Urine albumin-to-creatinine ratio and asymptomatic intracranial atherosclerotic stenosis in hypertensive patients
Urine albumin-to-creatinine ratio and asymptomatic intracranial atherosclerotic stenosis in hypertensive patients
复制标题
高血压患者尿白蛋白/肌酐比值与无症状颅内动脉粥样硬化性狭窄
DOI：
10.1038/s41371-019-0201-3
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发表时间：
2019-06-01
影响因子：
2.7
通讯作者：
Zhu, Dingliang
中科院分区：
文献类型：
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作者：
An, Dewei;Wang, Yan;Zhu, Dingliang
颅内动脉粥样硬化性狭窄（ICAS）是我国近50%脑卒中的病因，尤其是高血压患者。尿白蛋白与肌酐比值（ACR）与脑卒中和其他动脉粥样硬化性心血管疾病有关。然而，关于ACR与脑血管早期损伤的关系的信息有限。因此，我们评估了无卒中高血压人群中ICAS与ACR、估计肾小球滤过率（eGFR）和试纸蛋白尿的相关性。我们纳入了889例年龄≥60岁、既往无卒中的高血压患者。行CT血管造影检查ICAS。从随机点尿中检测ACR和试纸蛋白尿。使用CKD-EPI公式计算eGFR。Logistic回归分析肾功能与ICAS的存在、程度和病变数量的关系。调整混杂因素后，ACR升高（≥30 mg/g）与ICAS相关（比值比（OR）= 1.66，95%置信区间（CI）：1.21-2.29）。ACR升高的患者更容易发生中重度狭窄（OR = 1.57，95%CI：1.16-2.14）和更多病变（OR = 1.58，95%CI：1.16-2.15）。这种关联独立于先前确定的心血管危险因素。ICAS与试纸法蛋白尿或校正后的eGFR之间无显著相关性。我们的研究结果表明，在老年无卒中高血压人群中，ACR升高与无症状ICAS相关。
Intracranial atherosclerotic stenosis (ICAS) contributes to nearly 50% of stroke in China, especially in patients with hypertension. Urine albumin-to-creatinine ratio (ACR) has been related to stroke and other atherosclerotic cardiovascular diseases. However, there is limited information about the association of ACR and early impairment of cerebral vessels. Hereby we assessed the association of ICAS with ACR, estimated glomerular filtration rate (eGFR), and dipstick proteinuria in a stroke-free hypertensive population. We included 889 hypertension patients aged ≥60 years without prior stroke. Computed tomography angiography was performed to detect ICAS. ACR and dipstick proteinuria were tested from a random spot urine. eGFR was calculated using the CKD-EPI equation. Logistic regression was carried out to analyze the association of renal function with the presence, extent, and lesion number of ICAS. Elevated ACR (≥30 mg/g) was associated with ICAS after adjustment of confounding factors (odds ratio (OR) = 1.66, 95% confidence interval (CI): 1.21–2.29). Patients with elevated ACR were more prone to develop moderate-to-severe stenosis (OR = 1.57, 95% CI: 1.16–2.14) and more lesions (OR = 1.58, 95% CI: 1.16–2.15). Such association was independent of previously identified cardiovascular risk factors. No significant association was detected between ICAS and dipstick proteinuria or eGFR after adjustment. Our findings suggested that elevated ACR was associated with asymptomatic ICAS in an aged stroke-free hypertensive population.