老年患者肾小球滤过率和微量蛋白尿与外周动脉疾病的关系

Relationship between peripheral arterial disease and glomerular filtration rate and microalbuminuria in elderly patients

目的探讨老年患者肾小球滤过率(estimated glomerular filtration rate,eGFR)和微量蛋白尿(microalbuminuria,MA)与外周动脉疾病(peripheral arterial disease,PAD)之间的关系。方法对328例住院老年患者测定踝臂指数(ankle brachial index,ABI)、尿白蛋白/肌酐比值(urinary albumin/creatinine ratio,UACR)、肌酐(creatinine,Cr)、血脂、空腹血糖(fasting plasma glucose,FPG)和糖化血红蛋白(glycosylated hemoglobin,HbAlc)等指标,并收集心血管危险因素和心脑血管疾病史。UACR≥30 mg.g-1定义为MA,根据中国简化MDRD公式计算eGFR,eGFR<60 mL.min-1.1.73 m-2为eGFR降低,ABI<0.9定义为PAD。结果 328例老年患者中,PAD患病率为21.0%,24.4%的患者UACR增高,25.9%的患者eGFR降低。与非PAD患者比较,PAD患者年龄偏大,收缩压(systolic blood pressure,SBP)、糖化血红蛋白(HbAlc)和UACR增高(P<0.05或<0.01)。相关分析显示UACR与ABI值呈负相关(r=-0.323,P=0.000),eGFR与ABI值呈正相关(r=0.185,P=0.001)。Logistic回归分析显示,与非MA患者比较,MA与PAD有关,危险比〔OR(95%CI)〕为3.613(2.035～6.415)(P=0.000),调整年龄、性别和传统心血管危险因素后,MA仍与PAD有关,OR(95%CI)为3.033(1.601～5.748)(P=0.001),eGFR降低对PAD无影响。结论老年人PAD患病率较高,MA患者发生PAD的风险增加。

Objective To investigate the relationship between peripheral arterial disease（PAD） and estimated glomerular filtration rate（eGFR） and microalbuminuria（MA） in elderly patients.Methods A total of 328 consecutive patients were included in this study.ABI,Urinary albumin/creatinine ratio（UACR）,serum creatinine（Cr）,lipids profile,fasting plasma glucose（FPG） and glycosylated hemoglobin（HbA1c） were measured.Cardiovascular risk factors and cardiovascular diseases（CVD） were collected.eGFR was calculated according to Chinese modified MDRD formula based on Cr level.eGFR60 mL·min-1·1.73 m-2 was defined as eGFR reduced.ABI0.90 was defined as PAD.Results In 328 elderly patients,the prevalence of PAD was 21.0%,24.4% patients had MA and 25.9% patients had reduced eGFR.Compared to patients without PAD,the Age,levels of SBP,HbA1c,and UACR were significantly increased in patients with PAD（P0.05 or 0.01）.ABI showed a negative correlation with UACR（r =-0.323,P=0.000） and a positive correlation with eGFR（r = 0.185,P=0.001）.Logistic regression analysis showed that OR（95% CI） for PAD was 3.613＊2.035~6.415） for patients with MA.In models adjusted for age,sex and other traditional cardiovascular risk factors and medicine use,OR（95% CI） for PAD was 2.877（1.588~15.213） for patients with MA.There was no association between eGFR reduction and PAD.Conclusion The prevalence of PAD was higher in elderly patients.MA was associated with PAD,and patients with MA were at a high risk of PAD.