CKD的关系

, figureFileSmall=null, figureFileBig=null, tableContent=
交互类型变量对照组[n(%)]CKD组[n(%)]OR值（95%CI）aP值
相加无HHcy且无高血压110(42.80)19(7.39)1.000-
有HHcy且无高血压25(7.73)31(12.06)8.891（3.249~18.219）<0.001
无HHcy且有高血压56(21.79)63(24.51)2.512（1.373~4.596）<0.001
有HHcy且有高血压66(25.68)144(56.03)17.868（10.124~31.534）<0.001
相乘HHcy--7.476（2.737~20.421）<0.001
高血压--5.471（2.152~13.911）<0.001
HHcya高血压--0.428（0.067~1.078）0.180
), ArticleFig(id=1241102837401318369, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, language=EN, label=Table 5, caption=

Estimation of the interaction coefficient between Hcy and hypertension on CKD and 95%CI

, figureFileSmall=null, figureFileBig=null, tableContent=
交互类型指标OR（95%CI）
相加RERI7.465（4.338~13.188）
API0.418（0.191~0.645）
SI1.794（1.164~2.766）
相乘IOR0.428（0.067~1.780）
), ArticleFig(id=1241102837476815846, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102828878492163, language=CN, label=表5, caption=

Hcy与高血压对CKD的交互作用系数的估计及95%CI

, figureFileSmall=null, figureFileBig=null, tableContent=
交互类型指标OR（95%CI）
相加RERI7.465（4.338~13.188）
API0.418（0.191~0.645）
SI1.794（1.164~2.766）
相乘IOR0.428（0.067~1.780）
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H型高血压与慢性肾脏病的相关性研究
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龙田瑶 1, 2 , 郑刘扬奕 1, 2 , 丁梓豪 1, 2 , 禹彤 1, 2 , 洪秀琴 1
现代预防医学 | 临床与预防 2024,51(16): 3048-3054
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现代预防医学 | 临床与预防 2024, 51(16): 3048-3054
H型高血压与慢性肾脏病的相关性研究
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龙田瑶1, 2, 郑刘扬奕1, 2, 丁梓豪1, 2, 禹彤1, 2, 洪秀琴1
作者信息
  • 1.湖南师范大学附属第一医院，湖南 长沙 410005
  • 2.湖南师范大学医学院

    • 龙田瑶（1998—），女，硕士在读，研究方向：流行病与卫生统计学

通讯作者:

洪秀琴，E-mail：
Correlationstudy of H-type hypertension and chronic kidney disease
Tian-yao LONG1, 2, Liu-yang-yi ZHENG1, 2, Zi-hao DING1, 2, Tong YU1, 2, Xiu-qin HONG1
Affiliations
  • The First Affiliated Hospital with Hunan Normal University, Changsha, Hunan 410005, China
出版时间: 2024-08-25 doi: 10.20043/j.cnki.MPM.202405262
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摘要
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目的

探讨H型高血压与慢性肾脏病（chronic kidney disease，CKD）之间的关系，为慢性肾脏病的防治提供科学依据。

方法

2021年12月-2022年12月于湖南省人民医院肾内科随机收集CKD患者257例，体检科收集257例患者为对照组。收集所有研究对象的一般人口学特征、生活习惯、疾病史以及临床指标等数据。通过单因素及多因素分析方法分析CKD的流行现状和影响因素、H型高血压与CKD的关系。构建交互作用模型分析同型半胱氨酸（homocysteine，Hcy）、高血压对CKD发病的交互作用。通过亚组分析探索H型高血压与相关影响因素对CKD的影响。

