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Article(id=1241065987404002210, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241065978004557893, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202410272, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1729180800000, receivedDateStr=2024-10-18, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773822789288, onlineDateStr=2026-03-18, pubDate=1740412800000, pubDateStr=2025-02-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773822789288, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773822789288, creator=13701087609, updateTime=1773822789288, updator=13701087609, issue=Issue{id=1241065978004557893, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='4', pageStart='577', pageEnd='768', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773822787047, creator=13701087609, updateTime=1773823194927, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241067688831808347, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241065978004557893, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241067688831808348, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241065978004557893, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=756, endPage=761, ext={EN=ArticleExt(id=1241065987802461127, articleId=1241065987404002210, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between systemic inflammatory response index and albuminuria in patients with hypertension, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the relationship between the Systemic Inflammatory Response Index (SIRI) and the risk of albuminuria in hypertensive patients based on data from the National Health and Nutrition Examination Survey (NHANES).

Methods

This study utilized NHANES data from 2003 to 2018, including 5 705 hypertensive patients. Weighted logistic regression models were employed to adjust for confounding factors, and restricted cubic spline analysis was conducted to assess the correlation. Finally, subgroup analyses were performed to observe the correlation between SIRI and albuminuria in different hypertensive populations.

Results

Among the 5 705 recruited participants, 54.28% were male. The prevalence of albuminuria was 12.81%. In the multivariate logistic regression model 3 with full adjustment for confounding variables, for every one standard deviation increase in SIRI levels, there was a 20% increase in the risk of albuminuria (OR=1.20,95% CI:1.07-1.34). When SIRI was analyzed as quartiles, with Q1 serving as the reference group, Q2 (OR=1.42,95% CI:1.02-1.97), Q3 (OR=1.55,95% CI:1.13-2.11), and Q4 (OR=1.94,95% CI:1.40-2.69) all demonstrated a significant positive correlation with the risk of albuminuria. Restricted cubic spline fitting revealed a non-linear positive correlation between SIRI and albuminuria. Stratified and interaction analyses confirmed the robustness of the results.

Conclusion

SIRI levels demonstrate a non-linear positive correlation with the risk of albuminuria in hypertensive patients and represent a high-risk factor across different age groups and genders within the hypertensive population.

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目的

基于美国国家健康和营养调查数据（NHANES）探讨高血压患者中全身炎症反应指数（SIRI）与白蛋白尿风险的关系。

方法

本研究中使用NHANES 2003年至2018年的数据，纳入了5 705名高血压患者。采用加权logistic回归模型校正混杂因素、限制三次样条评估相关性，最后进行了亚组分析以观察不同高血压人群中SIRI与白蛋白尿的相关性。

结果

在招募的5 705名高血压患者中，男性占总数的54.28%。白蛋白尿的患病率为12.81%。在完全校正混杂变量的多因素logistic回归模型3中，SIRI水平每增加一个标准差，白蛋白尿的患病风险增加20%(OR=1.20,95% CI:1.07~1.34)，当SIRI作为四分位数分析时，以Q1组为参照，Q2(OR=1.42,95% CI:1.02~1.97)、Q3(OR=1.55,95% CI:1.13~2.11)、Q4(OR=1.94,95% CI:1.40~2.69)组均与白蛋白尿风险成显著正相关。限制立方样条拟合发现SIRI与白蛋白尿之间存在非线性正相关。分层和相互作用分析证实了结果的稳定性。

结论

SIRI水平与在高血压患者中与白蛋白尿风险呈非线性正相关，且在不同年龄段及性别的高血压人群中均为高危因素。

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邓辉胜；E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=uXnTzBMzvceR1dLeaEwpAQ==, magXml=IMRJYMD4o9sVPgKdPmHwCg==, pdfUrl=null, pdf=61ASBUEzNqJFRZr6y/B70Q==, pdfFileSize=722734, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=9MylvL+NEqrJWMUadziboQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=P7xZt6cK6fhNAr19KTiPgQ==, mapNumber=null, authorCompany=null, fund=null, authors=

陆豪（1999—），男，硕士在读，研究方向：高血压的慢病管理

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陆豪（1999—），男，硕士在读，研究方向：高血压的慢病管理

