收缩压纵向轨迹对新发慢性肾脏病的影响  

Relationship of longitudinal trajectory of systolic blood pressure to new-onset chronic kidney disease

作　　者：黄金杰[1] 李俊娟[1] 张昕蕾 周靖[1] 马一涵 张俊录[3] 王茹[1] 郭智珍 吴寿岭[4] Huang Jin-Jie;Li Jun-Juan;Zhang Xin-Lei;Zhou Jing;Ma Yi-Han;Zhang Jun-Lu;Wang Ru;Guo Zhi-Zhen;Wu Shou-Ling(Department of Nephrology,Kailuan General Hospital,Tangshan,Hebei 063000,China;Graduate School of North China University of Science and Technology,Tangshan,Hebei 063000,China;Department of Pathology,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]华北理工大学研究生院,河北唐山063000 [3]开滦总医院病理科,河北唐山063000 [4]开滦总医院心内科,河北唐山063000

出　　处：《解放军医学杂志》2021年第1期49-56,共8页Medical Journal of Chinese People's Liberation Army

基　　金：河北省卫生健康委员会科研基金(20171430)。

摘　　要：目的探讨收缩压(SBP)纵向轨迹对新发慢性肾脏病(CKD)的影响。方法选取符合标准的13 985名参加健康体检的开滦集团在职及离退休职工进行前瞻性队列研究,通过SAS Proc Traj程序确定研究对象前3次健康体检的SBP纵向轨迹,生成5个不同的SBP轨迹组:低-稳定轨迹组(106.42~109.43 mmHg,n=2927)、中-稳定轨迹组(120.63~124.46 mmHg,n=6916)、中-高轨迹组(132.22~142.97 mmHg,n=2716)、高-中轨迹组(156.77~134.15 mmHg,n=668)及高-稳定轨迹组(154.65~158.98 mmHg,n=758)。采用Log-Rank检验比较不同SBP轨迹组随访期间新发CKD的累积发病率,采用多因素Cox回归模型分析SBP纵向轨迹对新发CKD的影响。结果 13 985例受试者的年龄为(49.5±11.0)岁,其中男10 712例(76.6%),女3273例(23.4%)。随访时间为(6.8±1.0)年。新发CKD的累积发病率为13.9%(1187/13 985),其中低-稳定轨迹组、中-稳定轨迹组、中-高轨迹组、高-中轨迹组、高-稳定轨迹组分别为7.7%(147/2927)、12.2%(514/6916)、17.8%(291/2716)、21.9%(93/668)、35.4%(142/758),呈逐渐升高趋势,经Log-Rank检验差异有统计学意义(χ2=177.561,P<0.001)。多因素Cox风险比例回归模型分析结果显示,与低-稳定轨迹组比较,中-高轨迹组、高-中轨迹组、高-稳定轨迹组均为新发CKD的危险因素。多因素调整后,其HR值及95%CI分别为1.36(1.04~1.77)、1.62(1.08~2.43)、2.06(1.40~3.02),且SBP纵向轨迹对新发CKD的影响优于基线SBP水平。结论 SBP纵向轨迹水平升高是新发CKD的危险因素。Objective To investigate the relationship of longitudinal trajectory of systolic blood pressure (SBP) to new-onset chronic kidney disease (CKD).Methods A prospective cohort study was performed with a total of 13 985 on job and retired Kailuan Group employees who met the standard and participated in health examination.SAS Proc Traj program was used to identify the longitudinal trajectories of SBP of the first three times health examination,and 5 different SBP trajectory groups formed:low-stability trajectory group (106.42-109.43 mmHg,n=2927),medium-stability trajectory group (120.63-124.46 mmHg,n=6916),medium-high trajectory group (132.22-142.97 mmHg,n=2716),high-medium trajectory group (156.77-134.15 mmHg,n=668) and high-stability trajectory group (154.65-158.98 mmHg,n=758).Log-rank test was performed to compare the differences of new-onset CKD cumulative incidence among different SBP trajectory groups during follow-up;Multi-Cox regression model was used to analyze the effect of different SBP longitudinal trajectories on new-onset CKD.Results The mean age of 13 985 subjects was (49.5±11.0) years,including 10 712 males (76.6%) and 3273 females (23.4%),the mean follow-up time was (6.8±1.0) years.The cumulative incidence of CKD was 13.9% (1187/13 985).The cumulative incidences of CKD in low-stability trajectory group,medium-stability trajectory group,medium-high trajectory group,high-medium trajectory group and high-stability trajectory group were 7.7% (147/2927),12.2% (514/6916),17.8% (291/2716),21.9% (93/668),and 35.4% (142/758),respectively,the incidence of CKD increased with elevated stability trajectory (log-rank χ~2=177.561,P<0.001).Multi-Cox regression model analysis showed that with adjusted confounding factors,compared with the subjects in low-stability trajectory group,SBP longitudinal trajectories were the risk factors for new-onset CKD in medium-high trajectory group,high-medium trajectory group and high-stability trajectory group,and the HR and 95%CI were 1.36 (1.04-1.77),1.62 (1.08-2.43) and 2.06 (1

关 键 词：收缩压纵向轨迹 新发慢性肾脏病 队列研究 

分 类 号：R692.5[医药卫生—泌尿科学] R331.3[医药卫生—外科学]