老年人基线脉压水平对远期肾功能的影响

Effect of pulse pressure on long-term kidney function in the elderly

目的：研究脉压水平对老年人群远期肾功能的影响。方法用前瞻性队列研究法，选择开滦集团年龄≥60岁健康体检者9695例，以脉压水平分为：脉压＜40mmHg（1mm Hg＝0．133kPa，1组）972例、40～49mmHg（2组）2393例、50～59mmHg（3组）2553例、脉压≥60mmHg（4组）3777例，以估算肾小球滤过率（eGFR）＜60ml/（min·1．73m2）为肾功能受损。随访24～63（50．84±4．83）个月，用Kaplan-Meier法及多因素Cox回归模型分析脉压对远期肾功能的影响。结果1组、2组、3组和4组肾功能受损分别为11例、71例、81例和189例（1.1％vs3．0％vs3.2％vs5．0％，P＜0．01）。校正传统危险因素后，与1组比较，其他3组发生肾功能受损的相对风险分别为2．67（95％CI：1．33～5．38，P＜0．01）、2．98（95％CI：1．49～5．96，P＜0．01）和4．90（95％CI：2．50～9．63，P＜0．01）。结论脉压是老年人远期肾功能受损事件的独立危险因素，脉压升高，远期新发肾功能受损增加。

Objective To study the effect of PP on long-term kidney function in the elderly .Meth-ods A total of 9695 healthy people with their age ≥60 years who underwent physical examina-tion in our hospital were divided into PP〈 40 mm Hg group （group 1 ,n= 972） ,PP= 40 -49 mm Hg group （group 2 ,n=2393） ,PP=50 -59 mm Hg group （group 3 ,n=2553） ,and PP≥60 mm Hg group （group 4 ,n=3777） .Impaired kidney function was defined when the eGFR was 〈60 ml/（min · 1 .73 m2 ） .The elderly were followed up for 24 -63 （50 .84 ± 4 .83） months .The effect of PP on long-term kidney function was analyzed using the Kaplan-Meier method and multi-variate Cox proportional hazard regression model .Results Impaired kidney function was detected in 352 of the followed up elderly ,namely in 11 of group 1 ,in 71 of group 2 ,in 81 of group 3 ,and in 189 of group 4 （1.1% vs 3 .0% vs 3.2% vs 5 .0% ,P〈0 .01） .After adjustment for traditional risk factors ,the relative risk coefficient was 2 .67 （95% CI：1 .33-5 .38） ,2 .98 （95% CI：1 .49-5 .96） , and 4 .90 （95% CI：2 .50-9 .63） ,respectively ,in groups 2-4 ,which was higher than that in group 1 （P〈0 .01） .Conclusion PP is an independent risk factor for impaired kidney function in the eld-erly .New kidney funtion impairment increases with the increasing PP .