结果

CKD组和对照组之间一般人口学特征和临床指标的单因素分析结果显示：两组的年龄、民族、文化程度、家庭人均收入、运动情况、睡眠时间、BMI、H型高血压史、甘油三酯（Triglyceride, TG）、高密度脂蛋白胆固醇（Highdensity lipoprotein cholesterol，HDL)、白蛋白（albumin，ALB）、肾小球滤过率（glomerular filtration rate，GFR）、血尿素氮（Blood urea nitrogen，BUN）、尿酸（Uric acid，UA）、Hcy、总胆红素（total bilirubin，TBIL）、直接胆红素（direct bilirubin，DBIL）、C反应蛋白（C-reactive protein，CRP）水平存在差异（P<0.05）。二分类logistic回归分析结果显示，调整调整年龄、民族、文化程度、家庭人均收入、运动情况、睡眠时间、BMI、TG、HDL、ALB、GFR、BUN、UA、TBIL、DBIL、CRP等混杂因素后，H型高血压患者发生CKD的风险是非H型高血压的2.333倍（OR=2.333，95%CI：1.365~3.989，P=0.002）。高同型半胱氨酸血症（hyperhomocysteinemia，HHcy）与高血压的交互作用结果提示：HHcy与高血压存在正向相加交互作用，无相乘交互作用。H型高血压与年龄、文化程度、家庭年均人收入、睡眠时间对CKD的发病存在交互作用（P<0.05）。

结论

H型高血压是CKD的危险因素，且HHcy和高血压对CKD的影响具有正向的协同作用。

同型半胱氨酸  /  高血压  /  慢性肾脏病  /  病例对照研究  /  影响因素分析
Objective

To explore the relationship between H-type hypertension and chronic kidney disease (CKD) and provide scientific basis for the prevention and treatment of chronic kidney disease.

Methods

From December 2021 to December 2022, 257 patients with CKD were randomly collected from the Department of Nephrology of Hunan Provincial People’s Hospital, and 257 patients were collected in the physical examination department as the control group. Data on general demographic characteristics, lifestyle habits, disease history, and clinical indicators were collected for all study subjects. The epidemic status and influencing factors of CKD, and the relationship between H-type hypertension and CKD were analyzed by univariate and multivariate analysis methods. An interaction model was constructed to analyze the interaction effect of homocysteine (Hcy) and hypertension on the onset of CKD. The effect of H-type hypertension and related influencing factors on CKD were explored by subgroup analysis.

Results

The results of univariate analysis of general demographic characteristics and clinical indicators between CKD and control groups showed: age, ethnicity, educational level, per capita income, exercise status, sleep duration, BMI, history of H-type hypertension, triglycerides (TG), High-density lipoprotein cholesterol (HDL), albumin (ALB), glomerular filtration rate (GFR), blood urea nitrogen (BUN), uric acid (UA), Hcy, total bilirubin (TBIL), direct bilirubin (DBIL), C reactive protein (CRP) levels (P<0.05). Dichotomized Logistic regression analysis showed that the risk of CKD, adjusted for age, nationality, educational level, family income, exercise, sleep duration, BMI, TG, HDL, ALB, GFR, BUN, UA, TBIL, CRP was 2.333 times higher than in those without H-type hypertension(OR=2.333, 95%CI: 1.365-3.989, P=0.002). The interaction results between hyperhomocysteinemia (HHcy) and hypertension suggested that there was a positive additive interaction between HHcy and hypertension, with no multiplicative interaction. There was an interaction between H-type hypertension and age, educational level, average annual family income, and sleep duration on the onset of CKD (P<0.05).

Conclusion

H-type hypertension is a risk factor for CKD, and there is an additive interaction between the effects of HHcy and hypertension on CKD.

