非透析慢性肾脏病患者肾小球滤过率的评估值与动脉硬化的相关性

Study on Correlation Between eGFR and Arterosclerosis in Patients with Non-dialysis Chronic Kidney Disease

目的通过测量非透析慢性肾脏病(CKD)患者的踝臂指数(ABI)及肾小球滤过率的评估值(eGFR),分析ABI作为评估CKD患者动脉硬化程度的临床意义。方法横断面研究诊断明确的非透析CKD(1-5期)患者118例,记录患者性别、年龄、身高、体重、吸烟状况、血压、空腹血糖、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、肾功能。通过简化的肾脏病膳食改良公式计算eGFR,多普勒血流检测仪测定ABI。结果按eG-FR水平分为CKD1期、CKD2期、CKD3期、CKD4期、CKD5期五个组,与CKD1期组比较,CKD3期组、CKD4期组、CKD5期组ABI值明显降低(P<0.01),但CKD1期组与CKD2期组间ABI值无统计学差异(P>0.05)。在CKD 2-5期组间随着eGFR降低,ABI值也逐渐下降(P<0.01)。多元线性回归分析显示,年龄、糖尿病、高血压和eGFR为ABI的独立危险因素(P<0.01)。结论肾功能减退是动脉硬化的独立危险因素,eGFR下降与动脉硬化病变程度密切相关,而ABI可作为评估CKD患者动脉硬化程度的重要临床指标。

Aim To explore the relationship between ankle-brachial index （ABI） and arterosclerosis in patients with non-dialysis chronic kidney disease （CKD）. Methods As a cross-sectional study, 118 patients with diagnosis of non-dialysis CKD （ stage 1-5 ） were selected in our hospital from October 2008 to October 2009. Clinical data were recor- ded, including sex, age, height, weight, smoking status, blood pressure （BP）, fasting glucose, high density lipoprotein cholesterol （HDLC）, low density lipoprotein cholesterol （LDLC） and renal function. Estimated glomerular filtration rate （eGFR） was calculated by Modification of Diet in Renal Disease Study equation. ABI values were determined with a Dopper prober. Results According to eGFR, all patients were divided into 5 groups as CKD stage 1 group to CKD stage 5 group. Compared with CKD stage 1 group, ABI values were significantly decreased in CKD stage 3 group, stage 4 group and stage 5 group （ all P 〈 0. 01 ）. There was no difference between CKD stage 1 group and stage 2 group （ P 〉 0. 05）. ABI value was significantly decreased with gradual decline of eGFR level （ P 〈 0. 01 ）. Multiple regression a- nalysis showed that age, diabetes, hypertension and eGFR were risk factors for the ABI value （P 〈 0. 01 ）. Conclu- sions Renal dysfunction is an independent risk factor for arterosclerosis. Decline of eGFR was closely related with the de- gree of arterosclerotic lesions. ABI can be used as important clinical indicators of arterosclerosis in patients with CKD.