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BMC Nephrology, 2020, 21(1): 167., articleTitle=Kidney disease progression and all-cause mortality across estimated glomerular filtration rate and albuminuria categories among patients with vs. without type 2 diabetes, refAbstract=null), Reference(id=1241066001526223448, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, doi=null, pmid=null, pmcid=null, year=2020, volume=133, issue=6, pageStart=e269, pageEnd=e279, url=null, language=null, rfNumber=[21], rfOrder=20, authorNames=Fangel MV, Nielsen PB, Kristensen JK, journalName=American Journal of Medicine, refType=null, unstructuredReference=Fangel MV, Nielsen PB, Kristensen JK, et al. Albuminuria and risk of cardiovascular events and mortality in a general population of patients with type 2 diabetes without cardiovascular disease: a Danish cohort study[J]. 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Journal of Diabetes and Its Complications, 2018, 32(3): 291-297., articleTitle=The association between estimated glomerular filtration rate, albuminuria, and risk of cardiovascular hospitalizations and all-cause mortality among patients with type 2 diabetes, refAbstract=null), Reference(id=1241066001714967135, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, doi=null, pmid=null, pmcid=null, year=2022, volume=44, issue=7, pageStart=619, pageEnd=626, url=null, language=null, rfNumber=[23], rfOrder=22, authorNames=Yi Y, Qu T, Shi A, journalName=Clinical and Experimental Hypertension, refType=null, unstructuredReference=Yi Y, Qu T, Shi A, et al. Relationship between inflammatory cells level and longer duration of hypertension in Chinese community residents[J]. Clinical and Experimental Hypertension, 2022, 44(7): 619-626., articleTitle=Relationship between inflammatory cells level and longer duration of hypertension in Chinese community residents, refAbstract=null), Reference(id=1241066001794658915, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, doi=null, pmid=null, pmcid=null, year=2018, volume=65, issue=null, pageStart=503, pageEnd=510, url=null, language=null, rfNumber=[24], rfOrder=23, authorNames=Geng YT, Zhu DX, Wu C, journalName=International Immunopharmacology, refType=null, unstructuredReference=Geng YT, Zhu DX, Wu C, et al. A novel systemic inflammation response index (SIRI) for predicting postoperative survival of patients with esophageal squamous cell carcinoma[J]. International Immunopharmacology, 2018, 65: 503-510., articleTitle=A novel systemic inflammation response index (SIRI) for predicting postoperative survival of patients with esophageal squamous cell carcinoma, refAbstract=null), Reference(id=1241066001912099431, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, doi=null, pmid=null, pmcid=null, year=2023, volume=12, issue=3, pageStart=1128, pageEnd=null, url=null, language=null, rfNumber=[25], rfOrder=24, authorNames=Xia YY, Xia CL, Wu LD, journalName=Journal of Clinical Medicine, refType=null, unstructuredReference=Xia YY, Xia CL, Wu LD, et al. Systemic immune inflammation index (SII), system inflammation response index (SIRI) and risk ofall-cause mortality and cardiovascular mortality: a 20-year follow-up cohort study of 42,875 US adults[J]. Journal of Clinical Medicine, 2023, 12(3): 1128., articleTitle=Systemic immune inflammation index (SII), system inflammation response index (SIRI) and risk ofall-cause mortality and cardiovascular mortality: a 20-year follow-up cohort study of 42,875 US adults, refAbstract=null), Reference(id=1241066002004374122, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, doi=null, pmid=null, pmcid=null, year=2023, volume=16, issue=null, pageStart=4821, pageEnd=4832, url=null, language=null, rfNumber=[26], rfOrder=25, authorNames=Cai XT, Song SW, Hu JL, journalName=Journal of Inflammation Research, refType=null, unstructuredReference=Cai XT, Song SW, Hu JL, et al. Systemic inflammation response index as a predictor of stroke risk in elderly patients with hypertension: a cohort study[J]. Journal of Inflammation Research, 2023, 16: 4821-4832., articleTitle=Systemic inflammation response index as a predictor of stroke risk in elderly patients with hypertension: a cohort study, refAbstract=null), Reference(id=1241066002121814636, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, doi=null, pmid=null, pmcid=null, year=2023, volume=23, issue=1, pageStart=615, pageEnd=null, url=null, language=null, rfNumber=[27], rfOrder=26, authorNames=Jin N, Huang L, Hong J, journalName=BMC Cardiovascular Disorders, refType=null, unstructuredReference=Jin N, Huang L, Hong J, et al. The association between systemic inflammation markers and the prevalence of hypertension[J]. BMC Cardiovascular Disorders, 2023, 23(1): 615., articleTitle=The association between systemic inflammation markers and the prevalence of hypertension, refAbstract=null)], funds=[Fund(id=1241065997659075039, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, awardId=CYYY-PSTDXM-202406, language=CN, fundingSource=重庆医科大学第一临床学院2024年院级研究生导师团队项目(CYYY-PSTDXM-202406), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241065992835625212, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, xref=null, ext=[AuthorCompanyExt(id=1241065992844013821, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, companyId=1241065992835625212, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China), AuthorCompanyExt(id=1241065992852402430, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, companyId=1241065992835625212, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=重庆医科大学附属第一医院全科医学科，重庆 400010)])], figs=[ArticleFig(id=1241065996354646419, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, language=EN, label=Fig.1, caption=Flowchart of participant screening, figureFileSmall=YbssOQTZ+O9a2DB4umVtfQ==, figureFileBig=9MylvL+NEqrJWMUadziboQ==, tableContent=null), ArticleFig(id=1241065996484669853, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, language=CN, label=图1, caption=参与者筛选流程图, figureFileSmall=YbssOQTZ+O9a2DB4umVtfQ==, figureFileBig=9MylvL+NEqrJWMUadziboQ==, tableContent=null), ArticleFig(id=1241065996769882543, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, language=EN, label=Fig.2, caption=Association between SIRI and Risk of Proteinuria in Hypertensive Patients as Displayed by a Restricted Cubic Spline, figureFileSmall=z2eiP5DuDWjr+Zefz5VPQw==, figureFileBig=//hm0mlKA56/F8Zyya0sJw==, tableContent=null), ArticleFig(id=1241065996904100278, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, language=CN, label=图2, caption=限制性立方样条显示的SIRI与高血压患者蛋白尿发生风险的关系, figureFileSmall=z2eiP5DuDWjr+Zefz5VPQw==, figureFileBig=//hm0mlKA56/F8Zyya0sJw==, tableContent=null), ArticleFig(id=1241065997025735097, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, language=EN, label=Fig.3, caption=Weighted Analysis of Subgroups and Interactions between SIRI Index and Albuminuria, figureFileSmall=RIQJUTvk9/hcMSNnauDwOQ==, figureFileBig=exSl/eTPfi17M69y/LN3pg==, tableContent=null), ArticleFig(id=1241065997118009792, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, language=CN, label=图3, caption=SIRI指数与蛋白尿的加权亚组分析和相互作用分析, figureFileSmall=RIQJUTvk9/hcMSNnauDwOQ==, figureFileBig=exSl/eTPfi17M69y/LN3pg==, tableContent=null), ArticleFig(id=1241065997222867397, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, language=EN, label=Table 1, caption=