Homocysteine  /  Hypertension  /  Chronic kidney disease  /  Case-control study  /  Analysis of influencing factors
龙田瑶, 郑刘扬奕, 丁梓豪, 禹彤, 洪秀琴. H型高血压与慢性肾脏病的相关性研究. 现代预防医学, 2024 , 51 (16) : 3048 -3054 . DOI: 10.20043/j.cnki.MPM.202405262
Tian-yao LONG, Liu-yang-yi ZHENG, Zi-hao DING, Tong YU, Xiu-qin HONG. Correlationstudy of H-type hypertension and chronic kidney disease[J]. Modern Preventive Medicine, 2024 , 51 (16) : 3048 -3054 . DOI: 10.20043/j.cnki.MPM.202405262
正文
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慢性肾脏病（chronic kidney disease，CKD）是一种以肾脏结构功能障碍或肾小球滤过率下降为特征且难以治愈的慢性进行性疾病[1]。我国的一项流行病学显示，CKD的患病率为10.8%，患病人数高达1.32亿，位居世界首位[2]。此外，CKD还会导致心血管事件发生的增加，具有轻中度肾脏损伤的患者的死亡率及心血管事件发生率均高于正常肾脏损伤患者[3]。CKD患者的数量庞大、危害严重，给我国公共卫生系统造成了巨大负担[4]。因此，关于CKD的研究一直是肾脏疾病的重点之一。
CKD的危险因素众多，其中高血压与CKD的发生和发展之间有着密切的因果关系[5]。高血压是导致多种疾病发生、致残或致死的主要危险因素。许多研究证据表明高血压与CKD患者肾功能的减退密切相关[6]。因此，高血压的治疗对CKD患者十分重要。
在我国高血压患者中75%以上的患者伴有血浆同型半胱氨酸（Hcy）含量增高[7]。血浆Hcy浓度≥15umol/L被定义为高同型半胱氨酸血症（HHcy）。由于人体内70%的Hcy会通过肾脏排泄，因此肾脏功能与Hcy密切相关。一项研究发现随着Hcy的升高，患者肾小球滤过率下降，进而导致肾功能损害[8]。
由于人种、遗传基因等多方面因素，我国高血压患者中Hcy水平升高的现象远远高于西方国家患者[9]。因此，我国研究者首次将伴有血浆Hcy水平升高的原发性高血压定义为H型高血压[10]。H型高血压的危害远大于HHcy或高血压单独作用的效应。H型高血压患者心脑血管危险事件的风险是高血压患者的5倍，HHcy与高血压之间存在协同作用，增加心脑血管事件的风险[11]。因此，H型高血压可能也意味着高血压和高Hcy可对肾脏造成“双重伤害”。
目前关于H型高血压与慢性肾脏病的研究还很少，为了了解H型高血压与CKD的关系，本病例对照研究探索了两者的关系，为CKD的防治提供科学依据。
1　对象与方法
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1.1　研究对象
选取2021年12月—2022年12月在湖南省人民医院的肾内科住院的患者为研究对象。纳入标准：根据《KDOQI慢性肾脏病营养临床实践指南2020更新版》[12]诊断为CKD的患者。排除标准：（1）妊娠或哺乳期的女性人群；（2）近期使用可能影响血压及Hcy 水平药物的患者；（3）嗜铬细胞瘤、睡眠呼吸暂停综合征等引起的继发型高血压患者；（4）糖尿病肾病、痛风性肾病、狼疮性肾炎等明确肾脏疾病病史的患者；（5）合并器官衰竭、失代偿期的肝硬化、肾功能不全的患者。最终纳入257例CKD患者作为病例组，并从湖南省人民医院体检科随机抽取257例非CKD体检者作为对照组。本研究由湖南师范大学医学伦理委员会审查通过（2017034），所有研究对象在参与本次研究前均签署知情同意书。
1.2　研究方法
1.2.1　问卷调查
采用自制问卷对所有调查对象进行调查。调查内容包括研究对象一般人口学特征（年龄、性别、文化程度、婚姻状况）、生活习惯（运动情况、吸烟情况、饮酒情况）、既往病史（高血压史、降压药服用史）等信息。本研究将患者未婚、离异、丧偶定义为单身；根据患者一周锻炼的次数进行运动情况分组，0 次为基本不锻炼，1~3次为不规律锻炼，>3次为规律锻炼；连续或累积6个月吸烟>1支/天定义为吸烟，一周饮酒≥ 2次定义为饮酒。
1.2.2　体格检查和实验室检测
