北京市城市老年人群尿白蛋白-肌酐比值、心血管健康评分与心脑血管死亡及全因死亡的关联研究  

Association of urinary albumin-to-creatinine ratio and cardiovascular health score with cardio-cerebrovascular mortality and all-cause mortality in urban elderly residents in Beijing

作　　者：杨钧涵 李皓炜 陈仕敏 李蓉蓉 李怀昊 石岳庭 鲍颖慧 杜晟岩 王文畅 杨姗姗 王建华 方向华 杨鸿兵 马丁 王盛书 刘淼[2] 何耀 Yang Junhan;Li Haowei;Chen Shimin;Li Rongrong;Li Huaihao;Shi Yueting;Bao Yinghui;Du Shengyan;Wang Wenchang;Yang Shanshan;Wang Jianhua;Fang Xianghua;Yang Hongbing;Ma Ding;Wang Shengshu;Liu Miao;He Yao(Medical School of Chinese People's Liberation Army,Beijing 100853,China;Department of Anti-Nuclear,Biological,Chemical Medicine,Graduate School,Chinese People's Liberation Army General Hospital,Beijing 100853,China;Institute of Geriatrics,Beijing Key Laboratory of Aging and Geriatrics,National Clinical Research Center for Geriatrics Diseases,Second Medical Center,Chinese People's Liberation Army General Hospital,Beijing 100853,China;Department of Geriatrics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Cardiology,Second Medical Center,Chinese People's Liberation Army General Hospital,Beijing 100853,China;Department of Disease Control and Prevention,First Medical Center,Chinese People's Liberation Army General Hospital,Beijing 100853,China;Evidence-Based Medical Center,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Miyun County Hospital of Traditional Chinese Medicine,Beijing 101500,China;State Key Laboratory of Kidney Diseases,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]中国人民解放军总医院研究生院三防医学教研室,北京100853 [3]中国人民解放军总医院第二医学中心老年医学研究所,衰老及相关疾病研究北京市重点实验室,国家老年疾病临床医学研究中心,北京100853 [4]首都医科大学附属北京友谊医院老年医学科,北京100050 [5]中国人民解放军总医院第二医学中心心血管内科,北京100853 [6]中国人民解放军总医院第一医学中心疾病预防控制科,北京100853 [7]首都医科大学宣武医院循证医学中心,北京100053 [8]北京密云区中医医院,北京101500 [9]肾脏疾病国家重点实验室,北京100853

出　　处：《中华流行病学杂志》2025年第3期385-392,共8页Chinese Journal of Epidemiology

基　　金：国家自然科学基金(82173589,82173590);北京市自然科学基金(7252181);首都卫生发展科研专项(2022-2G-5031,2024-2G-5033);国家重点研发计划(2022YFC2503605);学科中坚人才。

摘　　要：目的探讨北京市城市老年人群中正常范围内尿白蛋白-肌酐比值(UACR)和心血管健康(CVH)评分与心脑血管死亡及全因死亡的关联。方法基于北京城乡健康老龄队列研究,对UACR处于正常范围内的1817名老年研究对象进行数据分析。UACR同时作为连续变量和分类变量纳入研究。使用“生命八要素”制定CVH评分。使用SPSS 26.0和R 4.2.1软件进行t检验、χ2检验及非参数检验,使用限制性立方样条及多因素Cox比例风险回归模型探究UACR与心脑血管死亡及全因死亡的非线性关系和风险关联,并按CVH评分进行分层分析。结果截至2021年3月31日,中位随访时间M(Q1,Q3)为11.28(10.84,11.36)年,随访期间共308名研究对象死亡,死亡密度为163.87/万人年。研究对象年龄为(71.4±6.6)岁;女性1070名。低CVH评分组中,随着UACR降低,心脑血管死亡及全因死亡风险均存在下降趋势(HR=0.500,95%CI:0.341~0.734;HR=0.793,95%CI:0.647~0.971),高CVH评分组中,随着UACR降低,心脑血管死亡风险存在下降趋势(HR=0.665,95%CI:0.447~0.990)。与低CVH评分组和高UACR组相比,高CVH评分组和低UACR组的心脑血管死亡及全因死亡风险分别降低68.9%和45.6%(HR=0.311,95%CI:0.131~0.739;HR=0.544,95%CI:0.360~0.822),高CVH评分组和高UACR组的全因死亡风险降低26.7%(HR=0.733,95%CI:0.542~0.993)。结论在北京市城市老年人群中,正常范围内UACR降低与心脑血管死亡及全因死亡风险降低相关,低CVH评分组中,UACR降低对心脑血管死亡及全因死亡均有保护作用,CVH状态与正常范围内UACR的联合效应对心脑血管死亡及全因死亡风险的保护效应更高。Objective To investigate the association of urinary albumin-to-creatinine ratio(UACR)in normal range and cardiovascular health(CVH)score with cardio-cerebroascular and all-cause mortality in urban elderly residents in Beijing.Methods Based on Beijing Healthy Aging Cohort Study,data from 1817 elderly participants with normal UACR were analyzed,and UACR was used as both continuous and categorical variable."Life's Essential 8"was used to develop a CVH score.Statistical analysis was performed by using software SPSS 26.0 and R 4.2.1,including two independent samples t-test,χ2 test and non-parametric test.Multivariable Cox proportional hazard regression models stratified by CVH score and the restricted cubic spline were used to analyse the association of UACR with the risk for cardio-cerebrovascular and all-cause mortality.Results By March 31,2021,the median follow-up time M(Q1,Q3)was 11.28(10.84,11.36)years,a total of 308 deaths were recorded during follow-up,and the mortality density was 163.87/10000 person-years.The age of the participants was(71.4±6.6)years,and 1070 participants were women.The results showed that the risk for both cardio-cerebrovascular disease and all-cause mortality decreased with the decrease of UACR in the low CVH score group(HR=0.500,95%CI:0.341-0.734;HR=0.793,95%CI:0.647-0.971),and in the high CVH score group,there was a decreasing trend in the risk for cardio-cerebrovascular mortality with the decrease of UACR(HR=0.665,95%CI:0.447-0.990).Compared with the participants with low CVH score and higher UACR,the risk for cardio-cerebrovascular and all-cause mortality decreased by 68.9%and 45.6%,respectively,in the participants with high CVH score and lower UACR(HR=0.311,95%CI:0.131-0.739;HR=0.544,95%CI:0.360-0.822),and the risk for all-cause mortality decreased by 26.7%in the participants with high CVH score and higher UACR(HR=0.733,95%CI:0.542-0.993).Conclusions In urban elderly residents in Beijing,higher UACR were associated with a significantly increased risk for cardio-cerebrovascular and a

关 键 词：老年人 心血管健康评分 尿白蛋白-肌酐比值 心脑血管死亡 全因死亡 

分 类 号：R54[医药卫生—心血管疾病]