老年慢性肾脏病3-4期患者的临床特点及影响肾功能进展的相关危险因素分析  

Clinical features and risk factors of the kidney function progression in elderly patients with stage 3-4 chronic kidney disease

作　　者：张燕京[1] 杨继红[1] 富小红[1] 吴华[1] 贾静[2] 贾雪飞 乔昱[3] 王萌[4] 李铭[5] 邱蕾[2] 施红[2] 奚桓[2] 汪耀[2] Zhang Yanjing;Yang Jihong;Fu Xiaohong;Wu Hua;Jia Jing;Jia Xuefei;Qiao Yu;Wang Meng;Li Ming;Qiu Lei;Shi Hong;Xi Huan;Wang Yao(Department of Nephrolog;Department of Gericatic;Department of Oncolog;Department of Laboratory Medicin;Department of Endocrinology ,Beijing Hospital, National Center of Gerontology, Beijing 100730, Chin)

机构地区：[1]北京医院国家老年医学中心老年医学部肾内科,100730 [2]北京医院国家老年医学中心老年医学部老年医学部,100730 [3]北京医院国家老年医学中心老年医学部肿瘤科,100730 [4]北京医院国家老年医学中心老年医学部检验科,100730 [5]北京医院国家老年医学中心老年医学部内分泌科,100730

出　　处：《中华老年医学杂志》2018年第6期631-635,共5页Chinese Journal of Geriatrics

基　　金：北京市科委首都市民健康项目(Z131100004013042)、人社部回国人员启动基金(2013277,bjyy201301)

摘　　要：目的探讨老年慢性肾脏病（CKD）3-4期患者的临床特点，并进行肾功能进展的相关危险因素分析。方法观察2014年1月至2015年12月我院门诊就诊，年龄≥60岁，病情稳定的患者，根据Cockcroft-Gault（CG）公式计算的估测肾小球滤过率（eGFR）〈60 ml·min-1·1.73 m^-2的患者进行横断面研究，根据eGFR和年龄将所有患者分为CKD3a期组、CKD3b期组、CKD4期组以及〈80岁组、≥80岁组。记录人口学特征及基础疾病病史，计算体质指数（BMI）。测定血常规、尿常规、血生化、胱抑素C（CystatinC）及全段甲状旁腺激素（iPTH）。对肾功能进展的相关危险因素进行多因素Logistic回归分析。结果入组患者共183例，平均年龄（80±9）岁。随着肾功能的减退，老年慢性肾脏病患者的年龄、尿蛋白水平和血iPTH水平逐渐增加（F＝12.352、5.910、5.910；P＝0.000、0.003、0.003），BMI水平和血白蛋白水平逐渐下降（F＝9.758、11.088；P＝0.000、0.000）。与〈80岁组相比，≥80岁组的eGFR水平[（37.1±9.9）ml·min-1·1.73 m^-2比（44.0±12.0）ml·min-1·1.73 m^-2]明显降低（t＝-4.280，P＝0.000），血CystatinC水平[（1.71±0.84）mg/L比（1.40±0.69）mg/L]明显升高（t＝3.484，P＝0.001）。多因素Logistic回归分析发现蛋白尿为肾功能进展的独立危险因素（OR＝3.856，P＝0.004）。结论随着eGFR的逐渐下降，老年CKD3-4期患者的年龄、尿蛋白及血iPTH的水平逐渐升高，BMI和血白蛋白水平逐渐下降。随着增龄，患者的eGFR水平明显下降，胱抑素C水平明显升高。蛋白尿是肾功能进展的独立危险因素。ObjectiveTo investigate the clinical features of elderly patients with stage 3-4 chronic kidney disease （CKD） and to analyze the risk factors of the kidney function progression.MethodsThis was a cross-sectional study.The clinic data of elderly patients （≥60 years） with stable clinical manifestation in Beijing Hospital from January, 2014 to December, 2015 was collected.Based upon the eGFR derived from Cockcroft-Gault （CG） equation, all patients were divided into groups of CKD 3a group, CKD 3b group and CKD 4 group, respectively.Moreover, patients were separated into the old group （〈 80 years） and the very old group （≥80 years） based on the age.The demographic features, primary diseases history, body mass index （BMI）, blood routine, urine routine, blood biochemistry, Cystatin C and iPTH were recorded.Logistic regression analysis of kidney function progression was also conducted.ResultsOne-hundred and eighty-three cases were enrolled with a mean age of（80±9）years.Along with the descent of kidney function, the age, levels of proteinuria and iPTH gradually ascended （F=12.352, 5.910, 5.910; P=0.000, 0.003, 0.003, respectively） and the BMI and serum albumin gradually descended （F=9.758, 11.088; P=0.000, 0.000, respectively）. In addition, compared to the old group, very old group was associated with decreased level of eGFR[（37.1±9.9） ml·min-1·1.73 m^-2vs.（44.0±12.0） ml·min-1·1.73 m^-2,t=-4.280, P=0.000] and increased level of CystatinC[（1.71±0.84） mg/L vs. （1.40±0.69） mg/L, t=3.484, P=0.001]. The Logistic regression analysis indicated that the proteinuria was an independent risk factor for the progression of kidney function （ OR =3.856, P=0.004）.ConclusionsAs the gradually descended of the eGFR level in elderly patients with stage 3-4 CKD, age, proteinuria and iPTH gradually ascended, BMI and serum albumin descended, respectively.The level of eGFR decreased and CystatinC increased significantly with the increasing age.Proteinuria was an independent ri

关 键 词：慢性肾脏病 肾小球滤过率 危险因素 

分 类 号：R692[医药卫生—泌尿科学]