住院老年患者估算的肾小球滤过率与外周动脉疾病相关性研究

Association between estimated glomerular filtration rate and peripheral arterial disease in elderly inpatients

目的分析老年住院患者估算的肾小球滤过率(eGFR)与外周动脉疾病(PAD)之间的相关性。方法对693例年龄≥60岁老年住院患者进行横断面研究,收集患者心血管危险因素,测定血糖、糖化血红蛋白、血脂和肌酐(Cr)等生化指标,根据Cr计算eGFR诊断CKD;依eGFR水平将患者分为四组,正常组[eGFR≥90ml.min-1.(1.73m2)-1],轻度降低组[eGFR60～89ml.min-1.(1.73m2)-1],中度降低组[eGFR30～59ml.min-1.(1.73m2)-1],重度降低组[eGFR<30ml.min-1.(1.73m2)-1];测量踝臂指数(ABI),ABI≤0.95定义为PAD。结果 (1)与非CKD患者比较,CKD患者ABI值明显降低,分别为1.06(0.16)和1.00(0.28)(P<0.001);PAD患病率明显增高,分别为41.6%和22.2%(P<0.001)。(2)eGFR正常组至重度降低组,ABI值水平逐渐降低,分别为1.08(0.15)、1.05(0.16)、1.01(0.26)和0.88(0.41)(P<0.001);PAD患病率逐渐增加,分别为16.0%、23.9%、37.4%和61.5%(P<0.001)。相关分析显示ABI值与eGFR水平呈正相关(r=0.207,P<0.001)。(3)Logistic回归分析显示,调整性别、年龄和其他传统危险因素后,CKD患者PAD风险增加,危险比(95%可信区间)[OR(95%CI)]为1.680(1.135～2.486),四组不同eGFR水平分组中,eGFR重度降低增加PAD风险,OR(95%CI)为5.455(2.078～14.324),eGFR中度降低有增加PAD风险趋势,OR(95%CI)为2.045(0.971～4.308)(P=0.06)。结论 eGFR降低的老年患者ABI值下降和发生PAD的风险增加,并且这种风险随eGFR降低程度的加重而加重。

Objective To explore the association between estimated glomerular filtration rate （eGFR）and peripheral arterial disease（PAD）in elderly inpatients. Methods A total of 693 patients aged 60 years or over were included in this cross-sectional study. Cardiovascular risk factors were collected and fasting plasma glucose, hemoglobin A1 c,lipid profile as well as creatinine were measured, eGFR was calculated using the modification of diet in renal disease equation for Chinese and chronic kidney disease （CKD）was defined by eGFR. Patients were categorized according to their level of eGFR into four groups： normal[ eGFR≥90 ml ·min^-1（1.73m^2）^-1], mildly decreased[ eGFR 60-89 ml ·min^-1（1.73m^2）^-1 ], moderately decreased[ eGFR 30-59 ml ·min^-1（1.73m^2）^-1 ] and severely decreased [ eGFR 〈 30 ml ·min^-1（1.73m^2）^-1 ]. Ankle hrachial index （ABI） was measured and PAD was defined as ABI 〈 0. 95 for elderly patients. Results （ 1 ） Compared to patients without CKD, the level of ABI was lower in patients with CKD, 1.06 （ 0. 16 ） and 1.00 （ 0. 28 ） （ P 〈 O. 001 ）, respectively. The prevalence of PAD was 41.6% in patients with CKD and 22. 2% in patients without CKD. （2）The level of ABI decreased and the prevalence of PAD increased in proportion to decreasing eGFR of four groups. The patients with severely decreased eGFR had the lowest level of ABI and the highest prevalence of PAD. There was a significant positive correlation between eGFR and ABI （ r = 0. 207, P 〈 0. 001 ）. （ 3 ） In models adjusted for age, sex and other traditional cardiovascular risk factors, odd ration （OR）for PAD was 1. 680 （95% CI： 1. 135-2. 488 ）for patients with CKD and 5. 455 （2. 078-14. 324）for patients with severely decreased eGFR. Moderately decreased eGFR might have atrend to increase the risk of PAD, OR for PAD was 2. 045 （95% CI： 0.971-4.308） （P = 0.06）. Conclusions Elderly patients with reduced eGFR are at a high risk of ABI decreased and the prevalence of PAD increased. The severer level of eGFR decreased, the higher risk of ABI decreased and the prevalence of PAD increased.