Abstract
Objectives: This study aimed to investigate the association between the metabolic syndrome (MetS) components and chronic kidney disease (CKD) in hypertension of different low-density lipoprotein cholesterol (LDL-C) levels. Methods: This national cross-sectional study was conducted in hospitals in 24 cities of China and comprised of 4792 eligible hypertensive participants with a recorded creatinine level between 2017 and 2018. All participants underwent a clinical survey and clinical assessment and were required to provide biomedical reports within 1 year from their outpatient visit. Student’s t-test, log-rank, and Chi-square tests and receiver operating characteristic curve (ROC) analysis were used in data analysis. Results: Participants’ average age was 65.82±12.74 years; 54.65% were male. Overall, 52.73%, 63.29%, 26.84%, and 77.27% of participants had a high waist circumference, elevated triglyceride (TG) level, low high-density lipoprotein cholesterol level, and impaired fasting glucose/diabetes, respectively. The adjusted odds ratio (OR) for CKD with MetS was 1.67 (95% confidence interval [CI] 1.32-2.10, P < 0.001). The risk of CKD was associated with older age (OR: 1.05, 95% CI: 1.04-1.06, P < 0.001), female (OR: 1.25, 95% CI: 1.01-1.55, P < 0.001), higher LDL-C level (OR: 1.17, 95% CI: 1.08-1.27, P = 0.03), higher TG level (OR: 1.38, 95% CI: 1.13-1.68, P =0.001), impaired fasting glucose/diabetes (OR 1.48, 95% CI: 1.2–1.85, P < 0.001), and a combination of two or more than three MetS components (OR: 1.7, 95% CI: 1.07-2.71, P=0.025; OR: 2.03, 95% CI: 1.08-3.13, P=0.008, respectively) (ROC curve: 0.7). MetS remained significantly associated with CKD in both LDL-C subgroups, but different associations between the MetS components and CKD were found. Conclusions: MetS and its components are less associated with CKD of LDL-C <2.6 mmol/L than LDL-C ≥2.6 mmol/L in hypertension. LDL-C is significantly associated with CKD in hypertension of LDL-C level ≥2.6 mmol/L subgroup.
文章摘要：
目的：本研究旨在探讨不同低密度脂蛋白（LDL-C）水平的高血压患者中代谢综合征（MetS）与慢性肾脏病（CKD）之间的关系。
方法：这项全国性的横断面研究是在中国24个城市的医院，由4792名符合条件的高血压患者参与进行的，这些参与者的肌酐水平在2017年至2018年之间有记录。所有参与者均接受了临床调查和临床评估，并提供门诊就诊后一年内的生物医学报告。数据使用t检验，对数秩检验和卡方检验以及接收者操作特征曲线（ROC）进行分析。
结果：参与者的平均年龄为65.82±12.74岁，男性占比54.65％。总体而言，分别有52.73％的参与者腰围增加，63.29％甘油三酸酯（TG）水平升高，26.84％高密度脂蛋白胆固醇水平降低，77.27％的参与者空腹血糖受损/糖尿病。CKD与MetS的校正比值（OR）为1.67（95％CI 1.32-2.10，P<0.001）。CKD的风险与年龄较大（OR 1.05，95％CI 1.04-1.06，P<0.001）、性别（女性/男性OR 1.25，95％CI 1.01-1.55，P <0.001）、LDL-C水平较高（OR 1.17，95％CI 1.08-1.27，P=0.03）、高水平的TG（OR 1.38，95％CI 1.13-1.68，P=0.001）、空腹血糖受损/糖尿病（OR 1.48，95％CI 1.2-1.85，P<0.001），以及两种或三种以上MetS组分的组合（OR 1.7，95％CI 1.07-2.71，P=0.025；OR 2.03，95％CI 1.08-3.13，P=0.008）（ROC曲线：0.7）有关。在两个LDL-C亚组中，MetS仍与CKD显著相关，但是发现MetS与CKD之间存在不同的关联。
结论：在高血压患者中，MetS及其组分与LDL-C <2.6 mmol/L的CKD相关性低于LDL-C≥2.6 mmol/L的CKD相关性。在LDL-C水平≥2.6 mmol/L的亚型高血压中，LDL-C与CKD显著相关。
Introduction
Although chronic kidney disease (CKD) is considered the major cause of morbidity and mortality in hypertension, the recognition and prevention of CKD remain deficient. In China, the incidence of CKD coexisting with hypertension is 6%-18%, and the prevalence of hypertension in CKD is estimated at 60%-80%. Many risk factors are associated with CKD. Metabolic syndrome (MetS), which is closely linked to insulinresistance and manifests as central obesity, elevated blood pressure, impaired fasting glucose, and high triglyceride (TG) and low high-density lipoprotein (HDL) cholesterol levels, seems to aggravate these risk factors. Numerous studies have demonstrated that MetS is associated with CKD. According to the National Cholesterol Education Program Adult Treatment Panel III (ATPIII) guideline, beyond low-density lipoprotein cholesterol (LDL-C)-lowering therapy, MetS is a secondary therapy target for reducing CVD. The relationship between MetS and CKD in hypertension with different LDL-C levels requires further investigation. Therefore, this study aimed to investigate this question.
介绍：尽管慢性肾脏病（CKD）被认为是高血压发病率和死亡率升高的主要原因，但对CKD的认识和预防仍然不足。在中国，CKD与高血压并存的发生率为6％~18％，据估计CKD中高血压的患病率为60％~80％。CKD受许多危险因素影响。代谢综合症（MetS）与胰岛素抵抗密切相关，表现为中枢型肥胖、血压升高、空腹血糖受损，甘油三酸酯（TG）和高密度脂蛋白（HDL）胆固醇水平低，且似乎加剧了这些风险因素。大量研究表明，MetS与CKD有相关性。根据国家胆固醇教育计划成人治疗小组Ⅲ（ATPⅢ）的指导原则，除了降低低密度脂蛋白胆固醇（LDL-C）的疗法外，MetS是降低CVD的二级治疗目标。在具有不同LDL-C水平的高血压患者中，MetS与CKD之间的关系需要进一步确定，本研究旨在调查该问题。
Conclusions
MetS and its components are less associated with an increased risk of CKD in hypertensive patients with LDL-C level <2.6 mmol/L than in those with LDL-C level >2.6 mmol/L, and LDL-C is significantly associated with CKD only in those with LDL-C level >2.6 mmol/L. In hypertensive patients with LDL-C level >2.6 mmol/L, elevated TG level, low waist circumference, impaired fasting glucose/diabetes, or a combination of two or more than three MetS components were also associated with an increased risk of CKD. Further prospective cohort study would be recommended to investigate the causal association between MetS and CKD in hypertension.
结论：与LDL-C> 2.6 mmol/L的高血压患者相比，MetS及其组分与LDL-C<2.6 mmol/L的高血压患者的CKD风险的相关性更小；而仅在LDL-C> 2.6 mmol/L的人群中LDL-C与CKD显著相关。在LDL-C> 2.6 mmol/L的高血压患者中，TG水平升高、较小的腰围、空腹血糖受损/糖尿病，或两种及三种以上MetS组分的组合也与CKD风险增加相关。建议进行进一步的前瞻性队列研究，以研究高血压中MetS和CKD之间的因果关系。
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