Associations of microalbuminuria with brain atrophy and white matter hyperintensities in hypertensive sibships
Associations of microalbuminuria with brain atrophy and white matter hyperintensities in hypertensive sibships
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DOI：
10.1016/j.jns.2008.03.009
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发表时间：
2008-08-15
影响因子：
4.4
通讯作者：
Turner, Stephen T.
中科院分区：
文献类型：
--
作者：
Knopman, David S.;Mosley, Thomas H., Jr.;Turner, Stephen T.
背景资料：由于脑和肾微血管疾病之间的相似性，在中年或老年个体中，肾微血管疾病的测量和脑结构变化之间可能存在关系。目的：确定尿白蛋白/肌酐比（UACR），肾微血管疾病的测量，是否与脑萎缩和白色物质高信号相关。方法：作为高血压遗传学研究的一部分，我们对1253名高血压同胞进行了脑成像，并评估了微量白蛋白尿和其他血管危险因素，包括糖尿病、高血压、高脂血症和高同型半胱氨酸血症（平均年龄63.8岁，范围50至91岁; 65%为女性; 49%为非洲裔美国人; 78%为高血压）。在脑MR扫描上进行脑萎缩（BA）、脑室容积和白色高信号（WMH）的半自动定量测量。在逻辑回归模型中，UACR升高与BA升高相关，在控制人口学因素、血糖、高血压严重程度、吸烟时间和血清同型半胱氨酸后，WMH负担的OR= 1.70（95% CI 1.14，2.54）和OR=2.06（95% CI 1.37，3.10）。相反，UACR升高，肌酐升高或降低肾小球滤过率和WMH的协会是不显着的充分调整models.Conclusions：在这个队列中，高血压的过度代表性，UACR升高是独立相关的脑萎缩和白色物质高信号。脑容量减少和WMH负荷可能代表与肾硬化有共同机制的微血管疾病的表达。(C)2008 Elsevier B. V.保留所有权利。
Background: Because of similarities between brain and kidney microvascular disease, there may be a relationship between measures of renal microvascular disease and brain structural changes in middle aged or elderly individuals.Objective: To determine whether the urine albumin/creatinine ratio (UACR), a measure of renal microvascular disease, is associated with brain atrophy and white matter hyperintensities.Methods: As part of a larger study of the genetics of hypertension, we performed brain imaging and assessed microalbuminuria and other vascular risk factors including diabetes, hypertension, hyperlipidemia and hyperhomocysteinemia in 1253 individuals from hypertensive sibships (age mean 63.8 years, range 50 to 91; 65% women; 49% African-American; 78% hypertensive). Semi-automated quantitative measurements of brain atrophy (BA) ventricular volume, and white matter hyperintensities (WMH) were carried out on the brain MR scans.Results: In logistic regression models, elevated UACR was associated with greater BA (odds ratio (OR)= 1.70 (95% CI 1.14, 2.54) and burden of WMH (OR=2.06 (95% CI 1.37, 3.10) after controlling for demographic factors, blood glucose, hypertension severity, duration of smoking and serum homocysteine. In contrast to elevated UACR, the associations with elevated creatinine or reduced glomerular filtration rate and WMH were not significant in the fully adjusted models.Conclusions: In this cohort with an overrepresentation of hypertensives, elevated UACR was independently associated with both brain atrophy and white matter hyperintensities. Brain volume loss and WMH burden might represent expressions of microvascular disease that share common mechanisms with nephrosclerosis. (C) 2008 Elsevier B.V. All rights reserved.