关键词: 原发性高血压, 肾素活性, 早期肾功能损伤, 胱抑素C, 影响因素分析

Abstract: Background　Kidney injury is one of the most common target organ damages in essential hypertension. Early detection and intervention will possibly reverse or even eliminate underlying renal damage. Previous studies have shown that plasma renin activity（PRA）plays an important role in appropriate treatment and prognosis evaluation of essential hypertensive patients，but it is unclear whether PRA can predict early hypertensive renal damage. Objective　To investigate the relationship of PRA with early renal damage in essential hypertensive patients. Methods　A total of 1 614 Han Chinese inpatients with essential hypertension were recruited between January 2007 and October 2014 from Department of Hypertension，People's Hospital of Xinjiang Uygur Autonomous Region. Data including gender，age，BMI，course of hypertension，blood pressure，fasting blood glucose，blood lipid，plasma aldosterone（PAC），and renal function indicators（urea nitrogen，creatinine，Cyst C，24-hour urine protein，24-hour urine microalbuminuria）were compared between sitting PRA quartiles 〔low renin（Q1，<0.44 μg?L-1?h-1），medium renin 1（Q2，0.44-1.07 μg?L-1?h-1），medium renin 2（Q3，1.08 -2.36 μg?L-1?h-1）and high renin（Q4，>2.36 μg?L-1?h-1）〕. Multivariate Logistic regression was used to explore factors associated with early hypertensive renal function damage. Results　Q1 group had lower male proportion，and lower levels of mean DBP，PRA and TG，and greater mean age and ARR ratio than other groups（P<0.05）. This group also showed lower levels of mean PAC，TC and LDL-C and longer mean course of hypertension than Q3 and Q4 groups（P<0.05）. Q2 group had greater mean age and longer mean course of hypertension as well as lower mean level of PRA than Q3 group（P<0.05）. Q2 group had lower male proportion，and lower mean DBP，greater mean age and longer mean course of hypertension，lower mean PRA and PAC，and higher mean ARR ratio than Q4 group（P<0.05）. Q3 group had lower male proportion，and lower mean DBP，PRA and PAC as well as greater mean age than Q4 group（P<0.05）. Q1 group had lower mean level of creatinine than Q2 and Q3 groups（P<0.05）. Q1 group showed lower mean levels of creatinine and Cyst C than Q4 group，so did Q3 group（P<0.05）. Multivariate Logistic regression analysis showed that gender，course of hypertension，BMI，SBP，DBP and PRA level were associated with early renal damage（P<0.05）. Conclusion　In Xinjiang Han Chinese people with essential hypertension，female，overweight，longer course of hypertension，higher blood pressure and higher PRA were risk factors for early renal damage.

Key words: Essential hypertension, Plasma renin activity, Early renal damage, Cyst C, Root cause analysis