| Background and PurposeEssential hypertension(EH),also known as hypertension,is a cardiovascular syndrome characterized by elevated systemic arterial blood pressure.The incidence rate of hypertension in China is increasing year by year,and the incidence population is becoming younger.At present,its awareness rate,treatment rate and control rate are still relatively low.In view of the fact that the diet of Chinese residents is mostly high in carbohydrate,the incidence of hypertension complicated with abnormal glucose metabolism has increased significantly.At present,simplified OGTT test has been widely used in clinical work to diagnose diabetes and glucose metabolism abnormalities by detecting fasting plasma glucose(FPG)and 2-hour hyperglycaemia(2hPG).In fact,only FPG and 2hPG are relied on,and there are still many cases in which patients with glucose abnormalities cannot be identified clinically.Studies at home and abroad have pointed out that FPG and 2hPG are normal in many hypertensive patients.Carotid atherosclerotic plaque has appeared at the stage of 1-hour hyperglycaemia(1hPG)level rise.The remarkable fluctuation of 1hPG can stimulate oxidative stress in the early stage and cause target organ damage.At present,there are few reports of target organ damage caused by 1hHPG in hypertensive patients at home and abroad,especially for early renal damage.this study intends to investigate the relationship between 1hPG and microalbuminuria in hypertensive patients complicated with abnormal glucose metabolism to explore its clinical value in early early renal injury.Information and Methods(1)Research objects and groups: 408 patients with hypertension of Grade 2 or above who met the diagnostic criteria for hypertension were selected from outpatients and inpatients in the Department of Cardiology of the Second Affiliated Hospital of Zhengzhou University from August 2016 to June 2018.All the selected patients underwent OGTT test and recorded FPG,1hPG and 2hPG of each patient.FPG of all patients was normal and 2hPG did not meet the diagnostic criteria for diabetes.According to the diagnostic criteria of OGTT for blood glucose abnormalities at various time points in the 2015 edition of the National Clinical Laboratory Practice,the patients were divided into four groups including A0 group: 100 patients with normal blood glucose(NGT),A1 group: 102 patients with simple 1hHPG,A2 group: 104 patients with simple 2hHPG,A3 group: 102 patients with 1hHPG/2hHPG.(2)Collection indicators:(1)General data: Age,sex,height,weight,calculated body mass index(BMI),systolic blood pressure,diastolic blood pressure,blood lipid,hypertension course(within 10 years),smoking,antihypertensive drugs and lipid-lowering drugs;(2)Determination of ACR level in instant urine samples by immunoturbidimetry and statistics on the incidence of microalbuminuria(MAU);(3)Detection of routine biochemical indexes: FPG,1hPG,2hPG,TG,TC,HDL-C,LDL-C,Cr,etc.were determined by full-automatic biochemical analyzer.(4)eGFR was calculated according to creatinine(Cr),age and sex.(3)Statistical methods: SPSS21.0 software was used for data analysis,chi-square test was used for counting data,Kolmogorov-Smirnov test was used for data to test the normal distribution of measurement type data,all measurement data were expressed by mean standard deviation(x ±s),and the mean comparison of multiple groups of samples was performed by one-way analysis of variance method,in which LSD method was used for testing both comparative variances.Tamhane'sT2 test was used for variance irregularity.Pearson analysis was used for correlation analysis of two variables conforming to normal distribution,and binary logistic regression analysis was used for Screening risk factors for MAU in selected patients.The test standard is p < 0.05 with statistical significance.Results(1)Comparison of ACR values of four groups of patientsACR values of A0 group,A1 group,A2 group and A3 group were(21.09±11.06)mg/g,(33.08±15.62)mg/g,(27.12±15.40)mg/g and(39.08±15.61)mg/g respectively.Compared with the four groups,the differences among A1 group,A2 group and A3 group were higher than A0 group with statistical significance(P < 0.01).Group A3 was higher than group A1,and the difference was statistically significant(p < 0.05).The difference between group A1 and group A2 was statistically significant(p<0.05).(2)Comparison of eGFR in Four Groups of PatientsThe eGFR values of A0 group,A1 group,A2 group and A3 group were(90.73 18.02)ml/(min× 1.73 m2),(90.04 17.31)ml/(min× 1.73 m2),(89.33 18.61)ml/(min× 1.73 m2),(82.98 16.97)ml/(min× 1.73 m2),respectively.The differences among the four groups were statistically significant(p < 0.05).Group A3 was lower than group A1,and the difference was statistically significant(p < 0.05).The difference between group A2 and group A1 was statistically significant(p < 0.05).Compared with the glomerular hyperfiltration ratio of the four groups,A0 group(5%),A1 group(9%),A2 group(7%)are lower than A3 group(16%)with statistically significant difference(p < 0.05).Group A2(7%)was lower than group A1(9%),and the difference was statistically significant(p<0.05).(3)Comparison of MAU in four groups of patientsThe MAU incidence rates in A0 group,A1 group,A2 group and A3 group were 29%,55%,53% and 66% respectively.compared with the four groups,A1 group,A2 group and A3 group were all higher than A0 group with statistically significant difference(p < 0.01).The difference between group A3 and group A1 was statistically significant(p < 0.05).The difference between group A1 and group A2 was statistically significant(p<0.05).(4)Correlation Analysis between 1hPG and Various IndicatorsA simple scatter plot of 1hPG and ACR was drawn.Pearson correlation analysis showed that 1hPG was correlated with ACR(r=0.528),SBP(r=0.360),BMI(r=0.412),TG(r=0.688),LDL-C(r=0.701),HDL-C(r=-0.506)?2hPG(r=0.558)and the difference was statistically significant(p<0.01).(5)Logistic regression analysis of MAU related risk factorsThe results showed that age(OR=1.030,p<0.05),hypertensive course(OR= 1.223,p<0.05)?1hPG(OR=2.461,p<0.01),creatinine(OR=1.071,p<0.01)and 2hPG(OR=2.016,p<0.01)were all risk factors for MAU(p<0.01).conclusion 1.Glucose tolerance for 1 hour and 2 hours increase are positively correlated with ACR value.2.The traditional simplified glucose tolerance test combined with 1-hour has important clinical value in finding early early renal injury in hypertensive patients complicated with abnormal glucose metabolism. |
PDF Full Text Request