超高龄人群肾功能及尿蛋白对心血管事件发病的影响  

Influence of renal function and proteinuria on cardiovascular events in octogenarian population

作　　者：包志伟[1] 喻业安 姜华军[3] 

机构地区：[1]江汉大学医院内科,湖北武汉430056 [2]武汉市第三医院肾内科,湖北武汉430060 [3]华中科技大学同济医学院附属协和医院肾内科,湖北武汉430022

出　　处：《临床荟萃》2015年第4期372-375,共4页Clinical Focus

基　　金：国家自然科学基金资助项目(30900682)

摘　　要：目的探讨肾小球滤过率估算值(eGFR)及尿蛋白水平对超高龄老年人发生心血管事件的影响。方法采用简化的MDRD公式进行估算,当eGFR<60ml·min-1·1.73m-2时提示肾功能下降,将98例80岁及以上的查体老年人,分为肾功能下降组和肾功能正常组;又根据尿常规检测结果,将此98例分为尿蛋白阳性组和尿蛋白阴性组。随访心血管事件,比较不同组的心血管事件发生率,分析心血管事件发生的危险因素。结果 1肾功能下降者(30/98)与尿蛋白阳性者(8/98)共占36.7%(36/98)。2随访时间平均(52.1±11.4)个月。至随访结束,存活42例,56例死亡者中发生心血管事件29例(29.6%)。3与肾功正常组比较,肾功能下降组患高血压、冠心病的比例升高(均P<0.05),其空腹血糖、血尿酸、血尿素氮、白细胞总数升高(均P<0.05),高密度脂蛋白胆固醇降低(P<0.05);与尿蛋白阴性组比较,尿蛋白阳性组中患高血压、糖尿病的比例高,eGFR降低,血尿素氮水平升高(均P<0.05)。4缺血性卒中、尿蛋白阳性、eGFR水平是心血管事件发生的危险因素。5肾功能下降组患者的心血管事件发生率显著高于肾功能正常组36.7%(11/30)vs 26.5%(18/68),P<0.05;尿蛋白阳性组患者心血管事件发生率明显高于尿蛋白阴性组62.5%(5/8)vs 26.7%(24/90),P<0.01;缺血性卒中患者心血管事件发生率明显高于无缺血性卒中患者37.0%(10/27)vs 26.8%(19/71),P<0.05。结论超高龄老年人的eGFR下降、尿蛋白阳性以及有缺血性卒中史是心血管事件发生的危险因素。Objective To explore the influence of renal function and proteinuria on cardiovascular events in octogenarian population.Methods Estimated glomerular filtration rate（eGFR）was estimated by modified abbreviated MDRD equation among 98 cases of octogenarian population.The patients were divided into normal renal function group（eGFR≥60ml·min-1·1.73m-2）and impaired renal function group（eGFR〈60ml·min-1·1.73m-2）.By means of urine routine,the patients were also divided into positive proteinuria group and negative proteinuria group.The cardiovascular events between groups were compared and risk factors for cardiovascular events were analyzed by followup survey.Results 1The population of impaired renal function（30/98）and proteinuria（8/98）accounted for 36.7%（36/98）.229 of 56cases of death suffered from cardiovascular events at a mean flow-up of（52.1±11.4）months.3Compared with normal renal function group,the proportion of hypertension and coronary heart disease,fasting blood glucose,blood uric acid,blood urea nitrogen,and total white blood cells were significantly increased in impaired renal function group,whereas high density lipoprotein cholesterol was significantly lower（P〈 0.05）;Compared with negative proteinuria group,the proportion of hypertension and diabetes and the level of blood urea nitrogen were significantly increased in positive proteinuria group,whereas eGFR was significantly lower（P〈 0.05）.4Ischemic stroke,proteinuria,and eGFR were considered as risk factors for cardiovascular events.5The cardiovascular events in imparied renal function group were significantly higher than those of normal renal function group（36.7%[11/30]vs26.5%[18/68],P 〈0.05）;The cardiovascular events in positive proteinuria group were significantly higher than those of negative proteinuria group（62.5%[5/8]vs 26.7%[24/90],P〈 0.01）;The cardiovascular events in ischemic stroke were significantly higher than those of non-ischemic stroke（37.0% [10/27]vs 26.8% [19/71],P〈 0.05）.Conc

关 键 词：心血管疾病 肾小球滤过率 尿蛋白 

分 类 号：R54[医药卫生—心血管疾病]