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收缩压异常与肾功能下降不同分期的关系
作者:王国威1  贡佳慧1  卓琳2  叶静陶1  刘丁阳1  汪秀英3  卓朗1 
单位:1. 徐州医科大学 公共卫生学院, 江苏 徐州 221004;
2. 新乡医学院 基础医学院, 河南 新乡 453000;
3. 徐州市中心医院 肾脏内科, 江苏 徐州 221004
关键词:肾功能下降 收缩压 危险因素 肾小球滤过率 慢性肾脏病 
分类号:R692
出版年·卷·期(页码):2018·37·第三期(385-390)
摘要:

目的:探讨体检者中收缩压(SBP)异常与肾功能下降不同分期之间的关系,为有效预防慢性肾脏病(CKD)提供决策依据。方法:收集178 617例健康体检者资料,以适合中国人的肾脏病饮食改良(cMDRD)简化公式估计肾小球滤过率(eGFR),根据eGFR水平将研究对象分为4组,通过χ2检验、Logistic回归分析探讨肾功能不同阶段与SBP异常的关系。结果:单因素分析中SBP异常是肾功能下降各阶段的危险因素(P<0.05,OR>1.00);多因素分析中SBP异常在eGFR<60 ml·min-1·1.73 m-2阶段是肾功能下降的危险因素(P<0.05,OR>1.00),在80 ml·min-1·1.73 m-2 ≤ eGFR < 90 ml·min-1·1.73 m-2时与肾功能下降存在关联但未表现出对肾脏的危险作用(P<0.05,OR<1.00),而在60 ml·min-1·1.73 m-2 ≤ eGFR < 80 ml·min-1·1.73 m-2时不是肾功能下降的影响因素(P>0.05)。结论:随着肾功能损伤阶段的前移,SBP异常所带来的危害可能更多地被肾脏代偿作用减轻或抵消。

Objective: To explore the relationship between abnormal systolic blood pressure(SBP) and different stages of decreased renal function, and to provide the basis for effective prevention of chronic kidney disease(CKD).Methods: A total of 178 617 people who took part in physical examination in the Central Hospital of Xuzhou from 2006 to 2012 were enrolled in this study and divided into four groups according to estimated glomerular filtration rate(eGFR) levels. eGFR was calculated by modified modification of diet in renal disease(MDRD) formula on the basis of data from Chinese chronic kidney disease patients. The association between elevated SBP and different stages of decreased renal function was assessed by χ2 test and Logistic regression analysis.Results: Univariate analysis showed that elevated SBP was associated with decreased renal function in all stages(P<0.05, OR>1.00). In multivariate Logistic regression analysis, elevated SBP was the risk factor for decreased renal function when eGFR<60 ml·min-1·1.73 m-2(P<0.05, OR>1.00), whereas the risk effect of elevated SBP on decreased renal function was no longer shown when 80 ml·min-1·1.73 m-2 ≤ eGFR < 90 ml·min-1·1.73 m-2(P<0.05, OR<1.00). In addition, multivariate Logistic regression analysis showed that the relationship between elevated SBP and decreased renal function disappeared when 60 ml·min-1·1.73 m-2 ≤ eGFR < 80 ml·min-1·1.73 m-2(P>0.05).Conclusion: In the early stage of decreased renal function, the damage of elevated SBP is more likely to be reduced or offset by the compensation of kidney.

参考文献:

