舒张压异常对肾功能的影响
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摘要
目的探讨舒张压与估算的肾小球滤过率(eGFR)下降的关系。方法收集2010-2012年徐州市中心医院健康体检者64 066人,应用中国肾脏病膳食改良公式(C-MDRD)方程计算eGFR,将研究人群分为eGFR正常组[≥60mL/(min·1.73m2)]和eGFR下降组[<60mL/(min·1.73m2)]。通过Logistic回归分析高舒张压与肾功能下降的关系。结果与eGFR正常组比较,eGFR下降组年龄较大[(68.3±13.6)比(47.5±13.4)岁,P<0.05],舒张压[(86.7±14.1)比(80.2±11.7)mm Hg,P<0.05]、收缩压[(143.5±19.8)比(126.9±17.1)mm Hg,P<0.05]较高,空腹血糖[(5.94±1.69)比(5.38±1.25)mmol/L,P<0.05]、三酰甘油[(1.77±1.31)比(1.50±1.44)mmol/L,P<0.05]较高,高密度脂蛋白胆固醇(HDL-C)[(1.19±0.32)比(1.28±0.34)mmol/L,P<0.05]、体质量指数(BMI)[(34.8±12.4)比(37.6±12.5)kg/m2,P<0.05]较低。多因素Logistic回归分析显示,控制年龄、性别、收缩压、三酰甘油、HDL-C、BMI后,舒张压对肾功能下降的影响有统计学意义(OR=1.523,P<0.05)。结论舒张压与肾功能下降相关。
Objective To investigate the relationship between diastolic blood pressure(DBP)and estimated glomerular filtration rate(eGFR). Methods A total of 64 066 healthy physical examinees in Xuzhou Central Hospital from 2010 to 2012 were enrolled and divided into 2 groups based on eGFR calculated by Chinese modification of diet in renal disease(C-MDRD)equation:eGFR normal group[>60 mL/(min·1.73 m2)]and eGFR decline group[<60 mL/(min·1.73 m2)]. Logistic regression analysis was used to investigate the relationship between DBP and eGFR.Results Compared with the normal eGFR group,in the eGFR decline group the examinees were older [(68.3±13.6)vs(47.5±13.4)years,P<0.05];and the DBP [(86.7±14.1)vs(80.2±11.7)mm Hg,P<0.05],systolic blood pressure[(143.5±19.8)vs(126.9±17.1)mm Hg,P<0.05],fasting blood glucose[(5.94±1.69)vs(5.38±1.25)mmol/L,P<0.05]and triglycerides [(1.77±1.31)vs(1.50±1.44)mmol/L,P<0.05]were higher;while high density lipoprotein cholesterol(HDL-C)[(1.19±0.32)vs(1.28±0.34)mmol/L,P<0.05]and body mass index(BMI)[(34.8±12.4)vs(37.6±12.5)kg/m2,P<0.05]were lower. Multivariable logistic regression analysis showed that after adjusting for age,gender,triglycerides,HDL-C,systolic blood pressure and BMI,DBP showed a significant effect on kidney function decline(OR=1.523,P<0.05). Conclusion DBP was significantly associated with renal function decline.
Objective To investigate the relationship between diastolic blood pressure(DBP)and estimated glomerular filtration rate(eGFR). Methods A total of 64 066 healthy physical examinees in Xuzhou Central Hospital from 2010 to 2012 were enrolled and divided into 2 groups based on eGFR calculated by Chinese modification of diet in renal disease(C-MDRD)equation:eGFR normal group[>60 mL/(min·1.73 m2)]and eGFR decline group[<60 mL/(min·1.73 m2)]. Logistic regression analysis was used to investigate the relationship between DBP and eGFR.Results Compared with the normal eGFR group,in the eGFR decline group the examinees were older [(68.3±13.6)vs(47.5±13.4)years,P<0.05];and the DBP [(86.7±14.1)vs(80.2±11.7)mm Hg,P<0.05],systolic blood pressure[(143.5±19.8)vs(126.9±17.1)mm Hg,P<0.05],fasting blood glucose[(5.94±1.69)vs(5.38±1.25)mmol/L,P<0.05]and triglycerides [(1.77±1.31)vs(1.50±1.44)mmol/L,P<0.05]were higher;while high density lipoprotein cholesterol(HDL-C)[(1.19±0.32)vs(1.28±0.34)mmol/L,P<0.05]and body mass index(BMI)[(34.8±12.4)vs(37.6±12.5)kg/m2,P<0.05]were lower. Multivariable logistic regression analysis showed that after adjusting for age,gender,triglycerides,HDL-C,systolic blood pressure and BMI,DBP showed a significant effect on kidney function decline(OR=1.523,P<0.05). Conclusion DBP was significantly associated with renal function decline.