General analysis of the study subjects

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总数
(n=5 705)		Q1
(0.06~0.74)
(n=1 431)		Q2
(0.74~1.11)
(n=1 417)		Q3
(1.11~1.61)
(n=1 428)		Q4
(1.61~24.60)
(n=1 429)		F/H/χ2值P值
加权29 080 8456 172 3127 588 3527 465 8387 854 343
年龄 (岁,)57.89±14.9855.92±13.6557.26±14.6957.87±15.1560.52±15.9723.973<0.001
性别[n(%)]<0.001
女性2 598(45.5)809(56.5)715(50.5)608(42.6)466(32.6)184.943
男性3 107(54.5)622(43.5)702(49.5%)820(57.4)963(67.4)
种族[n(%)]510.052<0.001
墨西哥美国人674(11.8)156(10.9)164(11.6)217(15.2)137(9.6)
非西班牙裔黑种人1 331(23.3)590(41.2)319(22.5)250(17.5)172(12.0)
非西班牙裔白种人2 827(49.6)435(30.4)692(48.8)776(54.3)924(64.7)
其他种族873(15.3)250(17.5)242(17.1)185(13.0)196(13.7)
婚姻[n(%)]10.8680.092
与伴侣居住323(5.3)87(6.1)89(6.3)70(4.9)77(5.4)
已婚3 269(57.3)784(54.8)822(58.0)856(59.9)807(56.5)
单身2 113(37.0)560(39.1)506(35.7)502(35.2)545(38.1)
教育[n(%)]8.7030.194
高中1427(25.0)349(24.4)335(23.6)349(24.4)394(27.6)
高中以下1223(21.4)303(21.2)307(21.7)325(22.8)288(20.2)
高中以上3 055(53.5)779(54.4)775(54.7)754(52.8)747(52.3)
贫困收入比[n(%)]16.8320.008
<1969(17.0)259(18.1)227(16.0)251(17.6)232(16.2)
>32 313(40.5)587(41.0)592(41.8)589(41.2)545(38.1)
1~32 423(42.5)585(40.9)598(42.2)588(41.2)652(45.6)
BMI(kg/m2,)30.70±6.8130.16±6.5730.70±6.8231.09±6.6430.84±7.164.7280.003
血清肌酐(mg/L, )9.62±4.249.08±2.829.36±3.919.66±4.0510.38±5.6025.225<0.001
血清白蛋白(g/L, )41.98±3.3142.01±3.2242.14±3.1442.09±3.2741.70±3.565.0800.002
收缩压(mm Hg,)134.42±19.16134.37±18.87134.95±19.89134.64±19.54133.71±18.321.0920.351
舒张压(mm Hg,)73.08±14.4074.58±13.7873.65±14.4573.05±14.9371.05±15.213.1420.069
钠摄入量(mg,)3 329.98±1 451.493 175.96±1 393.573 338.94±1 464.793 422.34±1 490.493 383.03±1 444.987.981<0.001
酒精摄入量 (mg, )8.93±22.348.25±20.248.53±21.809.28±21.1210.46±26.702.6750.187
eGFR[ml/(min·1.73m2),]81.76±21.7183.99±20.0482.94±21.3282.07±21.6278.04±23.2820.751<0.001
糖尿病[n(%)]15.2230.021
边界214(3.8)58(4.1)55(3.9)45(3.2)56(3.9)
无4 379(76.8)1 108(77.4)1 123(79.3)1 087(76.1)1 061(74.2)
有1 112(19.5)265(18.5)239(16.9)296(20.7)312(21.8)
吸烟史[n(%)]71.201<0.001
无2 800(49.1)795(55.6)737(52.0)689(48.2)579(40.5)
有2 905(50.9)636(44.4)680(48.0)739(51.8)850(59.5)
白蛋白尿[n(%)]30.103<0.001
无4 788(83.9)1 247(87.1)1 217(85.9)1 191(83.4)1 133(79.3)
有917(16.1)184(12.9)200(14.1)237(16.6)296(20.7)
), ArticleFig(id=1241065997319336394, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241065987404002210, language=CN, label=表1, caption=

