动态动脉硬化指数与慢性肾脏病患者不良预后的关系  

Association between ambulatory arterial stiffness index and poor prognosis in patients with chronic kidney disease

作　　者：郭辛茹 蔡广研 梁爽 王文苓 杨莹 李一莎 Guo Xinru;Cai Guangyan;Liang Shuang;Wang Wenling;Yang Ying;Li Yisha(Department of Nephropathy,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第一医学中心肾内科,北京100853

出　　处：《中华肾脏病杂志》2021年第7期552-557,共6页Chinese Journal of Nephrology

基　　金：国家科技支撑计划(2015BAI12B06);国家重点研发计划(2018YFA0108803)。

摘　　要：目的:探讨动态动脉硬化指数(ambulatory arterial stiffness index,AASI)与慢性肾脏病(chronic kidney disease,CKD)患者肾脏不良预后的关系。方法:采用前瞻性研究方法将2017年12月到2018年12月在中国人民解放军总医院第一医学中心肾内科住院期间自愿行动态血压监测的117例CKD非透析患者作为研究对象。根据AASI三分位数,将患者分为低AASI组(≤0.414,n=38)、中AASI组(0.414~0.517,n=40)和高AASI组(≥0.517,n=39),比较3组间临床基线资料的差异。对入组患者进行随访,随访截至2020年8月。应用Kaplan-Meier生存分析法及Cox比例风险回归模型分析AASI对肾脏不良预后的影响。结果:117例患者中位年龄为61(49,65)岁,男性80例(68.4%),高血压91例(77.8%)。经过27个月的中位随访时间,34例CKD患者出现复合终点事件[肾脏替代治疗(透析或肾移植)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)下降40%及死亡],其中10例透析,19例eGFR下降40%,5例死亡。不同AASI组年龄、血红蛋白、体重指数、eGFR、24 h平均收缩压、日间平均收缩压、夜间平均收缩压、清晨平均收缩压、24 h平均动脉压、24 h平均脉压之间的差异均具有统计学意义(均P<0.05)。Kaplan-Meier生存分析结果显示,患者AASI水平越高,累积生存率越低(Log-rank检验χ^(2)=13.111,P=0.001)。单因素Cox回归分析结果显示,高AASI是发生肾脏终点事件的影响因素(P<0.05),校正年龄、性别、平均动脉压、eGFR、24 h尿蛋白量、糖尿病及体重指数后,无论是在分类变量分析模型中还是在连续变量分析模型中,高AASI均为CKD患者肾脏不良预后的独立影响因素(HR=2.88,95%CI 1.00~8.26,P=0.050;HR=1.50,95%CI 1.02~2.21,P=0.039)。结论:高AASI是CKD患者肾脏不良预后的独立影响因素。Objective To investigate the association between ambulatory arterial stiffness index(AASI)and renal poor prognosis in patients with chronic kidney disease(CKD).Methods A prospective study was conducted to enroll 117 non-dialysis patients with CKD who volunteered for receiving ambulatory blood pressure monitoring test from December 2017 to December 2018 in the Department of Nephropathy of the First Medical Center of Chinese PLA General Hospital.According to the AASI tertiles,patients were divided into low AASI group(≤0.414,n=38),medium AASI group(0.414-0.517,n=40),and high AASI group(≥0.517,n=39).The differences of clinical baseline information among the three groups were compared.The follow-up time was until August 2020.Kaplan-Meier curve and Cox proportional hazard regression model were used to explore the effect of AASI on renal poor prognosis.Results The median age of 117 patients was 61(49,65)years old.There were 80 males(68.4%)and patients with hypertension accounted for 77.8%(91 cases).After a median follow-up of 27 months,34 cases had composite endpoint events[renal replacement therapy(dialysis or kidney transplantation),40%estimated glomerular filtration rate(eGFR)decline,and death],of which 10 patients were on dialysis,19 patients had 40%eGFR decline,and 5 patients died.There were significant differences in age,hemoglobin,body mass index,eGFR,24 h systolic blood pressure(SBP),daytime SBP,nighttime SBP,morning SBP,24 h mean arterial pressure and 24 h pulse pressure among the three groups(all P<0.05).Kaplan-Meier survival analysis indicated that higher AASI was associated with lower cumulative survival rate in patients(Log-rank testχ^(2)=13.111,P=0.001).Univariate Cox regression analysis showed that high AASI was an influencing factor for renal endpoint events(P<0.05),and after adjusting for age,gender,mean arterial pressure,eGFR,24 h urine protein,diabetes and body mass index,high AASI was an independent influencing factor for renal poor prognosis in classification and continuous variable analysis mo

关 键 词：肾功能不全 慢性 动脉硬化 血压 预后 

分 类 号：R692[医药卫生—泌尿科学]