糖尿病肾脏病患者体力活动水平与全因死亡风险研究及炎症的中介效应  

Study on the physical activity levels and all-cause mortality risk in diabetic kidney disease patients and mediating effect of inflammation

作　　者：田双双 张芳[1] 郝慧强 周晓霜[1] Tian Shuangshuang;Zhang Fang;Hao Huiqiang;Zhou Xiaoshuang(Big Data Center of Kidney Disease,Shanxi Provincial People's Hospital,Taiyuan 030012,China;Department of Emergency Medicine,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西省人民医院肾脏病大数据中心,太原030012 [2]山西医科大学第二医院急诊医学科,太原030001

出　　处：《中华流行病学杂志》2025年第4期717-723,共7页Chinese Journal of Epidemiology

摘　　要：目的分析糖尿病肾脏病(DKD)患者的体力活动水平与全因死亡风险之间的关联并探讨炎症的中介效应。方法基于美国国家健康和营养调查数据,与美国国家死亡指数进行匹配形成前瞻性队列,纳入2007-2018年共6个周期59482名参与者,经纳入排除标准确定2214名DKD患者为研究对象。采用Cox比例风险回归模型分析体力活动水平对全因死亡风险的影响;采用中介效应模型分析炎症指标在体力活动和全因死亡风险关联中的中介效应。结果不同体力活动水平组患者的生存曲线差异有统计学意义(P<0.001),随着体力活动水平的升高,患者的死亡风险降低;体力活动高水平组的患者死亡风险低于不活动组的患者(HR=0.64,95%CI:0.53~0.78),差异有统计学意义(P<0.001)。体力活动高水平组的患者体内炎症指标[白细胞(WBC)、中性粒细胞(NEU)、C反应蛋白(CRP)]水平低(P<0.001),WBC、NEU、CRP、NEU与淋巴细胞比率(NLR)以及全身炎症指数(SII)是DKD患者死亡的独立危险因素(均HR>1.00),其中综合指标lgNLR(HR=2.06,95%CI:1.76~2.41)和lgSII(HR=1.44,95%CI:1.26~1.64)的风险效应值较大。中介效应分析结果显示,体力活动通过NEU水平影响DKD患者全因死亡风险的间接效应为-0.033(95%CI:-0.052~-0.002),中介效应有统计学意义(P<0.05),中介效应比例为9.75%。结论体力活动是DKD患者全因死亡风险的保护因素,可以部分通过降低NEU水平来降低DKD患者的全因死亡风险。Objective To analyze the association between physical activity levels and all-cause mortality risk in patients with diabetic kidney disease(DKD)and to investigate the mediating effect of inflammation.Methods Based on National Health and Nutrition Examination Survey of America data matched with the National Death Index of America,a prospective cohort was formed,including 59482 participants from six cycles between 2007 and 2018.After applying inclusion and exclusion criteria,2214 DKD patients were selected for the study.Cox proportional hazard regression models were used to analyze the impact of physical activity levels on all-cause mortality risk.The mediating effect of inflammatory markers in the association between physical activity and all-cause mortality risk was explored.Results There were statistically significant differences in survival curves among different physical activity level groups(P<0.001).As physical activity levels increased,the risk of mortality decreased.Patients in the high physical activity group had a lower mortality risk compared to those in the inactive group(HR=0.64,95%CI:0.53-0.78),with a statistically significant difference(P<0.001).Patients with higher physical activity levels had lower levels of inflammation(white blood cell,neutrophil,and C-reactive protein)(P<0.001).White blood cell,neutrophil,C-reactive protein,the neutrophil-to-lymphocyte ratio(NLR),and the systemic inflammation index(SII)were independent risk factors for mortality in DKD patients(HR>1.00),with higher risk effects observed for the combined indicator lgNLR(HR=2.06,95%CI:1.76-2.41)and lgSII(HR=1.44,95%CI:1.26-1.64).Mediation analysis showed that physical activity had an indirect effect on all-cause mortality risk through neutrophil,with an effect size of-0.033(95%CI:-0.052--0.002),which was statistically significant(P<0.05),with a mediation effect proportion of 9.75%.Conclusion Physical activity is a protective factor against all-cause mortality risk in DKD patients,partly through reducing neutrophil levels.

关 键 词：糖尿病肾脏病 体力活动 炎症 死亡 中介分析 

分 类 号：R587.2[医药卫生—内分泌]