中老年人群尿蛋白水平与慢性阻塞性肺疾病发病的关联性研究  

Correlation between urinary protein levels and the incidence of chronic obstructive pulmonary disease in middle-aged and elderly population

作　　者：宋家慧 王小楠[1] 刘庆平 李智韬 吴抗[1] 刘晓琳[1] 高娇娇 柯居中[1] 王娜[2] 付朝伟[2] 赵根明[2] 阮晓楠[1] SONG Jiahui;WANG Xiaonan;LIU Qingping;LI Zhitao;WU Kang;LIU Xiaolin;GAO Jiaojiao;KE Juzhong;WANG Na;FU Chaowei;ZHAO Genming;RUAN Xiaonan(Pudong New Area Center for Disease Control and Prevention,Shanghai 200136,China;Fudan University,Shanghai 200433,China)

机构地区：[1]上海市浦东新区疾病预防控制中心,上海200136 [2]复旦大学,上海200433

出　　处：《公共卫生与预防医学》2024年第4期11-15,共5页Journal of Public Health and Preventive Medicine

基　　金：浦东新区卫生健康委员会卫生计生科研项目青年科技项目(PW2020B-19)。

摘　　要：目的 探索基线尿蛋白水平与慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)发病的关系。方法 对上海浦东新区40岁以上常住居民开展问卷调查、血样、尿样收集、体格检查和肺功能检查。根据基线尿微量白蛋白/尿肌酐(urine albumin-to-creatinine ratio,ACR)四分位数将观察对象分为4组(0~1.65 mg/g,1.65~4.89 mg/g,4.89~10.78 mg/g,≥10.78 mg/g)。采用Cox回归探究ACR水平与中老年人群新发COPD的关系。结果 3 105名调查对象中位随访时间为3.212年(P_(25)~P_(75):3.102~3.473),共发现116名COPD新发病例,发病密度为10.423/千人年。4组ACR水平发病密度分别依次为7.922/千人年、8.300/千人年、11.419/千人年和13.843/千人年。Cox回归分析显示,随着ACR水平的升高,COPD发病率呈上升趋势(χ^(2)=4.396,P=0.036)。校正性别、年龄、文化程度、工作中是否接触粉尘、儿童期是否发生肺炎、吸烟、COPD家族史、向心性肥胖、糖尿病和高血压等多因素后,以基线ACR水平0~1.65 mg/g为参考组,ACR水平≥10.78 mg/g时,COPD的发病风险是参考组的2.499倍(95%CI:1.460~4.276)。结论 中老年人群尿蛋白升高可增加COPD发病风险,早期监测尿蛋白水平有益于COPD预防。Objective To explore the relationship between baseline urinary protein levels and the onset of chronic obstructive pulmonary disease(COPD).Methods A questionnaire survey,blood and urine sample collection,physical examination,and pulmonary function test were conducted among permanent residents over 40 years old in Pudong New Area,Shanghai.The subjects were divided into four groups based on the baseline urine albumin-to-creatinine ratio(ACR) quartiles(0~1.65 mg/g,1.65~4.89 mg/g,4.89~10.78 mg/g,and ≥10.78 mg/g).Cox regression analysis was used to explore the relationship between ACR levels and the incidence of COPD in middle-aged and elderly people.Results Among the 3 105 subjects,the median follow-up time was 3.212 years(P_(25)~P_(75)∶3.102~3.473).116 new cases of COPD were observed,with an incidence density of 10.423 per 1 000 person-years.The incidence densities for COPD at four ACR levels were 7.922 per 1 000 person-years,8.300 per 1 000 person-years,11.419 per 1 000 person-years,and 13.843 per 1 000 person-years,respectively.Cox regression analysis revealed that as the ACR level increased,there was a rising trend in the incidence rate of COPD( χ~2 =4.396,P=0.036).After adjusting for gender,age,education level,occupational exposure to dust,history of childhood pneumonia,smoking,family history of COPD,central obesity,and hypertension,the risk of developing COPD was 2.499 times higher(95% CI:1.460~4.276) for ACR levels ≥10.78 mg/g compared to the reference group with a baseline ACR level of 0~1.65 mg/g.Conclusion Elevated ACR levels in middle-aged and elderly population may increase the risk of COPD,and early monitoring of urine protein levels is beneficial for COPD prevention.

关 键 词：中老年人群 慢性阻塞性肺疾病 尿蛋白 前瞻性研究 

分 类 号：R181[医药卫生—流行病学]