引文
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[13]中华医学会糖尿病学分会代谢综合征研究协作组.中华医学会糖尿病学分会关于代谢综合征的建议[J].中华糖尿病杂志,2004,12(3):156-161.
[14]卫生部疾病控制司.中国成人超重和肥胖预防控制指南[M].北京:人民卫生出版社,2006.
[15]Lim SS,Vos T,Flaxman AD,et al.A comparative risk assessment of burden of disease and injury attributable to 67risk factors and risk factor clusters in 21regions,1990-2010:a systematic analysis for the global burden of disease study 2010[J].Lancet,2012,380(9859):2224-2260.
[16]恽振先.多因素人群归因危险度估计及其计算程序[J].中国卫生统计,1993,10(5):53-55.
[17]陈法东,包国豪,陈秀媚,等.代谢综合征与肾功能损害的相关性研究[J].中国中西医结合肾病杂志,2013,14(11):983-985.
[18]陈秀玲,王莉,李贵森,等.健康体检者代谢综合征及肾功能相关性的调查[J].四川医学,2008,29(10):1426-1428.
[19]Oldrizzi L,Rugiu C,Maschio G.Hypertension and progression of renal failure in patients on protein-restricted diet[J].Contrib Nephrol,1987,54:134-143.
[20]Brazy PC,Stead WW,Fitzwilliam JF.Progression of renal insufficiency:role of blood pressure[J].Kidney Int,1989,35(2):670-674.
[21]Huh JH,Yadav D,Kim JS,et al.An association of metabolic syndrome and chronic kidney disease from a 10-year prospective cohort study[J].Metabolism,2017,67:54-61.
[22]吴文芳,曹长春,万辛,等.2型糖尿病合并代谢综合征组分与慢性肾脏病的相关性[J].中国临床医学,2009,16(1):108-111.
[23]Wolff FW,Lindeman RD.Effects of treatment in hypertension.Results of a controlled study[J].J Chronic Dis,1966,19(3):227-240.
[24]Magee JH,Unger AM,Richardson DW.Changes in renal function associated with drug or placebo therapy of human hypertension[J].Am J Med,1964,36:795-804.
[25]Moyer JH,Heider C,Pevey K,et al.The effect of treatment on the vascular deterioration associated with hypertension,with particular emphasis on renal function[J].Am J Med,1958,24(2):177-192.
[26]赵艳坤.慢性肾功能不全透析对血压的影响分析[J].世界最新医学信息文摘,2015,15(28):18-19.
[27]杨艳燕,白光辉.慢性肾功能不全的血液流变学变化[J].医学综述,2009,15(18):2806-2807.
[28]王国印.慢性肾功能不全的分期及发病机理[J].中国社区医师,1989,5(11):11-12.
[29]Johnson RJ,Herrera-Acosta J,Schreiner GF,et al.Subtle acquired renal injury as a mechanism of salt-sensitive hypertension[J].N Engl J Med,2002,346(12):913-923.
[30]许志贤,蓝剑.对称动态动脉硬化指数预测高血压早期肾损伤的价值[J].实用临床医学,2017,18(4):26-27,47.
[2]Zhang L,Long J,Jiang W,et al.Trends in chronic kidney disease in China[J].N Engl J Med,2016,375(9):905-906.
[3]Zolfaghari M,Mousavifar SA,Haghani H.Mobile phone text messaging and telephone follow-up in type 2diabetic patients for 3months:a comparative study[J].J Diabetes Metab Disord,2012,11(1):7.
[4]Kaze FF,Meto DT,Halle MP,et al.Prevalence and determinants of chronic kidney disease in rural and urban Cameroonians:a cross-sectional study[J].BMC Nephrol,2015,16:117.
[5]Lim WH,Lewis JR,Wong G,et al.Comparison of estimated glomerular filtration rate by the chronic kidney disease epidemiology collaboration(CKD-EPI)equations with and without cystatin C for predicting clinical outcomes in elderly women[J].PLoS One,2014,9(9):e106734.
