健康老年人群血浆可溶性血栓调节蛋白和肾小球滤过率的关系

Relationship between plasma soluble thrombomodulin and glomerular filtration rate in healthy elderly

目的：探讨老年人群血浆可溶性血栓调节蛋白（sTM）与估算的肾小球滤过率（eGFR）的相关性。方法采用整群随机抽样的方法对北京市9个社区283名≥65岁健康老年人进行研究，酶联免疫吸附法测定血浆可溶性血栓调节蛋白水平，应用CKD-EPI公式评估eGFR，同时行人体学测量及血清生化指标测定，并做相关和回归分析。结果北京社区健康老年人群eGFR水平与sTM、年龄、尿素氮、肌酐、C反应蛋白（CRP）及收缩压呈负相关，与白蛋白、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平呈正相关；在校正了年龄、血压、血糖（GLU）、CRP、血脂、尿酸（UA）等指标后，健康老年人血浆sTM仍然和eGFR呈负相关（B＝-3.340，P＝0.000）。在进一步的研究中，将入组的北京社区健康老年人分为老年（65～80岁）和高龄老年（＞80岁）两组；两组之间eGFR和sTM水平差异均无统计学意义（P＞0.05），老年组和高龄老年组eGFR均与sTM水平呈负相关（r＝-0.229，P＝0.000；r＝-0.3613，P＝0.02），校正了年龄、血压、GLU、CRP、血脂、UA等指标后差异仍有统计学意义（B＝-3.26，P＝0.000；B＝-4.45，P＝0.013）。结论 sTM可作为判断老年人群肾功能下降的指标。

Objective To analyze the correlation of plasma level of soluble thrombomodulin （sTM） and glomerular filtration rate （GFR） in healthy elderly. Methods A total of 283 healthy elderly subjects （〉65 years） were selected by cluster sampling from 9 communities of Beijing. Their plasma levels of sTM were measured by ELISA. Their estimated GFR （eGFR） was evaluated with Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） formula. And also, their anthropometric measurements and serum biochemical indices were measured. Pearson and Spearman correlation tests and multiple linear regression analysis were used to analyze the data and their correlations. Results eGFR had negative correlation with plasma sTM, age, urea nitrogen, C-reactive protein （CRP）, and systolic pressure in these subjects, and had positive correlation with albumin, high density lipoprotein cholesterol （HDL-C）, and low density lipoprotein cholesterol （LDL-C）. After adjusting age, blood pressure, blood glucose （GLU）, CRP, blood lipid, uric acid （UA） and the other factors in the multiple linear regression, a negative correlation was still seen between plasma sTM and eGFR in the elderly （B=-3.340, P=0.000）. When the cohort of patients was divided into elderly （65 to 80 years） and very elderly groups （＆gt;80 years）, there was no difference in eGFR and plasma sTM between them. While negative correlation of eGFR with plasma sTM was still seen within both groups （r=-0.229, P=0.000;r=-0.3613, P=0.02）. And the negative correlation was still observed after adjusting age, blood pressure, GLU, CRP, blood lipid, and UA （B=-3.26, P=0.000;B=-4.45, P=0.013）. Conclusion The plasma level of sTM may be used as an index of renal function decline in healthy elderly.