基于回顾性队列探索云南省老年人代谢综合征与慢性肾脏病早期肾脏损伤联系  

Metabolic syndrome and early renal function injury of chronic kidney disease in elderly: A retrospective cohort study in Yunnan Province

作　　者：李瑞芬 张燕梅 韦琳誉 马剑华[3] 古雪岩 白俊 李鹏 陈琬琰 赵惠敏 张莉[4] 苏莉[1] Li Ruifen;Zhang Yanmei;Wei Linyu;Ma Jianhua;Gu Xueyan;Bai Jun;Li Peng;Chen Wanyan;Zhao Huimin;Zhang Li;Su Li(Department of Maternal,Child and Adolescent Health,School of Public Health,Lanzhou University,Lanzhou 730000,China;Center for Disease Control and Prevention,Mengzi City,Honghe Prefecture,Yunnan Province,Honghe 661199,China;Institute of Nutrition and Food Hygiene,School of Public Health,Lanzhou University,Lanzhou 730000,China;Medical Experimental Center,School of Public Health,Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学公共卫生学院儿少卫生与妇幼保健研究所,兰州730000 [2]云南省红河州蒙自市疾病预防控制中心,红河661199 [3]兰州大学公共卫生学院营养与食品卫生研究所,兰州730000 [4]兰州大学公共卫生学院实验中心,兰州730000

出　　处：《中华内分泌代谢杂志》2023年第9期765-771,共7页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探究老年人代谢综合征与慢性肾脏病(chronic kidney disease, CKD)早期肾脏损伤发生风险的联系。方法利用云南省蒙自市2016年1月至2018年12月4 495名常住老年人体检数据建立回顾性队列, 收集疾病史、生活习惯及相关体检信息, 采用Cox风险回归模型探究代谢综合征及其各组分与CKD早期肾脏损伤发生风险的联系。结果 4 495名老年人年龄中位数为71.00(67.00, 75.00)岁, 代谢综合征检出率为21.98%。随访期1 300例(28.92%)发生CKD早期肾脏损伤。单因素Cox回归显示, 代谢综合征组分数量与CKD早期肾脏发生风险有关, 1个代谢组分异常(HR=1.23, 95%CI 1.03~1.47,P=0.022)、2个代谢组分异常(HR=1.54, 95%CI 1.28~1.84,P<0.001)、3个及以上代谢组分异常(HR=1.38, 95%CI 1.14~1.67,P<0.001)均会显著增加CKD早期肾脏损伤发生的风险。多因素Cox回归显示, 空腹三酰甘油升高(HR=1.20, 95%CI 1.07~1.36,P=0.003)、高密度脂蛋白胆固醇(HDL-C)降低(HR=1.25, 95%CI 1.09~1.43,P=0.002)是CKD早期肾脏损伤的危险因素, 偶尔进行体育锻炼(HR=0.57, 95%CI 0.33~0.98,P=0.042)、每天进行体育锻炼(HR=0.57, 95%CI 0.49~0.66,P<0.001)是CKD早期肾脏损伤保护因素。结论 1个及以上代谢组分异常即可显著增加老年人CKD早期肾脏损伤发生风险, 三酰甘油升高、HDL-C降低可能是老年人短期内发生CKD早期肾脏损伤的危险因素。Objective To investigate the association between metabolic syndrome and the risk of early renal function injury in chronic kidney disease(CKD)in the elderly.Methods A retrospective cohort was established based on health check-up data of 4495 elderly residents in Mengzi City,Yunnan Province from January 2016 to December 2018.The medial history,living habits,and related physical examination information were collected.Cox hazard regression model was used to explore the association between metabolic syndrome,along with its components,and the early renal function injury in CKD.Results The median age of the elderly was 71.00(67.00,75.00)years,with metabolic syndrome detection rate of 21.98%.Early renal function injury of CKD developed in 1300(28.92%)subjects during the follow-up.Univariate Cox regression showed that the number of metabolic syndrome components was associated with the risk of early kidney development in CKD.The HRs were 1.23(95%CI 1.03-1.47,P=0.022)with 1 component,1.54(95%CI 1.28-1.84,P<0.001)with 2,and 1.38(95%CI 1.14-1.67,P<0.001)with 3 or more.Multivariate Cox regression showed that elevated fasting triglycerides(HR=1.20,95%CI 1.07-1.36,P=0.003)and lower high density lipoprotein-cholesterol(HDL-C;HR=1.25,95%CI 1.09-1.43,P=0.002)were risk factors for early kidney injury in CKD,while doing some physical activity(HR=0.57,95%CI 0.33-0.98,P=0.042),or on daily basis(HR=0.57,95%CI 0.49-0.66,P<0.001)was a protective factor for early kidney injury in CKD.Conclusion The abnormality of one or more metabolic components can significantly increase the risk of early kidney injury in the elderly with CKD.Elevated triglyceride and decreased HDL-C may be the risk factors.

关 键 词：代谢综合征 慢性肾脏病 回顾性队列 老年人 

分 类 号：R692[医药卫生—泌尿科学] R589[医药卫生—外科学]