妊娠期高血压疾病患者醛固酮水平及动态血压参数对早期肾损害的预测OA

Objective To investigate the predictive value of aldosterone levels and ambulatory blood pressure parameters for early renal damage in patients with hypertensive disorders of pregnancy(HDP).Methods A total of 100 patients diagnosed with HDP who were admitted to Chaohu Hospital Affiliated to Anhui Medical University between December 2020 and December 2023 were enrolled.According to disease severity,the patients were divided into an HDP group(n=41),a mild preeclampsia(PE)group(n=33),and a severe PE group(n=26).Based on the presence of renal impairment,patients were further classified into a renal damage group(n=42)and a non-renal damage group(n=58).Multivariate linear regression analysis was used to evaluate the associations between aldosterone levels,ambulatory blood pressure parameters,and early renal function impairment.Multivariate logistic regression analysis was performed to identify independent risk factors for early renal damage.Restricted cubic spline(RCS)and threshold effect analyses were conducted to explore the relationship between aldosterone levels and early renal damage.A mediation effect model was constructed to assess the mediating role of blood pressure in the association between aldosterone and early renal damage.Results The 24-hour average systolic blood pressure(24hSBP),24-hour average diastolic blood pressure(24hDBP),average systolic blood pressure during the daytime(dSBP),average diastolic blood pressure during the daytime(dDBP),average systolic blood pressure during the night(nSBP),and average diastolic blood pressure during the night(nDBP)increased progressively across the HDP,mild PE,and severe PE groups,with statistically significant differences(F values ranging from 8.973 to 13.505,P<0.05).Levels of aldosterone,cystatin C(CysC),homocysteine(Hcy),β2-microglobulin(β2-MG),uric acid(UA),and 24-hour urinary total protein(24 h-UTP)increased sequentially among the three groups,whereas estimated glomerular filtration rate(eGFR)and creatinine clearance rate(CCR)decreased progressively(F values ranging from 12.225 to 852.509,P<0.05).Blood urea nitrogen(BUN)levels in the severe PE group were higher than those in the HDP group,and urine creatinine(UCr)levels were higher in the severe PE group than in both the HDP and mild PE groups,with statistically significant differences(F=108.901 and 5.141,respectively,P<0.05).Multivariate linear regression analysis showed that aldosterone,systolic blood pressure(SBP),and diastolic blood pressure(DBP)were positively correlated with levels of CysC,BUN,UCr,Hcy,β2-MG,UA,and 24 h-UTP(β values ranging from 1.562 to 6.010,P<0.05),and negatively correlated with eGFR and CCR(β values ranging from-2.560 to-1.030,P<0.05).Multivariate logistic regression analysis demonstrated that SBP,DBP,CysC,β2-MG,24 h-UTP,aldosterone,and severe PE were independent risk factors for early renal damage in patients with HDP(OR values ranging from 1.677 to 3.669,,P<0.05),whereas eGFR was identified as a protective factor(OR=0.741,P<0.05).RCS and threshold effect analyses revealed that when aldosterone levels exceeded 22.12 ng/dL,25.15 ng/dL,and 32.45 ng/dL,respectively,the probability of early renal damage increased with rising aldosterone levels in patients with HDP,mild PE,and severe PE.Mediation analysis indicated that ambulatory blood pressure exerted a significant mediating effect in the relationship between aldosterone and early renal damage(P<0.001).Conclusion Aldosterone levels increase with the severity of hypertensive disorders of pregnancy.Combined assessment of aldosterone levels and ambulatory blood pressure monitoring may facilitate early diagnosis and intervention,reduce the risk of early renal damage in patients with HDP,and ultimately improve patients'quality of life.