健康人群衰老相关心血管亚临床指标与肾功能的相关性  

Relationship between aging-related cardiovascular subclinical biomarkers and glomerular filtration rate in healthy population

作　　者：韩璐璐[1] 白小涓[2] 于凯[1] 任飞[1] 陈香美[3] 

机构地区：[1]中国医科大学附属第一医院老年病科,沈阳110001 [2]中国医科大学附属盛京医院老年病干诊科,沈阳110004 [3]解放军总医院肾脏内科,北京100853

出　　处：《中华老年多器官疾病杂志》2013年第5期330-335,共6页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：国家重点基础研究发展计划基金（2007CB507405,2013CB530804）;辽宁省科学技术厅课题基金（No.2007225004）

摘　　要：目的评价沈阳地区健康人群衰老相关心血管亚临床状态改变及其与肾小球滤过率（GFR）的相关性。方法在横断面研究中，将沈阳地区505例健康人群按照年龄分为≤60岁组（n=274）和〉60岁组（n=231）。进行基本身体状况、血压、血液生化和心血管超声检查。采用左室射血分数（LVEF）评价心脏收缩功能，二尖瓣E峰与A峰的比值（E／A）、二尖瓣减速时间（MV-DT）、左房容积指数（LAVI）评价心脏舒张功能，颈动脉内中膜厚度（IMT）、臂踝指数（ABI）和脉搏波速度（PWV）评价血管结构和僵硬度。采用Cockcroft—Gault公式（GFR_CG）、中国改良MDRD公式（GFRMDRD）和CKD-EPI（GFR_CKD-EPI）公式计算的GFR评价肾脏功能。结果在≤60岁组，GFRcG与IMT（r=-0．238，P〈0．01）和PWV（r=-O．281，P〈0．01）呈显著负相关。GFRMDRD与LVEF呈显著负相关（r=-0．221，P〈O．01）。GFR_CKD-EPI与IMT（r=-0．360，P〈0．01）和PWV（r=-0．327，P〈0．01）呈显著负相关。利用偏相关分析调整年龄、体质量指数、腰臀比、收缩压、舒张压、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇等混杂变量后，GFR_CG与LAVI呈显著正相关（r=0．168，P〈0．05）。GFRMDRD与LVEF呈显著负相关（r=-0．212，P〈0．01）。GFR_CKD-EPI与LAVI呈显著正相关（r=0．195，P〈0．01），与EA呈显著负相关（r=-0．137，P〈0．05）。在〉60岁组，GFRMDRD与ABI呈显著正相关（r=-0．167，P〈0．05），且在调整混杂变量后，该相关依然显著（r=0．175，P〈0．05）。结论衰老与肾功能下降、大动脉僵硬度及心脏舒张功能下降密切相关。在健康人群，心血管系统和肾脏存在年龄特异的交互作用。Objective To evaluate the relationship between aging-related cardiovascular subclinical state and estimated glomerular filtration rate （GFR） in healthy population in Shenyang. Methods In the cross-sectional study, 505 healthy people in Shenyang area were devided into ≤ 60 years and 〉 60 years group. The physical condition, blood pressure, blood biochemical examination and cardiovascular ultrasound were performed. GFR was evaluated by Cockcroft-Gault equation （GFR_CG）, Chinese modified MDRD formula （GFR_MDRD）, Chronic Kidney Disease Epidemiology Collaboration equation （GFR_CKD-EPI）. Cardiac systolic function was assessed by the left ventricular ejection fraction （LVEF）. Cardiac diastolic function was assessed by the ratio between mitral E/A ratio, deceleration time of the early mitral velocity （MV-DT）, left atrial volume index（LAV1）. Vascular structure and stiffness were assessed by carotid intema-media thickness （IMT）, ankle brachial index （ABI） and pulse wave velocity （PWV）. Results In ≤60 years group, GFR_CG was significantly negative correlated with IMT （r = -0.238, P 〈 0.01） and PWV （r = -0.281, P 〈 0.01）. There was significant negative correlation between GFRMDRD and LVEF （r =-0.221, P〈 0.01）. GFRcKD-EPI was significantly negatively correlated with IMT （r =-0.360, P 〈 0.01） and PWV （r =-0.327, P 〈 0.01）. After adjusting for age, body mass index （BMI）, waist-hip ratio （WHR）, blood pressure, blood lipid, and GFRc6 was significantly positively correlated with LAVI （r = 0.168, P 〈 0.05）. There was significant negative correlation between GFR_MDRDand LVEF （r=-0.212, P〈 0.01）. A significant positivecorrelation of GFR_CKD-EPIwith LAVI （r = 0.195, P 〈 0.01）, and negative correlation with EA （r = -0.137, P 〈 0.05） were observed. In 〉 60 years group, GFR_MDRD was positively correlated with ABI （r = -0.167, P 〈 0.05）, which remained significant （r = 0.175, P 〈 0.05） even after adjusting for confound

关 键 词：健康人群 心血管亚临床指标 肾小球滤过率 

分 类 号：R592[医药卫生—老年医学] R692[医药卫生—内科学]