慢性肾脏病患者肾小球滤过率下降速率与疾病进展的关系  

The short-term decline of eGFR and the progression of chronic kidney disease

作　　者：向海燕[1] 刘晔[1] 陈莎莎[1] 李小伟[1] 杨静[1] 安玉[1] 乐伟波[1] 左科[1] 章海涛[1] 刘志红[1] 

机构地区：[1]南京大学医学院附属金陵医院,国家肾脏疾病临床医学研究中心 全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2015年第6期518-523,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家科技支撑计划课题(2013BAI09B04,2015BAI12B05);江苏省临床医学科技专项(BL2012007)

摘　　要：目的:分析慢性肾脏病(CKD)患者短期内肾功能下降对疾病进展的影响。方法:回顾性分析随访时间>2年的CKD患者在初次就诊的两年内估算的肾小球滤过率(eGFR)变化情况,采用Kaplan-Meier法比较不同疾病初次就诊至CKD 5期的病程,并采用单因素及多因素COX回归分析各种因素对病程的影响。结果:所有患者从初次就诊至CKD 5期的中位病程为5.8年,糖尿病肾病患者为4年,明显短于其他疾病患者。所有患者1年eGFR下降率平均为9.8%,两年eGFR下降率平均为21.6%,糖尿病肾病1年eGFR下降率平均为22.7%,两年eGFR下降率平均为41.0%,明显高于其他病因;2年内eGFR下降率>40%患者病程中位数为3.3年,病程较下降缓慢者明显缩短;多因素分析显示男性、糖尿病、初诊时eGFR较低、两年eGFR下降较快是CKD进展的危险因素,使用血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂治疗可减缓肾脏疾病进展。结论:不同疾病的eGFR下降速度不同,糖尿病肾病进展相对较快。2年内eGFR快速下降是CKD进展的独立危险因素;对eGFR短期少量下降作为CKD进程替代诊断终点的临床研究,应考虑病因、基线eGFR、药物治疗等因素。Objective：To determine the relationship between the short-term decline of eGFR and the progression of chronic kidney disease （ CKD） . Methodology：The changes of eGFR within the first two years of initial referral of all CKD patients followed for more than 2 years in our department were retrospectively investigated. Kaplan-Meier method was used to compare the duration from first visit to stage 5 CKD of different diseases and the impact of various factors on disease progression was evaluate by Cox regression analysis. Results：The median period from first visit to stage 5 CKD was 5.8 years of the whole group, in which patients with diabetic nephropathy had significantly shorter period of 4 years. The average annual and two？year rates of decline in eGFR were 9.8% and 21.6% in the whole group, while diabetic nephropathy showed remarkably higher rates of 22.7% and 41.0%. The median period from first visit to stage 5 CKD was 3.3 years in patients with more than 40% dicrease in eGFR within two years, which was notably shorter than those with slower decline of eGFR. Multivariate cox regression analysis indicated that male, diabetes, lower eGFR at first visit and rapid decline of eGFR within 2 years were risk factors for the progression of CKD, the use of ACEI/ARB therapy could slow the progression of kidney disease. Conclusion：The decline of eGFR varies in different diseases, among which diabetic nephropathy has relatively faster rate of progression. The rapid decline of eGFR within 2 years is an independent risk factor for progression of CKD. Factors such as etiology, baseline eGFR and medications should be considered in clinical trials using lesser eGFR declines as a surrogate end point for progression of CKD.

关 键 词：慢性肾脏病 糖尿病肾病 估算的肾小球滤过率 危险因素 

分 类 号：R692[医药卫生—泌尿科学]