晚期慢性肾脏病进展相关因素分析

Risk factors related with progression of advanced chronic kidney disease

目的：探讨晚期慢性肾脏病（CKD）肾功能下降的危险因素。方法收集62例CKD 4～5期患者19个月的临床资料，以至少4次估计肾小球率滤过率（eGFR）及相应随访时间作直线，用斜率计算 eGFR的下降幅度，记录患者至少6个月的血磷、血钙、血尿酸、全段甲状旁腺激素（iPTH）和24 h 尿蛋白及尿素氮。分析影响 eGFR下降的危险因素。结果 eGFR 平均下降幅度[-1.82 ml/（min·1.73 m2·年）]与血磷[（1.4±0.5）mmol/L]、iPTH [（276±184）ng/L]和尿蛋白[（0.94±1.21）g/24 h]均呈负相关（P均＜0.01）；与血钙、高血压呈正相关（P均＜0.05）。多因素分析显示，高血磷、高血PTH和尿蛋白升高是eGFR下降的危险因子。与eGFR不稳定者比较，eGFR平稳者的血磷较低、血钙较高、iPTH较低、尿蛋白较少（P均＜0.05）。多因素分析显示，稳定eGFR与血磷、血钙、iPTH及尿蛋白水平有关。结论 eGFR平均下降幅度与血磷、PTH和尿蛋白有关。

Objective To explore the risk factors associated with progression of chronic kidney dis-ease （CKD）. Methods Sixty-two patients with advanced CKD were followed up for 19 months and the clini-cal data was collected. Regression line was drawn with eGFR measured for at least 4 times and corresponding follow-up time. The rates of decline in eGFR were calculated by the slope. Serum phosphate,serum calcium, serum uric acid,serum iPTH,urinary protein and urea nitrogen in 24 hours were recorded for at least 6 months. The risk factors for decreased eGFR were analyzed. Results The mean rate of decline in eGFR-1.84 ml/（min·1.73 m2 ）was inversely related with levels of serum phosphate （1.4 ±0.5 ）mmol/L, PTH （276±184）ng/L and urinary protein （0.94 ±1.21）g/24 h,all P〈0.01. And it was positively relat-ed with the level of serum calcium and hypertension,both P〈0.05. However,only serum phosphate,serum PTH,and urinary protein were risk factors for eGFR decline in multivariate analysis. Compared with unstable-eGFR patients,stable-eGFR patients had lower levels of serum phosphate,serum PTH and proteinuria,all P〈0.05. In multivariate analysis,serum phosphate,serum calcium,serum PTH,urinary protein were related with stable-eGFR. Conclusions The mean decline rate of eGFR was correlated with levels of serum phos-phate,PTH levels and urinary protein.