老年男性患者肾小管功能的增龄变化及相关危险因素分析

Analysis of age-related changes and risk factors of renal tubular function in elderly male cases

目的总结我院干部门诊老年男性患者肾小管功能增龄性变化，并进行相关危险因素分析。方法研究对象共229例，分为〈80岁组和≥80岁组，排除诊断为慢性肾脏病的患者。测定尿常规、血肌酐、血尿素、尿β2微球蛋白（β2-MG）、尿α1微球蛋白（α1-MG）；根据Cockcroft Gault公式计算估测肾小球滤过率（eGFR）。总结年龄与上述指标的相关关系，并对相关危险因素进行多因素Logistic回归分析。结果229例患者平均年龄（76±10）岁，其中〈80岁组142例，≥80岁组87例。与〈80岁组比较，≥80岁组eGFR水平明显降低，分别为（80．3±18．0）ml／min比（55．0±12．7）ml／min（t=9．882，P〈0．01）；尿比重明显降低（1．016±0．006比1．013±0．006）；尿pH值（6．2±0．8比6．6±0．8）、尿β2-MG（（0．96±1．02）mg／L比（2．08±3．56）mg／L]和尿α1-MG[（6．67±3．57）mg／L比（8．71±6．59）mg／L]则明显升高，差异均有统计学意义。相关分析结果显示，eGFR和尿比重与患者年龄分别呈明显负相关（r=-0．692和r=-0．280，P〈0．01），与尿pH值（r=0．255）、尿β2-MG（r=0．262）和尿α1-MG（r=0．228）呈明显正相关（均P〈0．01）。多因素Logistic回归分析显示冠心病为肾小管功能进展的独立危险因素（OR=4．251，P=0．002）。结论高龄老年男性患者肾小管功能随着年龄的增长而明显减退，冠心病是肾小管功能进展的独立危险因素。

Objective To summarize the age related changes and the risk factors of renal tubular function in the elderly male cases. Methods Totally 229 cases without chronic kidney disease were divided into two groups： group aged 〈80 years and group aged ≥80 years. We measured the urine routine, serum creatine, serum urea, urine β2-microglobin （β2-MG）, urine α1-microglobin （α1-MG） and calculated the eGFR based on Cockcroft-Gault equation. Logistic regression was used to analyze the risk factors which may accelerate the progression of the renal tubular impairment. Results The average age of 229 cases was （76±10）years. There were 142 cases in the group of 〈80 years old and 87 cases in the group of ≥80 years old. The level of eGFR in the group of ≥80 years old was （55.0± 12.7）ml/min, which was lower than that of the group of 〈80 years old（80.3±18.0 ml/min）（t 9. 882,P〈0.01）. The level of urine SG was decreased in the group of ≥80 years old versus in the group of 〈80 years old（1. 016±0. 006 vs. 1. 013±0. 006）. The value changes of urine pH, urine β2- MG and urine α1 MG were of statistical differences between the two groups [（6.2±0.8） vs. （6.6± 0.8）, （0.96 ± 1.02） mg/L vs. （2.08 ±3.56） rag/L, （ 6.67 ±3.57） mg/L vs. （8.71 ± 6.59） mg/L]. The correlation analysis showed that age correlated negatively with eGFR and urine SG（r=-0. 692 and r=-0. 280, both P〈0.01）and positively with urine pH（r=0. 255）, urine β2=MG（r=0. 262）, urine α1-MG（r=0. 228）（all P〈0.01）. The Logistic regression analysis showed that coronary heart disease was an independent risk factor for the progression of renal tubular impairment （OR= 4.251, P =0. 002）. Conclusions Renal tubular functions is decreased with ageing age in the elderly male, especially in the advanced elderly. The coronary heart disease is an independent risk factor of the progression of renal tubular impairment.