测量研究对象身高、体质量，计算体质指数（BMI）。实验室检测指标包括包括：Hcy、总胆固醇（total cholesterol，TC）、HDL、低密度脂蛋白胆固醇（Low density lipoprotein cholesterol，LDL)、TG、TBIL、DBIL、间接胆红素（indirect bilirubin，IBIL）、总蛋白（total protein，TP）、ALB、球蛋白（globulin，GLB）、UA、血肌酐（Serum creatinine，Scr）、BUN、CRP等指标。
1.3　统计学方法
数据处理及分析采用SPSS 26.0软件。符合正态分布的计量资料采用（）来描述，不符合正态分布的数据使用四分位数M（P25，P75）描述，分类资料采用率或构成比来描述。使用单因素分析方法比较病例组和对照组基线资料、生活习惯、体格检查指标、实验室检测指标之间的差异，寻找CKD的可能危险因素，其中采用t检验分析计量资料，采用非参数检验分析不符合正态分布的资料，采用卡方检验分析计数资料。采用二分类logistic回归分析H型高血压与CKD的关系。进一步构建相加交互和相乘交互模型分析HHcy、高血压对CKD的交互作用。相加交互模型采用Delta法并引入Andersson等编制的Excel表格，通过交互作用超额相对危险度（relative excess risk of interaction，RERI）、交互作用归因比（attributable ratio of interaction，API）和交互作用指数（synergy index，S）进行评价。检验水准α=0.05。
2　结果
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2.1　基本资料
本次研究选取257名CKD患者为病例组，年龄范围28~86岁，平均年龄61.23±13.14岁。257名非CKD患者为对照组，年龄范围24~81岁，平均年龄58.31±13.41岁。CKD组和对照组年龄、民族、文化程度、家庭人均收入、运动情况、睡眠时间、BMI、H型高血压史比较，差异有统计学意义（P<0.05），结果见表1。比较CKD组和对照组之间的临床指标，两组之间的TG、HDL、ALB、GFR、BUN、UA、TBIL、DBIL、CRP之间存在差异（P<0.05），结果见表2。
2.2　不同模型中H型高血压与CKD的关系
模型1以是否发生CKD（赋值：是 =1，否 =0）为因变量,以是否患H型高血压为自变量，进行二分类logistic 回归，结果显示与非H型高血压相比，患H型高血压会使CKD的患病风险升高（OR=3.688，95%CI：2.540~5.354，P<0.001）。模型2在模型1的基础上调整年龄、民族、文化程度、家庭人均收入、运动情况、睡眠时间、BMI，结果显示与非H型高血压相比，H型高血压会使CKD的患病风险升高（OR=3.491，95%CI：2.340~5.208，P<0.001）。模型3在模型2的基础上调整TG、HDL、ALB、GFR、BUN、UA、TBIL、DBIL、CRP，结果显示与非H型高血压患者相比，H型高血压仍会使CKD的患病风险升高（OR=2.333，95%CI：1.365~3.989，P=0.002）。H型高血压是CKD的危险因素，结果见表3。
2.3　HHcy和高血压对CKD的交互作用
控制混杂因素后，同时存在HHcy和高血压患CKD的风险是两者均不存在者的17.868倍(95%CI：10.124~31.534)；HHcy和高血压存在相加交互作用，即HHcy和高血压存在协同作用，该协同效应是两者单独产生效应之和的1.794倍(S=1.794, 95%CI：1.164~2.766)；两者协同作用导致患CKD的风险是其他因素所致患病风险的7.465倍(RERI=7.465, 95%CI：4.338~13.188);全部CKD患者中41.8%的病例归因于两者的协同作用(API=0.418, 95%CI: 0.191~0.645)。结果见表4、表5。
将HHcy、高血压和两者的乘积项共同纳入logistic回归分析并进行相乘交互作用分析。结果提示，HHcy和高血压对CKD的影响不存在相乘交互作用。结果见表4、表5。
2.4　H型高血压与 CKD 发病风险之间的亚组分析
亚组分析结果显示，H型高血压与文化程度、家庭年均人收入、睡眠时间对CKD的发病存在交互作用（交互作用P<0.05）。H 型高血压与年龄、民族、运动情况对CKD的发病不存在交互作用（P>0.05）。结果见图1。
3　讨论
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Hcy是一种含硫氨基酸，是蛋氨酸代谢过程中的中间产物[13]。而肾脏作为Hcy的主要代谢场所，在Hcy的代谢过程中发挥了重要的作用[14]。多项流行病学调查显示，体内Hcy水平的增高在CKD的发生过程中起到了关键作用，是CKD发生的主要危险因素之一[15]。Liu等人[16]回顾性分析了7 240名高血压患者，发现发生HHcy的患者与未发生 HHcy 的患者相比，有更高的长期肾功能下降率[17]。本研究结果同样发现，CKD 患者的Hcy水平明显高于非CKD患者。目前的实验研究发现Hcy可通过诱导氧化应激、炎症反应、低甲基化等途径促进CKD的发生发展[18]。有研究更是发现与HHcy相关的血管密度降低、血流减少和平滑肌细胞增殖增加等的肾脏血管改变是肾功能受损的原因之一[17]。