研究对象的一般情况分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总数
(n=5 705)		Q1
(0.06~0.74)
(n=1 431)		Q2
(0.74~1.11)
(n=1 417)		Q3
(1.11~1.61)
(n=1 428)		Q4
(1.61~24.60)
(n=1 429)		F/H/χ2值P值
加权29 080 8456 172 3127 588 3527 465 8387 854 343
年龄 (岁,)57.89±14.9855.92±13.6557.26±14.6957.87±15.1560.52±15.9723.973<0.001
性别[n(%)]<0.001
女性2 598(45.5)809(56.5)715(50.5)608(42.6)466(32.6)184.943
男性3 107(54.5)622(43.5)702(49.5%)820(57.4)963(67.4)
种族[n(%)]510.052<0.001
墨西哥美国人674(11.8)156(10.9)164(11.6)217(15.2)137(9.6)
非西班牙裔黑种人1 331(23.3)590(41.2)319(22.5)250(17.5)172(12.0)
非西班牙裔白种人2 827(49.6)435(30.4)692(48.8)776(54.3)924(64.7)
其他种族873(15.3)250(17.5)242(17.1)185(13.0)196(13.7)
婚姻[n(%)]10.8680.092
与伴侣居住323(5.3)87(6.1)89(6.3)70(4.9)77(5.4)
已婚3 269(57.3)784(54.8)822(58.0)856(59.9)807(56.5)
单身2 113(37.0)560(39.1)506(35.7)502(35.2)545(38.1)
教育[n(%)]8.7030.194
高中1427(25.0)349(24.4)335(23.6)349(24.4)394(27.6)
高中以下1223(21.4)303(21.2)307(21.7)325(22.8)288(20.2)
高中以上3 055(53.5)779(54.4)775(54.7)754(52.8)747(52.3)
贫困收入比[n(%)]16.8320.008
<1969(17.0)259(18.1)227(16.0)251(17.6)232(16.2)
>32 313(40.5)587(41.0)592(41.8)589(41.2)545(38.1)
1~32 423(42.5)585(40.9)598(42.2)588(41.2)652(45.6)
BMI(kg/m2,)30.70±6.8130.16±6.5730.70±6.8231.09±6.6430.84±7.164.7280.003
血清肌酐(mg/L, )9.62±4.249.08±2.829.36±3.919.66±4.0510.38±5.6025.225<0.001
血清白蛋白(g/L, )41.98±3.3142.01±3.2242.14±3.1442.09±3.2741.70±3.565.0800.002
收缩压(mm Hg,)134.42±19.16134.37±18.87134.95±19.89134.64±19.54133.71±18.321.0920.351
舒张压(mm Hg,)73.08±14.4074.58±13.7873.65±14.4573.05±14.9371.05±15.213.1420.069
钠摄入量(mg,)3 329.98±1 451.493 175.96±1 393.573 338.94±1 464.793 422.34±1 490.493 383.03±1 444.987.981<0.001
酒精摄入量 (mg, )8.93±22.348.25±20.248.53±21.809.28±21.1210.46±26.702.6750.187
eGFR[ml/(min·1.73m2),]81.76±21.7183.99±20.0482.94±21.3282.07±21.6278.04±23.2820.751<0.001
糖尿病[n(%)]15.2230.021
边界214(3.8)58(4.1)55(3.9)45(3.2)56(3.9)
无4 379(76.8)1 108(77.4)1 123(79.3)1 087(76.1)1 061(74.2)
有1 112(19.5)265(18.5)239(16.9)296(20.7)312(21.8)
吸烟史[n(%)]71.201<0.001
无2 800(49.1)795(55.6)737(52.0)689(48.2)579(40.5)
有2 905(50.9)636(44.4)680(48.0)739(51.8)850(59.5)
白蛋白尿[n(%)]30.103<0.001
无4 788(83.9)1 247(87.1)1 217(85.9)1 191(83.4)1 133(79.3)
有917(16.1)184(12.9)200(14.1)237(16.6)296(20.7)
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Multivariate Weighted Logistic Regression Model of the Association between SIRI Levels and the Risk of Proteinuria in Patients with Hypertension

