天津市和平区新兴街社区老年人慢性肾脏疾病调查

Investigation on chronic kidney diseases among the elderly in Xinxing Street Community of Heping District in Tianjin City

目的慢性肾脏疾病(chronic kidney disease,CKD)已经成为全球性公共卫生问题,开展CKD社区筛查具有重要意义,本研究调查天津市和平区新兴街社区老年人CKD患病率并分析其影响因素,提出早期防治对策。方法选取2018-01-01-2018-12-31天津市和平区新兴街社区健康体检≥60岁老年人6213名,采用肾脏疾病饮食改良简化公式(modification of diet inrenal disease,MDRD)计算肾小球滤过率估计值(estimated glomerular filtration rate,eGFR)。将eGFR<60mL/(min·1.73m^2)定义为eGFR下降;将尿蛋白+^++++定义为蛋白尿。分析eGFR下降和蛋白尿的患病率。Logistic回归分析年龄、血清肌酐、血红蛋白、空腹血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、高血压和糖尿病对eGFR下降和蛋白尿的影响。结果和平区新兴街老年人eGFR下降检出率为4.5%。蛋白尿检出率为3.7%。CKD患病率为8.2%。女性eGFR下降检出率高于男性(χ~2=33.83,P<0.01),男性蛋白尿检出率高于女性(χ~2=9.80,P<0.05),eGFR下降和蛋白尿检出率性别差异有统计学意义。年龄增加eGFR下降检出率(χ~2=264.01,P<0.01)和蛋白尿检出率(χ~2=11.85,P<0.01),eGFR下降和蛋白尿检出率年龄差异有统计学意义;高血压合并糖尿病患者eGFR下降检出率(χ~2=40.48,P<0.01)和蛋白尿检出率(χ~2=64.47,P<0.01)高于单纯患高血压或糖尿病的老年人,差异有统计学意义。多因素分析结果显示,血清肌酐(OR=1.221,95%CI为1.191~1.252,P<0.001)、年龄(OR=1.053,95%CI为1.027~1.079,P<0.001)、血红蛋白(OR=0.930,95%CI为0.917~0.942,P<0.001)、总胆固醇(OR=1.535,95%CI为1.250~1.884,P<0.001)和高血压(OR=1.998,95%CI为1.475~2.706,P<0.001)是eGFR下降的危险因素;血清肌酐(OR=1.016,95%CI为1.012~1.020,P<0.001)、空腹血糖(OR=1.267,95%CI为1.204~1.334,P<0.001)、高血压(OR=1.636,95%CI为1.146~2.334,P=0.007)和年龄(OR=1.020,95%CI为1.002~1.038,P=0.026)是蛋白尿的危险因素。结论社区全科医生应加强对社区老年人血脂、血糖和血压的管理,关注eGFR值计算及蛋白尿检查,及时早发现,早干预CKD。

OBJECTIVE Chronic kidney disease has become a global public health problem.This study investigates the prevalence rate of chronic kidney disease of old people in Xinxingjie Community of Heping District in Tianjin,and analyzes the influencing factors to propose early prevention and treatment strategies.METHODS From January 1,2018 to December 31,2018,6213 aged 60 or more old people were enrolled with health physical examination.The estimated glomerular filtration rate(estimated glomerular filtration rate,eGFR)were calculated with the kidney disease diet improved simplified formula(modification of diet inrenal diseases,MDRD)and eGFR<60 ml/(min·1.73 m^2)was defined as eGFR decreased.The prevalence of eGFR decline and proteinuria were analyzed.Logistic regression analysis was usd to investigate the effects of age,serum creatinine,hemoglobin,fasting blood glucose,total cholesterol,triglyceride,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,hypertension and diabetes on eGFR decline and proteinuria.RESULTS The detection rate of eGFR decrease was 4.5%.The detection rate of proteinuria was 3.7%.The prevalence of CKD was 8.2%.The detection rate of decreased eGFR in women was significantly higher than that in men(χ~2=33.83,P<0.01).And the detection rate of proteinuria in men was significantly higher than that in women(χ~2=9.80,P<0.05).With the increase of age,there was statistically significant difference in the detection rate of eGFR decreased(χ~2=264.01,P<0.01)and the detection rate of proteinuria(χ~2=11.85,P<0.01).The detection rates of eGFR decreased(χ~2=40.48,P<0.01)and proteinuria(χ~2=64.47,P<0.01)in hypertensive patients with diabetes mellitus were significantly higher than those in the elderly with hypertension or diabetes mellitus alone.The results of multivariate analysis showed that,serum creatinine(OR=1.221,95%CI:1.191-1.252,P<0.001),age(OR=1.053,95%CI:1.027-1.079,P<0.001),hemoglobin(OR=0.930,95%CI:0.917-0.942,P<0.001),total cholesterol(OR=1.535,95%CI:1.250-1.884,P<0.001),and hypertension(OR=1.998,95%CI:1.475-2.706,P<0.001)were the risk factors of eGFR decreased.Serum creatinine(OR=1.016,95%CI:1.012-1.020,P<0.001),fasting blood glucose(OR=1.267,95%CI:1.204-1.334,P<0.001),hypertension(OR=1.636,95%CI:1.146-2.334,P=0.007)and age(OR=1.020,95%CI:1.002-1.038,P=0.026)were risk factors for proteinuria.CONCLUSION All of general practitioners should strengthen the management of blood lipid,blood glucose and blood pressure of the elderly in the community,pay attention to the calculation of eGFR value and examination of proteinuria,and timely detect and treat chronic renal insufficiency as early as possible.