健康体检者肾小球滤过率下降的危险因素研究

Screening risk factors for decrease of eGFR in people receiving physical examination

摘要:

目的??分析健康体检者肾小球滤过率（eGFR）下降相关危险因素， 为延缓肾功能下降、提高人群 生命质量提供参考依据。方法??选取 2005 年 1 月—2012 年 12 月徐州市中心医院连续体检大于 4 次者作为研 究对象。eGFR 下降趋势者 614 人 2?643 人次作为病例组，与其性别相同、年龄相近及工作性质相似未见肾功 能下降趋势者 614 人 2?524 人次作为对照组。比较两组收缩压（SBP） 、舒张压（DBP） 、血糖及血脂等 20 个 指标。结果??两组 SBP、DBP、谷草转氨酶（AST） 、脉压（PP） 、空腹血糖（FPG） 、总胆固醇（TC） 、体重 指数（BMI） 、血浆黏度、尿蛋白阳性、乙肝表面抗原阳性、亚硝酸盐阳性、尿红细胞阳性、尿白细胞阳性 及镜检尿红细胞阳性比较， 差异无统计学意义 （ P >0.05） ； 两组 TG、 HDL-C 比较， 差异有统计学意义 （ P <0.05） 。 多因素分析显示 TG 为保护因素（ P <0.05） 。结论??未发现 SBP、TC、FPG 及 BMI 等危险因素对健康体检者 eGFR 下降的关联， “潮汐损害理论”能否解释、是否合理， 有待进一步研究。

关键词:肾病 ; eGFR 下降 ; 病例对照研究 ; 因素分析

Abstract:

Objective To screen the risk factors of decreased eGFR in people receiving physical examination. Methods People who had more than four consecutive physical examinations in Xuzhou Central Hospital from 2005 to 2012 were enrolled in this study. Totally 614 patients (2,643 times) were diagnosed with decreased eGFR and 614 (2,525 times) healthy volunteers matched with sex, age, work and without eGFR decline were involved as control. SBP, DBP, FPG and other 20 indicators in two groups were recorded. Results No statistically significant difference was identified between the two groups regarding SBP, DBP, AST, PP, TC, BMI, plasma viscosity, urine protein positive, hepatitis B surface antigen positive, nitrite positive, urine erythrocyte positive, urine white blood cell positive and microscopic urine erythrocyte positive (P > 0.05). The levels of TAG, HDL-C were obviously altered between two groups (P < 0.05). Multiple factors analysis suggested that TG was a protective factor of decreased eGFR (P < 0.05). Conclusions In this study, we are not able to find the association of well-established risk factors such as SBP, TC, FPG, BMI with decreased eGFR. Theory of “tidal damage” is incapable of explaining the decrease of eGFR.

Key words:nephrosis; decreased eGFR; case-control study; factors analysis