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SIRI模型1模型2模型3
OR(95% CI)P值OR(95% CI)P值OR(95% CI)P值
每增加一个标准差1.25(1.14~1.36)<0.0011.29(1.17~1.43)<0.0011.20(1.07~1.34)0.002
分类
Q1参照参照参照
Q21.30(0.95~1.79)0.1021.51(1.09~2.07)0.0101.42(1.02~1.97)0.038
Q31.51(1.12~2.05)0.0081.80(1.33~2.43)<0.0011.55(1.13~2.11)0.013
Q42.07(1.55~2.76)<0.0012.56(1.88~3.48)<0.0011.94(1.40~2.69)<0.001
趋势P值<0.001<0.001<0.001
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SIRI水平与高血压患者蛋白尿发生风险关联的多元加权logistic回归模型

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SIRI模型1模型2模型3
OR(95% CI)P值OR(95% CI)P值OR(95% CI)P值
每增加一个标准差1.25(1.14~1.36)<0.0011.29(1.17~1.43)<0.0011.20(1.07~1.34)0.002
分类
Q1参照参照参照
Q21.30(0.95~1.79)0.1021.51(1.09~2.07)0.0101.42(1.02~1.97)0.038
Q31.51(1.12~2.05)0.0081.80(1.33~2.43)<0.0011.55(1.13~2.11)0.013
Q42.07(1.55~2.76)<0.0012.56(1.88~3.48)<0.0011.94(1.40~2.69)<0.001
趋势P值<0.001<0.001<0.001
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全身炎症反应指数与高血压患者白蛋白尿的关联
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陆豪 , 尹欢 , 邓辉胜
现代预防医学 | 临床与预防 2025,52(4): 756-761
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现代预防医学 | 临床与预防 2025, 52(4): 756-761
全身炎症反应指数与高血压患者白蛋白尿的关联
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陆豪, 尹欢, 邓辉胜
作者信息
  • 重庆医科大学附属第一医院全科医学科，重庆 400010

    • 陆豪（1999—），男，硕士在读，研究方向：高血压的慢病管理

通讯作者:

邓辉胜；E-mail：
Association between systemic inflammatory response index and albuminuria in patients with hypertension
Hao LU, Huan YIN, Hui-sheng DENG
Affiliations
  • The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
出版时间: 2025-02-25 doi: 10.20043/j.cnki.MPM.202410272
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摘要
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目的

基于美国国家健康和营养调查数据（NHANES）探讨高血压患者中全身炎症反应指数（SIRI）与白蛋白尿风险的关系。

方法

本研究中使用NHANES 2003年至2018年的数据，纳入了5 705名高血压患者。采用加权logistic回归模型校正混杂因素、限制三次样条评估相关性，最后进行了亚组分析以观察不同高血压人群中SIRI与白蛋白尿的相关性。

结果

在招募的5 705名高血压患者中，男性占总数的54.28%。白蛋白尿的患病率为12.81%。在完全校正混杂变量的多因素logistic回归模型3中，SIRI水平每增加一个标准差，白蛋白尿的患病风险增加20%(OR=1.20,95% CI:1.07~1.34)，当SIRI作为四分位数分析时，以Q1组为参照，Q2(OR=1.42,95% CI:1.02~1.97)、Q3(OR=1.55,95% CI:1.13~2.11)、Q4(OR=1.94,95% CI:1.40~2.69)组均与白蛋白尿风险成显著正相关。限制立方样条拟合发现SIRI与白蛋白尿之间存在非线性正相关。分层和相互作用分析证实了结果的稳定性。

结论

SIRI水平与在高血压患者中与白蛋白尿风险呈非线性正相关，且在不同年龄段及性别的高血压人群中均为高危因素。

高血压  /  全身炎症反应指数  /  白蛋白尿  /  NHANES
Objective

To investigate the relationship between the Systemic Inflammatory Response Index (SIRI) and the risk of albuminuria in hypertensive patients based on data from the National Health and Nutrition Examination Survey (NHANES).

