高血压或糖尿病及二者联合作用对新发慢性肾脏病的影响  

Effects of hypertension, diabetes and the joint action of the two on the new chronic kidney disease

作　　者：李俊娟[1] 周靖[1] 李慧英[2] 陆春红[1] 王剑利[1] 黄金杰[1] 鲁德江[1] 吴寿岭[2] LI Jun-juan;ZHOU Jing;LI Hui-ying;LU Chun-hong;WANG Jian-li;HUANG Jin-jie;LU De-jiang;WU Shou-ling(Department of Nephrology,Kailuan General Hospital,Tangshan,Hebei 063000,China;Department of Cardiology,Kailuan General Hospital,Tangshan,Hebei 063000,China)

机构地区：[1]开滦总医院肾内科,河北唐山063000 [2]开滦总医院心内科,河北唐山063000

出　　处：《解放军医学杂志》2018年第10期890-896,共7页Medical Journal of Chinese People's Liberation Army

基　　金：河北省卫生和计划生育委员会科研基金(20171448)~~

摘　　要：目的探讨高血压、糖尿病及二者联合对新发慢性肾脏病(CKD)的影响。方法本研究为前瞻性队列研究,以参加开滦集团2006-2007年度健康体检的101 510例在职及离退休员工为研究对象,每2年进行1次健康体检,排除基线资料缺失、CKD、癌症、心脑血管病史者,以及随访过程中因各种原因未参加体检、随访资料缺失者,共51156例纳入研究。将研究对象分为血压及血糖水平正常组、单纯高血压组、单纯糖尿病组及高血压合并糖尿病组4组,采用多因素COX风险比例回归分析高血压、糖尿病及二者联合对新发CKD的影响。结果至2014-2015年度健康体检结束时,随访(7.3±2.3)年,新发CKD 8179例,发病密度为22.19/千人年。在总人群中,上述4组发病密度分别为17.39、27.78、31.39、42.58/千人年。在男性人群中,上述4组发病密度分别为18.20、28.29、32.77、44.37/千人年。在女性人群中,上述4组发病密度分别为15.28、25.37、26.99、36.42/千人年。多因素COX风险比例回归模型分析显示,进一步校正年龄、性别、体育锻炼水平、家庭收入水平、吸烟、饮酒、体重指数(BMI)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、使用降压药物及降糖药物情况后,与血压及血糖水平正常组比较,总人群中单纯高血压组、单纯糖尿病组及高血压合并糖尿病组新发CKD的HR值(95%CI)分别为1.57(1.49～1.66)、1.67(1.45～1.92)、2.13(1.89～2.39),按性别分层后该趋势一致。结论高血压、糖尿病是新发CKD的独立危险因素,且二者联合可显著增加新发CKD的发病风险。Objective To investigate the effects of hypertension,diabetes and the joint action of the two on the new chronic kidney disease (CKD).Methods This is a prospective cohort study.A total of 101,510on job and retired Kailuan employees who participated in 2006-2007annual physical examinations were as the research objects.Those without baseline data, and patients with CKD,cancer and history of cardiovascular and cerebrovascular diseases were excluded,and those with no physical examination during follow-up or missing follow-up data were also excluded,then 51,156cases were included in the final analysis and divided into 4groups:normal blood pressure (BP)and fasting blood glucose (FBG)group,hypertension group,diabetes group and hypertension+diabetes group.Multivariate COX risk proportional regression was performed to analyze the effect of hypertension, diabetes and the joint action of the two on the new CKD.Results After an average of 7.3±2.3years follow-up,8,179participants were found to have developed CKD,the incidence density of CKD was 22.19per 1000person-year.The incidence density of CKD in the 4groups above was 17.39,27.78,31.39and 42.58per 1000person-year,respectively;while in males of the 4groups was 18.20, 28.29,32.77and 44.37per 1000person-year,and in females of the 4groups was 15.28,25.37,26.99and 36.42per 1000person-year. Multivariate COX risk proportional regression analysis showed that,further adjusted by age,gender,physical exercise level,income level,smoking status,drinking status,body mass index (BMI),total cholesterol (TC),low density lipoprotein (LDL-C),high-density lipoprotein (HDL-C) and using of anti-hypertensive drugs and hypoglycemic drugs,and compared with the normal BP and FBG group,the HR and 95%CI in hypertension group,diabetes group and hypertension+diabetes group showed an increased risk of CKD as 1.57(1.49-1.66),1.67(1.45-1.92)and 2.13(1.89-2.39),respectively.It generated similar results in different gender.Conclusion Hypertension and diabetes are the independent risk factors for new-onset

关 键 词：高血压 糖尿病 慢性肾脏病 队列研究 

分 类 号：R691.5[医药卫生—泌尿科学]