肾小球滤过率增龄变化及其影响因素的研究  

Study on changes in the glomerular filtration rate with aging and their influencing factors

作　　者：张娟[1] 魏璐[1] 张宇[1] 裴小华[1] 柏云[1] 雍珍珠 沈雪 张群 赵卫红[1] Zhang Juan;Wei Lu;Zhang Yu;Pei Xiaohua;Bai Yun;Yong Zhenzhu;Shen Xue;Zhang Qun;Zhao Weihong(Division of Nephrology,Department of Geriatrics,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Health Management Center,the First Affiliated Hospital of Nanjing Medical University,Nanjing,210029,China)

机构地区：[1]南京医科大学第一附属医院老年肾科,210029 [2]南京医科大学第一附属医院健康管理中心,210029

出　　处：《中华老年医学杂志》2021年第10期1250-1254,共5页Chinese Journal of Geriatrics

基　　金：国家重点研发计划(2018YFC2002100、2018YFC2002102);江苏省医学重点学科(ZDXKA2016003);江苏省医学人才项目(ZDRCA2016021);江苏省干部保健课题(BJ17018);江苏省人民医院511工程(JSPH-511A-2018-5)。

摘　　要：目的探讨大样本量体检人群肾小球滤过率(eGFR)增龄变化,分析其相关影响因素。方法横断面研究,纳入2017年1月至2018年1月在南京医科大学第一附属医院体检中心体检的成年患者,依据年龄分为7组(18~29、30~39、40~49、50~59、60~69、70~79、≥80岁)。使用基于血清肌酐的慢性肾脏病流行病学合作研究公式(CKD-EPIScr)计算eGFR,采用多元线性回归法分析eGFR降低的影响因素,线性趋势χ^(2)检验比较不同年龄组eGFR<60 ml·min^(-1)·1.73m^(-2)发生率的差异。结果共33824例体检者纳入本研究,eGFR随增龄下降,平均年下降速度为0.83 ml·min^(-1)·1.73m^(-2),在30~39岁及70~79岁组eGFR的年平均下降速度显著增快(F=9.51、5.37,均P=0.000)。多元线性回归分析结果显示,无论非老年组或老年组,年龄均为eGFR降低的最主要因素(β=-0.604、-0.534,均P=0.000),其次为血尿酸(BUA)(β=-0.270、-0.280,均P=0.000)及空腹血糖(FBG)(β=-0.064、-0.046,均P=0.000)、收缩压(SBP)(β=-0.015、-0.028,均P<0.05)和舒张压(DBP)(β=-0.010、-0.026,均P<0.05)。非老年组中eGFR与体质指数(BMI)、血清白蛋白(ALB)呈负相关(β=-0.028、-0.047,均P=0.000);在老年组中eGFR与ALB呈正相关(β=0.022,P=0.031),但与BMI、TC、LDL-C无明显相关性。体检人群eGFR<60 ml·min^(-1)·1.73m^(-2)的发生率随增龄而增加,总发生率为1.55%(523/33824),其中60岁及以上老年人占73.80%;各年龄组发生率自18~29岁组的0.22%(14/6453)升至≥80岁组的22.57%(214/948),上升趋势变化有统计学意义(χ^(2)=2433.71,P=0.000)。结论体检人群eGFR随增龄显著降低,老年人eGFR<60 ml·min^(-1)·1.73m^(-2)发生率高;除年龄外,BUA、FBG、SBP、DBP水平增高及ALB降低是老年人eGFR降低的影响因素。Objective To evaluate changes in the estimate glomerular filtration rate(eGFR)with aging and the risk factors.Methods A retrospective cross-sectional study was performed based on people receiving physical examinations at the First Affiliated Hospital of Nanjing Medical University from January 2017 to January 2018.Subjects were divided into seven subgroups according to age:18-29,30-39,40-49,50-59,60-69,70-79,and≥80 years old.eGFR was estimated by the Chronic Kidney Disease Epidemiology Collaboration(CKD-EPIScr)equation.Multivariate linear regression was used to analyze the correlation between eGFR and the influencing variables.The chi-square test was used to compare the incidences of eGFR<60 ml·min^(-1)·1.73m^(-2)in different age groups.Results A total of 33824 participants were included in this study.There was a negative linear eGFR-age correlation in the subjects.The mean annual rate of decline in eGFR was 0.83 ml·min^(-1)·1.73m^(-2).Furthermore,the decline was steady and accelerated from the third and seventh decade onward(F=9.51,5.37,both P=0.000).Multiple linear regression analysis showed that aging was the most prominent factor(β=-0.604,-0.534,both P=0.000),followed by serum uric acid(BUA)(β=-0.270,-0.280,both P=0.000),fasting blood-glucose(FBG)(β=-0.064,-0.046,both P=0.000),systolic blood pressure(SBP)(β=-0.015,-0.028,both P<0.05),and diastolic blood pressure(DBP)(β=-0.010,-0.026,both P<0.05).In non-elderly subjects,eGFR was found to have negative associations with body mass index(BMI)and albumin(ALB)(β=-0.028,-0.047,all P=0.000).However,in the elderly,eGFR was positively associated with ALB(β=0.022,P=0.031).eGFR showed no statistically significant correlation with BMI,TC and LDL-C.The prevalence of eGFR<60 ml·min^(-1)·1.73m^(-2)increased with age,at 1.55%(523/33824)for all subjects,of whom 73.80%(386/523)were aged over 60.The incidence obviously increased from 0.22%(14/6453)for aged 18-29 to 22.57%(214/948)for aged 80 and above(χ^(2)=2433.71,P=0.000).Conclusions eGFR decreases significantly

关 键 词：肾小球滤过率 危险因素 

分 类 号：R692[医药卫生—泌尿科学]