Methods

This study utilized NHANES data from 2003 to 2018, including 5 705 hypertensive patients. Weighted logistic regression models were employed to adjust for confounding factors, and restricted cubic spline analysis was conducted to assess the correlation. Finally, subgroup analyses were performed to observe the correlation between SIRI and albuminuria in different hypertensive populations.

Results

Among the 5 705 recruited participants, 54.28% were male. The prevalence of albuminuria was 12.81%. In the multivariate logistic regression model 3 with full adjustment for confounding variables, for every one standard deviation increase in SIRI levels, there was a 20% increase in the risk of albuminuria (OR=1.20,95% CI:1.07-1.34). When SIRI was analyzed as quartiles, with Q1 serving as the reference group, Q2 (OR=1.42,95% CI:1.02-1.97), Q3 (OR=1.55,95% CI:1.13-2.11), and Q4 (OR=1.94,95% CI:1.40-2.69) all demonstrated a significant positive correlation with the risk of albuminuria. Restricted cubic spline fitting revealed a non-linear positive correlation between SIRI and albuminuria. Stratified and interaction analyses confirmed the robustness of the results.

Conclusion

SIRI levels demonstrate a non-linear positive correlation with the risk of albuminuria in hypertensive patients and represent a high-risk factor across different age groups and genders within the hypertensive population.

