原发性高血压患者脂蛋白相关磷脂酶A2与高血压肾病的相关性分析

Analysis of the Relationship between Lipoprotein-Associated Phospholipase A2 and Hypertensive Nephropathy in Patients with Primary Hypertension

摘要: 目的：探讨原发性高血压患者脂蛋白相关磷脂酶A2 (Lp-PLA2)与高血压肾病发生率之间的关系。方法：回顾性分析2022年8月到2023年2月青岛大学第一附属医院收治的455例患者的临床资料，根据估算肾小球滤过率(eGFR)是否降低将患者分为高血压肾病组(115例)和非高血压肾病组(330例)，两组患者均采用卡方检验、Spearman相关性分析、logistic回归分析等统计学方法，比较Lp-PLA2、血常规、血脂谱、糖化血红蛋白(HbA1c)、尿酸(UA)、胱抑素C (Cys-C)、尿素/肌酐(Urea/Crea)等指标在两组之间差异性。结果：在原发性高血压患者中25.3%诊断为高血压肾病，高血压肾病组和非高血压肾病组患者的Lp-PLA2水平比较，差异有统计学意义(P < 0.05)；经多因素logistic回归分结果提示，Lp-PLA2 (β: 0.866, OR: 0.011, 95%CI: 1.215~4.647)、冠状动脉粥样硬化性心脏病(β: 3.011, OR: 0.001, 95%CI: 3.195~128.975)、糖尿病(β: 0.720, OR: 0.032, 95%CI: 1.064~3.967)、胱抑素C (Cys-C) (β: 5.133, OR < 0.001, 95%CI: 40.854~703.289)、TC (β: 0.623, OR < 0.001, 95%CI: 1.399~2.487)是高血压肾病的危险因素(P < 0.05)；Lp-PLA2与高血压肾病的相关性分析结果提示两者具有显著相关性(OR = 5.077, P < 0.001)。在调整年龄、性别、体重指数(BMI)、高血压病程、HbA1c、血脂、血压(BP)、有无冠心病和颈动脉斑块等因素后，Lp-PLA2水平的升高也与高血压肾病独立相关(OR = 2.487, P = 0.003)。Spearman相关分析结果提示，Lp-PLA2水平与eGFR呈负相关(OR = −0.372, P < 0.001)，与Cys-c呈正相关(OR = 0.239, P < 0.001)。结论：血浆Lp-PLA2水平升高与原发性高血压患者高血压肾病的发生发展相关，Lp-PLA2可作为高血压肾病早期检测和随访的生物标志物。

Abstract: Objective: The objective of this study was to explore the relationship between lipoprotein-associated phospholipase A2 (Lp-PLA2) and the incidence of hypertensive nephropathy in patients with primary hypertension. Methods: A retrospective analysis was conducted on the clinical data of 455 patients admitted to the First Affiliated Hospital of Qingdao University from August 2022 to February 2023. Based on whether estimated glomerular filtration rate (eGFR) was reduced, patients were divided into a hypertensive nephropathy group (115 cases) and a non-hypertensive nephropathy group (330 cases). Statistical methods such as chi-square test, Spearman correlation analysis, and logistic regression analysis were used to compare Lp-PLA2 levels, complete blood count, lipid profile, glycated hemoglobin, uric acid, cystatin C (Cys-C), urea/creatinine, and other indicators between the two groups. Results: Among patients with primary hypertension, 25.3% were diagnosed with hypertensive nephropathy. The Lp-PLA2 levels in the hypertensive nephropathy group were higher than those in the non-hypertensive nephropathy group, and the difference was statistically significant (P < 0.05). Multivariate logistic regression analysis showed that Lp-PLA2 (β: 0.866, OR: 0.011, 95%CI: 1.215~4.647), coronary artery atherosclerotic heart disease (β: 3.011, OR: 0.001, 95%CI: 3.195~128.975), diabetes (β: 0.720, OR: 0.032, 95%CI: 1.064~3.967), cystatin C (β: 5.133, OR < 0.001, 95%CI: 40.854~703.289), and total cholesterol (β: 0.623, OR < 0.001, 95%CI: 1.399~2.487) were risk factors for hypertensive nephropathy (P < 0.05). The correlation analysis indicated a significant association between Lp-PLA2 and hypertensive nephropathy (OR = 5.077, P < 0.001). After adjusting for factors such as age, gender, body mass index, hypertension duration, glycated hemoglobin, lipid profile, blood pressure, presence of coronary heart disease, and carotid plaque, the elevated level of Lp-PLA2 was independently associated with hypertensive nephropathy (OR = 2.487, P = 0.003). Spearman correlation analysis revealed a negative correlation between Lp-PLA2 levels and estimated glomerular filtration rate (eGFR) (OR = −0.372, P < 0.001), and a positive correlation with cystatin C (OR = 0.239, P < 0.001). Conclusion: Elevated plasma Lp-PLA2 levels are associated with the incidence and progression of hypertensive nephropathy in patients with primary hypertension. Lp-PLA2 can serve as a biomarker for early detection and follow-up of hypertensive nephropathy.