[1] ZHANG L,WANG F,WANG L,et al.Prevalence of chronic kidney disease in China:a cross-sectional survey[J].The Lancet,2012,379(9818):815-822.
[2] 夏春英,姚利群,邵维斌,等.慢性肾脏病患者红细胞免疫功能异常及相关因素探讨[J].现代医学,2013,41(2):85-87.
[3] 布海霞,程李涛,张爱华,等.慢性肾脏病门诊患者单纯收缩期高血压与肾脏病分期的关系[J].中华肾脏病杂志,2015,31(1):19-23.
[4] YOUNG J H,KLAG M J,MUNTNER P,et al.Blood pressure and decline in kidney function:findings from the Systolic Hypertension in the Elderly Program(SHEP)[J].J Am Soc Nephrol,2002,13(11):2776-2782.
[5] CHENG L T,GAO Y L,GU Y,et al.Stepwise increase in the prevalence of isolated systolic hypertension with the stages of chronic kidney disease[J].Nephrol Dial Transplant,2008,23(12):3895-3900.
[6] MA Y C,ZUO L,CHEN J H,et al.Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease[J].J Am Soc Nephrol,2006,17(10):2937-2944.
[7] National Kidney Foundation.K/DOQI clinical practice guidelines for chronic kidney disease:evaluation,classification,and stratification[J].Am J Kidney Dis,2002,39(2 Suppl 1):S1-266.
[8] 中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华心血管病杂志,2011,39(7):579-616.
[9] WANG J G,STAESSEN J A,GONG L,et al.Chinese trial on isolated systolic hypertension in the Elderly Systolic Hypertension in China(Syst-China)Collaborative Group[J].Arch Intern Med,2000,160(2):211-220.
[10] 张路霞,左力,徐国宾,等.北京市石景山地区中老年人群中慢性肾脏病的流行病学研究[J].中华肾脏病杂志,2006,22(2):67-71.
[11] 林静,丁小强,吉俊,等.慢性肾脏病患者高血压现状的横断面调查[J].中华肾脏病杂志,2009,25(11):827-831.
[12] PARATI G,LIU X,OCHOA J E,et al.Clinical relevance of visit-tovisit blood pressure variability:impact on renal outcomes[J].J Hum Hypertens,2014,28(7):403-409.
[13] CORESH J,ASTOR B C,GREENE T,et al.Prevalence of chronic kidney disease and decreased kidney function in the adult US population:Third National Health and Nutrition Examination Survey[J].Am J Kidney Dis,2003,41(1):1-12.
[14] JOHNSON R J,HERRERA-ACOSTA J,SCHREINER G F,et al.Subtle acquired renal injury as a mechanism of salt-sensitive hypertension[J].N Engl J Med,2002,346:913-923.
[15] HOWIE A J.Benign' essential hypertension and kidney damage:a histopathologist's view[J].J Hum Hypertens,1996,10(10):691-694.
[16] HSU C Y.Does non-malignant hypertension cause renal insufficiency? Evidence based perspective[J].Curr Opin Nephrol Hypertens,2002,11(3):267-272.
[17] KOBORI H,NANGAKU M,NAVAR L G,et al.The intrarenal renin-angiotensin system:from physiology to the pathobiology of hypertension and kidney disease[J].Pharmacol Rev,2007,59(3):251-287.
[18] TOWNSEND R R,TALER S J.Management of hypertension in chronic kidney disease[J].Nat Rev Nephrol,2015,11(9):555-563.
[19] KLEIN I H,LIGTENBERG G,NEUMANN J,et al.Sympathetic nerve activity is inappropriately increased in chronic renal disease[J].J Am Soc Nephrol,2003,14(12):3239-3244.
[20] 唐朝枢.病理生理学[M].2版.北京:北京大学医学出版社,2009:183.
[21] NAVAR L G,KOBORI H,PRIETO-CARRASUQERO M,et al.Intrarenal angiotensin Ⅱ and hypertension[J].Curr Hypertens Rep,2003,5(2):135-143.
[22] NAVAR L G.The role of the kidneys in hypertension[J].J Clin Hypertens(Greenwich),2005,7(9):542-549.
[23] 陈灏珠.实用内科学[M].11版.北京:人民卫生出版社,2001:1929-1948.
[24] 肖相如.慢性肾功能衰竭的治疗思路研究[J].中医杂志,1994,35(12):716.
[25] JATOS Study Group.Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients(JATOS)[J].Hypertens Res,2008,31(12):2115-2127.
[26] ACCORD Study Group,CUSHMAN W C,EVANS G W,et al.Effects of intensive blood pressure control in type 2 diabetes mellitus[J].N Engl J Med,2010,362(17):1575-1585.
[27] SPRINT Research Group,WRIGHT J T Jr,WILLIAMSON J D,et al.A randomized trial of intensive versus standard blood-pressure control[J].N Engl J Med,2015,373(22):2103-2116.

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