Hypertension  /  Systemic Inflammatory Response Index  /  Albuminuria  /  NHANES
陆豪, 尹欢, 邓辉胜. 全身炎症反应指数与高血压患者白蛋白尿的关联. 现代预防医学, 2025 , 52 (4) : 756 -761 . DOI: 10.20043/j.cnki.MPM.202410272
Hao LU, Huan YIN, Hui-sheng DENG. Association between systemic inflammatory response index and albuminuria in patients with hypertension[J]. Modern Preventive Medicine, 2025 , 52 (4) : 756 -761 . DOI: 10.20043/j.cnki.MPM.202410272
正文
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高血压是世界上最普遍的心血管疾病，2019年全球30岁至79岁成年人高血压患者约有30%[1]。高血压和肾脏疾病密不可分，其共同的病理生理特征始于胎儿在子宫内的程序化发育[2]。白蛋白尿是肾脏损伤的敏感指标，研究表明，白蛋白尿是高血压患者的不良预测因素[3]，因此，蛋白尿在高血压的诊治中具有重要意义。
炎症在高血压的发展和维持中具有关键作用[4]。研究表明，炎症失调和免疫细胞的激活与迁移后，会引起血压的升高及血管重塑等病理改变[5]。白蛋白尿与炎症反应也具有密切关系，Shahzad 等[6]发现在具有核苷酸结合寡聚化结构域样受体蛋白3（NOD-like receptor protein 3, NLRP3）功能获得突变体的足细胞特异性表达的高血糖小鼠中，肾损伤加重，白蛋白尿增加。全身炎症反应指数(Systemic immune-response index, SIRI)是一种新型的炎症指标，能反应全身炎症状态[7]，在各种心血管疾病如中风、缺血性心脏病中具有广泛的应用[8-9]。Zhao等[10] 研究发现，SIRI 水平升高与高血压患者的全因死亡率和心血管疾病死亡率增加有关。在预测慢性肾脏病及白蛋白尿时，研究发现SIRI与慢性肾脏病及白蛋白尿都呈非线性正相关[11]。目前，在高血压患者人群有关SIRI与白蛋白尿联系的研究尚不多见，因此，本研究利用2003—2018年美国国家健康与营养检查调查(National Health and Nutrition Examination Survey, NHANES)的数据，评估SIRI与高血压人群白蛋白尿之间的关系，并探讨其预测优势和潜在的诊疗指导作用。
1　对象与方法
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1.1　研究对象
本研究的数据来源于NHANES数据库。国家卫生统计中心(NCHS)伦理审查委员会批准了NHANES协议，所有参与者都知情同意将其数据用于研究。本研究使用了2003—2018年的NHANES数据，排除了缺少高血压诊断数据、年龄小于18岁、缺少尿白蛋白肌酐比值（Urine albumin creatine ratio, UACR）诊断数据或至少缺少一项协变量的数据，最终本研究纳入5 705名参与者。筛选过程流程见图1。
1.2　高血压评估
血压测量由医疗专业人员在流动检查中心使用水银血压计进行。测量是在坐姿下进行的，除非有特殊情况，否则主要使用右臂。在参与者休息5分钟后，连续测量三次血压，将这三次读数的平均值用于后续分析。高血压的定义为收缩压≥140 mm Hg，舒张压≥90 mm Hg，或自我报告的医生诊断的高血压或使用抗高血压药物[12]。
1.3　SIRI及蛋白尿测定
血细胞计数测量使用Beckman Coulter MAXM自动分析仪器(Beckman Coulter Inc.)进行。淋巴细胞、中性粒细胞、单核细胞数以×103细胞/ml为单位表达。SIRI=中性粒细胞计数×单核细胞计数/淋巴细胞计数。尿白蛋白和肌酐通过固相荧光免疫测定法和改良的Jaffe动力学方法测定，使用单个斑点尿液样本。UACR的计算方法是将尿白蛋白浓度(mg)除以尿肌酐浓度(g)来计算。白蛋白尿定义为UACR>30 mg /g[13]。
1.4　协变量的选择
年龄、种族(墨西哥裔美国人、非西班牙裔白人、非西班牙裔黑人、其他)、性别（男性/女性）、身体质量指数(BMI,kg/m2 )、婚姻状况(已婚、单身、与伴侣同居)、家庭收入与贫困比率(PIR)、教育水平(高中以下、高中、高中以上)、糖尿病史(有，没有，边缘)、酒精和钠摄入量(两次24小时饮食回忆数据的平均摄入量)、吸烟状况(一生中是否至少吸烟100支)、血清肌酐(mg/dl)、血清白蛋白(g/l)等是本研究定义的可能影响SIRI与高血压及蛋白尿的协变量。在这项研究中，PIR分为<1、1~3、>3。根据CKD流行病学协作(CKD-EPI)肌酐方程，使用有关性别、种族、年龄和SCr的数据计算每个参与者的估计肾小球滤过率[eGFR,ml/(min·1.73m2)][14]。
1.5　统计分析
根据美国疾病控制与预防中心（Centers for Disease Control and Prevention, CDC）的指南，使用wtmec2yr对数据进行加权。应用R 4.3.2软件进行数据分析处理。连续变量若符合正态分布表示为()，采用方差检验比较，否则采用M(P25,P75)进行描述，采用Kruskal-Wallis秩和检验分析,分类变量以频率和百分比表示，采用卡方检验或Fisher确切概率法进行组间比较。采用多因素加权线性回归模型评估SIRI在高血压患者中与蛋白尿之间的关系，用比值比(OR)和95%置信区间(Confidence intervals,Cl)来表示。同时，绘制限制性立方样条(Restricted cubic spline, RCS)评估SIRI在高血压患者中与蛋白尿之间非线性关系，最后通过分层分析确定SIRI与蛋白尿之间的分层关联，检验水准α=0.05。
2　结果
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2.1　参与者基线特征
