慢性肾功能衰竭影响因素的病例对照研究

A Case-control Study on the Influencing Factors of Chronic Renal Failure

目的探讨慢性肾功能衰竭的影响因素,为预防及治疗提供依据。方法选取2011年9月—2012年9月在徐州医学院附属医院肾内科诊治的新发慢性肾功能衰竭患者206例作为病例组;与病例组以年龄相差不超过±5岁、性别和居住地相同进行1∶3匹配,选取同期在徐州医学院附属医院其他科诊治的患者618例作为对照组。对病例组和对照组采用统一的自制调查问卷进行资料的收集。将收集到的70%的病例组患者(144例)和对照组患者(433例)资料作为训练集,采用条件Logistic回归模型分析疾病的影响因素,最终建立疾病预测模型;用30%的病例组患者(62例)和对照组患者(185例)资料作为测试集,计算受试者工作特征(ROC)曲线下面积,评价疾病预测模型效果。结果单因素分析结果显示,居住地、个人收入、高血压病史、糖尿病病史、高血压家族史、糖尿病家族史、初次妊娠年龄、生育孩子个数、性格、体育锻炼、周工作时间对慢性肾功能衰竭的影响有统计学意义(P<0.05)。多因素Logistic回归分析显示,个人收入、居住地、高血压病史、糖尿病病史、高血压家族史、体育锻炼、性格对慢性肾功能衰竭的影响有统计学意义(OR值分别为2.105、0.299、11.417、4.105、3.002、0.477、1.838,P<0.05)。其条件Logistic回归模型的ROC曲线下面积为0.820〔95%CI(0.761,0.879),P=0.000〕。结论个人高收入、高血压病史、糖尿病病史、高血压家族史、急躁性格是慢性肾功能衰竭的危险因素,体育锻炼和居住在城镇是保护因素。

Objective To investigate the risk factors of chronic renal failure and provide scientific basis for its prevention and treatment. Methods A 1 ： 3 matched case - control study was carried out in Xuzhou Medical College Hospital Including 206 cases with new chronic renal failure treated in our Department of Nephrology from September, 2011 to September, 2012 and 618 controls in the same gender and resident area and similar ages （±5 years old） with the cases treated in other departments during the same period. Self - designed questionnaires were used for data collecting. 70% of the returned questionnaires including 144 cases and 433 controls were used as the training set and a prediction model was finally determined based on the influencing factor analysis by means of conditional logistic regression model. The remaining 30% including 62 cases and 185 controls were used as the test set to evaluate the validity of the prediction model by calculating the area under ROC curve of the subjects. Results Univariate Logistic regression analysis showed that resident area, personal income, history of hypertension and diabetes, genetic history of hypertension and diabetes, first pregnant age, number of children, disposition, physical exercises, working hours within a week were statistically associated with chronic renal failure （P 〈 0. 05 ） . Multivariate logistic analysis showed that personal income, place of residence, history of hypertension, history of diabetes, genetic history of hypertension, physical exercise and disposition had statistical influence over the disease and the odds ratio （OR） value was 2. 105, 0. 299, 11. 417, 4. 105, 3. 002, 0. 477, 1. 838 respectively （ P 〈 0. 05 ） . ROC curve of conditional Logistic regression was 0. 820 [ 95 % CI （0. 761, 0. 879）, P = 0. 000]. Conclusion The risk factors of chronic renal failure include high individual income, history of hypertension, history of diabetes mellitus, genetic history of hypertension and impatience. Physical exercise and living in towns have a positive effecti on the prevention of chronic renal failure.