老年慢性阻塞性肺疾病早期肾损伤相关因素探讨

Related factors of early renal injury in the elderly with chronic obstructive pulmonary disease

目的：探讨影响老年慢性阻塞性肺疾病（COPD）患者早期肾损伤的临床指标。方法收集入住于宁夏人民医院呼吸内科的60例COPD患者作为研究对象（COPD组）；选择该院体检中心的30例健康体检者（对照亚组）。亚组：60例COPD组依据患病时间分为病程≤10年亚组和病程＞10年亚组；依据营养状况分为营养欠佳亚组和营养正常亚组。营养状况主要测定COPD患者白蛋白（ALB）、血红蛋白（Hb）、总胆固醇（TC）水平。评估COPD组及对照组的血清肌酐（SCr）、尿素氮（BUN）、β2微球蛋白（β2-MG）、白细胞（WBC）、中性粒细胞百分比（NE%）、血清胱抑素C（CysC）及估算肾小球滤过率（eGFR）等指标。结果与对照组比较，COPD组SCr、BUN、WBC、NE%差异无统计学意义（P＞0.05），eGFR， ALB，Hb，TC均明显降低，CysC 及β2-MG明显升高，差异均有统计学意义（P＜0.05）；亚组分析，与病程≤10年亚组和营养状况正常亚组比较，血清CysC及β2-MG浓度在病程＞10年亚组及营养状况欠佳亚组均明显升高（P＜0.05）；eGFR在病程＞10年亚组明显低于病程≤10年亚组（P＜0.05）；SCr在各亚组间比较差异均无统计学意义（P＞0.05）；Pearson线性相关性分析：eGFR与ALB和Hb呈正相关，与患病时间呈负相关；CysC和β2-MG与eGFR呈负相关。结论老年COPD患者存在早期肾损伤，随COPD病程延长及ALB，Hb，TC降低，早期肾损伤加重；患病时间、血清ALB和Hb水平影响老年COPD患者慢性缺氧早期肾损伤，与早期肾损伤呈线性相关。

Objective To investigate the related factors of early renal injury in the elderly with chronic obstructive pulmonary disease （COPD）. Methods Sixty patients with COPD [age：（65±6） years] admitted in the Department of Respiratory Diseases of Ningxia People’s Hospital were enrolled in this study. Another 30 healthy individuals [age：（63±6） years] receiving physical examination during the same period served as normal controls. The COPD group was further divided into subgroups according to disease duration and nutrition： ≤10 years and 〉10 years subgroups; and poor nutrition and normal nutrition subgroups. Serum levels of albumin （ALB）, hemoglobin （Hb） and total cholesterol （TC） were used to evaluate their nutriture. Routine laboratory markers of kidney injury were detected, including serum creatinine （SCr）, blood urea nitrogen （BUN）, β2-microglobulin （β2-MG）, cystatin C （CysC）, white blood cells （WBC）, and neutrophilic granulocyte percentage （NE%）. Estimated glomerular filtration rate （eGFR） was calculated using the chronic kidney disease epidemiology collaboration （CKD-EPI） formula. Results There was no significant difference in serum SCr, BUN, WBC and NE%between COPD group and control group （P〉0.05）. But the serum levels of CysC andβ2-MG were significantly higher, while those of ALB, Hb, TC and the eGFR were obviously lower in COPD group than in control group （P〈0.05）. In the comparison of subgroups, the serum levels of CysC andβ2-MG were significantly higher in the course over 10-year subgroup and the poor nutrition （hypoproteinemia, anemia and lower cholesterol） subgroup than in less than 10-year course and normal nutrition subgroups （P〈0.05）. The eGFR was obviously lower in the course over 10-year subgroup than in less than 10-year course subgroup （P〈0.05）. But no significant difference was seen in the serum level of SCr among different subgroups （P〉0.05）. Pearson linear correlation analysis indicated that eGFR was positively correlated with ALB and Hb, and negatively correlated with disease duration, whileβ2-MG and CysC were negatively correlated with eGFR in COPD group. Conclusion Elderly with COPD have early renal injury. With the increase in the duration of disease and the decrease in ALB, Hb, and TC, the early renal injury becomes worse. There is a linear correlation of disease duration, ALB, and Hb with early renal injury in the elderly with COPD.