2022 年第 6 期 第 17 卷

超重青年尿液样本检测对高血压病和肾病的风险评估

Risk assessment for hypertension and kidney disease by testing urine samples from overweight youths

作者：毕智敏1喻业安1张艳霞1朱戈丽1李玉明2郭然3

英文作者：Bi Zhimin1 Yu Yean1 Zhang Yanxia1 Zhu Geli1 Li Yuming2 Guo Ran3

单位：1湖北省武汉市第三医院肾内科，武汉430074；2武警特色医学中心心血管病研究所，天津300162；3武警特色医学中心门诊部，天津300162

英文单位：1Department of Nephrology Wuhan Third Hospital Hubei Province Wuhan 430074 China; 2Heart Research Institute Characteristic Medical Center of Chinese People′s Armed Police Force Tianjin 300162 China; 3the Outpatient Department Characteristic Medical Center of Chinese People′s Armed Police Force Tianjin 300162 China

关键词：慢性肾脏病；超重；高血压；肾脏损伤标记物；肾素血管紧张素系统

英文关键词：Chronickidneydisease;Overweight;Hypertension;Renalinjurymarkers;Renin-angiotensinsystem

• 摘要：

• 目的 通过检测超重青年尿液样本中肾素血管紧张素系统（RAS）和肾脏损伤标志物的水平评估高血压病和慢性肾脏病（CKD）的发病风险。方法 选取武汉市第三医院2018年6月至2020年6月体检人群中年龄18～25岁、体重指数25.0~29.9 kg/m2的体检者40例作为超重组，选取同期体重指数正常（<25.0 kg/m2）的体检者40例作为对照组。收集2组临床资料，检测2组人群尿液中RAS和肾脏损伤标志物的mRNA水平，并进行组间比较。结果 超重组收缩压、舒张压、体质量、体重指数、基础代谢率、内脏脂肪含量、总水含量、内脏脂肪指数、代谢年龄均高于对照组，差异均有统计学意义（均P＜0.05）。超重组人群的体重指数与收缩压和舒张压均呈正相关（r=0.61、0.72，均P＜0.05）。超重组尿液中白细胞计数、尿胆原阳性率、尿蛋白、尿液pH值和尿隐血阳性率均高于对照组［（2.5±0.4）个/高倍镜视野比（2.3±0.4）个/高倍镜视野、35.0%（14/40）比5.0%（2/40）、（42±9）mg/d比（35±8）mg/d、（5.92±0.11）比（5.83±0.13）、27.5%（11/40）比7.5%（3/40）］，差异均有统计学意义（均P＜0.05）。超重组人群尿液中肾素、血管紧张素原、不含赖氨酸激酶1（WNK1）、WNK4、囊性纤维化跨膜电导调节因子和白细胞介素18、结缔组织生长因子、肾损伤分子1的mRNA水平均明显高于对照组［（2.59±0.15）比（1.01±0.17）、（3.12±0.65）比（0.99±0.25）、（2.59±0.15）比（0.99±0.17）、（1.44±0.21）比（0.99±0.18）、（1.54±0.11）比（1.01±0.13）、（4.21±0.94）比（1.01±0.21）、（2.04±0.54）比（0.99±0.26）、（2.03±0.94）比（1.01±0.32）］，差异均有统计学意义（均P＜0.05），而中性粒细胞明胶酶相关的脂钙素水平与对照组比较差异无统计学意义（P＞0.05）。结论 超重可能直接影响血压和肾小管内RAS的激活，从而导致高血压病和肾脏损伤。因此即使在血压正常的青年中，超重也可能是初期肾脏疾病的危险因素。

• Objective To assess risks of hypertension and chronic kidney disease (CKD) by detecting the renin-angiotensin system (RAS) and kidney injury markers in urine samples from overweight youths. Methods From June 2018 to June 2020, 40 physical examinees aged 18-25 years with body mass index (BMI) 25.0-29.9 kg/m2 were selected as overweight group in Wuhan Third Hospital, and 40 physical examinees with normal BMI<25.0 kg/m2 were selected as the control group. Clinical data were collected and mRNA levels of RAS and renal injury markers from urine were compared between the two groups. Results   The systolic blood pressure, diastolic blood pressure, body mass, BMI, basal metabolic rate, visceral fat content, total water content, visceral fat index and metabolic age of the overweight group were higher than those of the control group (all P＜0.05). There was a positive correlation of BMI with systolic blood pressure and diastolic blood pressure in the overweight group(r=0.61, 0.72, both P＜0.05). The white blood cell count in urine, the positive ratio of urobilinogen, urinary protein, urinary pH value and the positive ratio of urinary occult blood in the overweight group were higher than those in the control group［(2.5±0.4)cells/high-power field vs (2.3±0.4)cells/high-power field, 35.0%(14/40) vs 5.0%(2/40), (42±9)mg/d vs (35±8)mg/d, (5.92±0.11) vs (5.83±0.13), 27.5%(11/40) vs 7.5%(3/40)］(all P＜0.05). The mRNA levels of renin, angiotensinogen, with no lysine kinase 1 (WNK1), WNK4, cystic fibrosis transmembrane conductance regulator, interleukin-18, connective tissue growth factor and kidney injury molecule-1 in the urine of the overweight group were significantly higher than those of the control group［（2.59±0.15） vs （1.01±0.17）, （3.12±0.65） vs （0.99±0.25）, （2.59±0.15） vs （0.99±0.17）, （1.44±0.21） vs （0.99±0.18）, （1.54±0.11） vs （1.01±0.13）, （4.21±0.94） vs （1.01±0.21）, （2.04±0.54） vs （0.99±0.26）, （2.03±0.94） vs （1.01±0.32）］(all P＜0.05). There was no significant difference in the level of neutrophil gelatinase related lipocalcin between the two groups (P＞0.05). Conclusions  Overweight may directly affect blood pressure and the activation of RAS in renal tubules, resulting in hypertension and renal injury. Therefore, even in youths with normal blood pressure, overweight may be a risk factor for early renal disease.