同时，高血压不仅是CKD的常见并发症之一，也是明确的 CKD 的危险因素，长期高血压会导致肾功能损害，最终将导致终末期肾病[19]。《KDOQI 慢性肾脏病营养临床实践指南 2020》[12]着重指出，控制高血压是预防 CKD 发生和发展的焦点环节。正常肾脏对由肾动脉进入的血流量有自身调节作用，在肾脏无实质性病变情况下，轻至中度高血压并不引起肾血流量的变化，但肾脏损伤合并高血压时可导肾脏自身调节能力降低，高血压可通过增加肾小球毛细血管内压力对肾产生损害作用，从而加重或加速肾小球损伤和肾脏结构的毁损[20]。
大量流行病调查显示，与欧美高血压患者相比，我国高血压患者多伴发HHcy，我国人群中可能存在Hcy敏感性基[21]。因此我国学者提出了H型高血压的概念针对此特有的这种现象进行解释[9]。HHcy 已被证明能协同高血压增加心脑血管疾病的风险，且研究者认为H型高血压可能与CKD有着密切相关性[8]。本研究通过单因素分析和多因素分析发现H型高血压是 CKD 的独立危险因素。调整协变量后H型高血压患者CKD发病的可能性是非H型高血压患者的2.333倍。一项针对12 873名27~75岁之间的H型高血压中国成年人的横断面研究中同样发现Hcy对中国H型高血压患者CKD和eGFR患病率存在影响[22]。因此在 CKD 的防治中应高度关注H型高血压的发病情况。
H型高血压是CKD的一个重要的危险因素，且高血压和HHcy两个危险因子同时存在时可对肾脏造成双重损害。一方面，高血压患者常伴有血浆hcy的升高；另一方面，HHcy可引起小动脉收缩、动脉僵硬和内皮损伤导致高血压的发生，而HHcy和高血压协同作用引起严重的肾脏损伤[8]。GAO等通过实验表明，HHcy和高血压协同作用会增强氧化应激及免疫炎症反应，破坏细胞膜结构和细胞内的信号转导，最终使肾脏结构损坏和功能下降[23]。本研究中运用流行病学的交互作用模型，对研究内容进行统计分析发现高血压与HHcy具有协同作用；且在CKD的发病中41.8%是由于高血压和HHcy两者共同作用引起的。即当高血压和HHcy同时存在时，CKD的发病风险大大提高。这提示我们在CKD的早期预防中既应该关注血压变化也要注意Hcy水平，充分认识H型高血压的双重危害，避免对CKD患者造成更严重的双重损害和较差的预后。
本研究仍存在一定局限性。首先本研究为病例对照研究，因果论证能力较弱，无法证明H型高血压与CKD的因果关系。本研究还存在一定的回忆偏倚，会对结果产生一定的影响。其次，本研究的研究对象均来自于湖南省人民医院，存在一定的选择偏倚，本研究结果只能代表本医院患者的情况，所得结论无法外推至整个人群。最后，本研究未调整相关疾病史、饮食等其他可能对研究结果有影响的相关混杂因素。
综上所述，本研究发现HHcy和高血压对CKD的影响有协同作用，当两者同时存在时会大大增加CKD的发生风险，H型高血压是CKD的危险因素。
基金
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  • 国家自然科学基金资助项目(81773530)
  • 湖南省自然科学基金(2020JJ4047)
  • 湖南省教育厅(22A0078)
文献
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2024年第51卷第16期
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doi: 10.20043/j.cnki.MPM.202405262
  • 接收时间：2024-05-16
  • 首发时间：2026-03-18
  • 出版时间：2024-08-25
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  • 收稿日期：2024-05-16
基金
国家自然科学基金资助项目(81773530)
湖南省自然科学基金(2020JJ4047)
湖南省教育厅(22A0078)
作者信息
    1.湖南师范大学附属第一医院，湖南 长沙 410005
    2.湖南师范大学医学院

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洪秀琴，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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