5 705名NHANES高血压患者加权后共有29 080 845名全国代表性参与者，研究对象的平均年龄为55.93岁，非西班牙裔白种人是主要人群，共有917名患者出现蛋白尿，占总人数的16.07%。对象按SIRI四分位数(Q1~Q4)分组后的基线特征表见表1，年长、男性、吸烟、非西班牙裔白种人的SIRI水平更高，同时他们发生蛋白尿的风险也更高。平均收缩压、平均舒张压、酒精摄入量、婚姻状况、教育水平分布差异不具有统计学意义（P>0.05）。
2.2　SIRI水平与高血压患者蛋白尿的关系
在未调整任何可能的混杂因素的模型1中，SIRI水平每增加一个标准差，高血压患者蛋白尿发生的风险就增加25%。模型2根据性别、种族、吸烟史进行调整。模型3调整了性别、种族、吸烟史、年龄、BMI、血清肌酐、血清白蛋白、钠摄入量、家庭贫困指数、糖尿病史、估算肾小球滤过率。在模型3中，SIRI水平每增加一个标准差，高血压患者蛋白尿发生的风险就增加20%，从最低到最高SIRI类别(0.06~0.74、0.74~1.11、1.11~1.61、1.61~24.60)蛋白尿发生风险呈逐渐上升趋势(趋势性P值<0.05)(表2)。
2.3　限制性立方样条曲线分析
根据性别、种族、吸烟史、年龄、BMI、血肌酐、血清白蛋白、钠摄入量、家庭贫困指数、糖尿病史、估算肾小球滤过率校正后，限制性立方样条提示SIRI与高血压患者蛋白尿发生率之间的关系为非线性关系(非线性P值< 0.05)，见图2。随着SIRI指数的升高，蛋白尿的发生风险逐渐升高。
2.4　亚组分析
图3显示了按不同性别、年龄、种族、PIR、BMI、吸烟、糖尿病史的SIRI水平与蛋白尿发生风险分层的结果。结果发现，SIRI在性别、各年龄阶段、各PIR分层、各吸烟状况、非糖尿病患者、超重和肥胖、非西班牙黑人和白人的人群中呈正相关。所有分层分析均显示无交互作用(交互作用的P值均>0.05)。
3　讨论
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本研究结果发现，在美国高血压患者人群中，SIRI水平与蛋白尿水平呈非线性正相关，亚组分析发现在不同年龄段及性别的高血压人群中均为高危因素。蛋白尿是高血压最常见的并发症之一，是反映肾脏血流动力学及代谢紊乱的敏感指标[15]。在高血压肾损伤的机制中，慢性低度炎症、水钠潴留、交感神经和RASS系统激活以及内皮功能障碍被认为是潜在的机制[16-18]。研究表明，尿蛋白的增加在一定程度上可以预测高血压的发生，即便是正常范围内，且收缩压、舒张压、平均动脉压、脉压均随尿蛋白的增加而升高[19]。蛋白尿与死亡率之间的关联已在有和没有糖尿病的普通人群队列、无心血管疾病的糖尿病患者和其他高危人群中得到证实[20-22]。Drexler等人[3]通过对比研究，深入探讨了在不同人群及合并症背景下，蛋白尿与死亡率之间的复杂关联，结果显示，在罹患高血压及高胆固醇血症的患者群体中，蛋白尿与死亡率之间的关联性表现得尤为显著。在本研究中，SIRI水平的升高会增加蛋白尿的发生风险，提示炎症反应可能在不同程度的高血压患者中，对肾脏损害的作用存在差异。这种非线性关系可能反映了复杂的病理生理过程，包括炎症介导的血管内皮损伤、氧化应激增加以及肾单位进行性丧失等，为高血压患者的肾脏保护提供了新的视角。
既往研究发现，高血压患者外周血白细胞计数、中性粒细胞比例、中性粒细胞/淋巴细胞比值显著高于非高血压患者，炎症生物标志物在长期高血压患者中不断恶化[23]。SIRI整合了中性粒细胞、单核细胞和淋巴细胞，反映了免疫和炎症之间的相互作用[24-25]。在Cai等[26]的一项回顾性队列研究中，纳入了4749名基线时没有中风病史的老年高血压参与者，发现SIRI水平升高与老年高血压患者中风及其亚型的风险显著相关。Jin等[27]研究发现，SIRI与高血压患病率呈显著正相关。上述研究表明，SIRI与高血压及其预后密切相关。本研究发现SIRI在高血压人群中不仅普遍表现出对蛋白尿的预测价值，而且这一预测作用在男性和女性患者以及大于或小于60岁的不同年龄组中都得到了验证，显示出其作为高危因素的广泛适用性。这一发现提示全身炎症反应可能是高血压导致肾脏损害的机制之一，且不依赖于特定的性别或年龄特征。
本研究发现，在美国成年高血压人群中，SIRI与蛋白尿呈非线性正相关，这表明全身炎症反应可能是高血压导致肾脏损害的机制之一。但是本研究作为一项观察性研究，不能推断因果关系。其次，由于NHANES数据库的限制，本研究使用一次性全血细胞计数计算SIRI，并没有考虑到受试者在采血时的身体状况，如他们是否患有急性、慢性感染疾病等，这可能会导致偏倚。因此，有必要进行更多的前瞻性研究，以阐明SIRI在高血压患者蛋白尿发生中的潜在作用及机制。
基金
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  • 重庆医科大学第一临床学院2024年院级研究生导师团队项目(CYYY-PSTDXM-202406)
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doi: 10.20043/j.cnki.MPM.202410272
  • 接收时间：2024-10-18
  • 首发时间：2026-03-18
  • 出版时间：2025-02-25
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  • 收稿日期：2024-10-18
基金
重庆医科大学第一临床学院2024年院级研究生导师团队项目(CYYY-PSTDXM-202406)
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    重庆医科大学附属第一医院全科医学科，重庆 400010

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species		 占总种数比例
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total species (%)		 属
Genus		 种数
Number of
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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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