[6]邱玉军,王玉兰,韩梅,等.慢性肾功能不全程度与肾血管阻力关系的探讨[J].中外医疗,2008(33):173-174.
[7]赵庆辉,陈宇,詹庆虹,等.舒张压高的发病机制与治疗方法进展[J].当代医学,2017,23(9):183-184.
[8]全国eGFR课题协作组.MDRD方程在我国慢性肾脏病患者中的改良和评估[J].中华肾脏病杂志,2006,14(10):589-595.
[9]National Kidney F.K/DOQI clinical practice guidelines for chronic kidney disease:evaluation,classification,and stratification[J].Am J Kidney Dis,2002,39(2Suppl 1):S1-266.
[10]兰晓鹏,蒋伟,孙桢,等.各年龄段(青年、中年、老年)肾癌患者临床特征及诊治分析[J].泌尿外科杂志(电子版),2013,(4):4-8,66.
[11]Song H,Wang X,Cai Q,et al.Association of metabolic syndrome with decreased glomerular filtration rate among 75 468Chinese adults:a cross-sectional study[J].PLoS One,2014,9(11):e113450.
[12]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].中华高血压杂志,2011,19(8):701-743.
[13]中华医学会糖尿病学分会代谢综合征研究协作组.中华医学会糖尿病学分会关于代谢综合征的建议[J].中华糖尿病杂志,2004,12(3):156-161.
[14]卫生部疾病控制司.中国成人超重和肥胖预防控制指南[M].北京:人民卫生出版社,2006.
[15]Lim SS,Vos T,Flaxman AD,et al.A comparative risk assessment of burden of disease and injury attributable to 67risk factors and risk factor clusters in 21regions,1990-2010:a systematic analysis for the global burden of disease study 2010[J].Lancet,2012,380(9859):2224-2260.
[16]恽振先.多因素人群归因危险度估计及其计算程序[J].中国卫生统计,1993,10(5):53-55.
[17]陈法东,包国豪,陈秀媚,等.代谢综合征与肾功能损害的相关性研究[J].中国中西医结合肾病杂志,2013,14(11):983-985.
[18]陈秀玲,王莉,李贵森,等.健康体检者代谢综合征及肾功能相关性的调查[J].四川医学,2008,29(10):1426-1428.
[19]Oldrizzi L,Rugiu C,Maschio G.Hypertension and progression of renal failure in patients on protein-restricted diet[J].Contrib Nephrol,1987,54:134-143.
[20]Brazy PC,Stead WW,Fitzwilliam JF.Progression of renal insufficiency:role of blood pressure[J].Kidney Int,1989,35(2):670-674.
[21]Huh JH,Yadav D,Kim JS,et al.An association of metabolic syndrome and chronic kidney disease from a 10-year prospective cohort study[J].Metabolism,2017,67:54-61.
[22]吴文芳,曹长春,万辛,等.2型糖尿病合并代谢综合征组分与慢性肾脏病的相关性[J].中国临床医学,2009,16(1):108-111.
[23]Wolff FW,Lindeman RD.Effects of treatment in hypertension.Results of a controlled study[J].J Chronic Dis,1966,19(3):227-240.
[24]Magee JH,Unger AM,Richardson DW.Changes in renal function associated with drug or placebo therapy of human hypertension[J].Am J Med,1964,36:795-804.
[25]Moyer JH,Heider C,Pevey K,et al.The effect of treatment on the vascular deterioration associated with hypertension,with particular emphasis on renal function[J].Am J Med,1958,24(2):177-192.
[26]赵艳坤.慢性肾功能不全透析对血压的影响分析[J].世界最新医学信息文摘,2015,15(28):18-19.
[27]杨艳燕,白光辉.慢性肾功能不全的血液流变学变化[J].医学综述,2009,15(18):2806-2807.
[28]王国印.慢性肾功能不全的分期及发病机理[J].中国社区医师,1989,5(11):11-12.
[29]Johnson RJ,Herrera-Acosta J,Schreiner GF,et al.Subtle acquired renal injury as a mechanism of salt-sensitive hypertension[J].N Engl J Med,2002,346(12):913-923.
[30]许志贤,蓝剑.对称动态动脉硬化指数预测高血压早期肾损伤的价值[J].实用临床医学,2017,18(4):26-27,47.