吸烟对慢性肾脏病患者肾功能减退及肾脏病理损伤的影响

Effects of Smoking on Renal Insufficiency and Kidney Pathological Lesions in Patients with Chronic Kidney Disease

目的:探讨吸烟对慢性肾脏病(chronic kidney disease,CKD)患者肾功能减退和肾脏病理损伤的影响。方法:分析285例经肾活体组织病理检查诊断为CKD的患者的吸烟状态与估算肾小球滤过率(estimated glomerular filtration rate,eGFR)及肾脏病理损伤指标的关系。结果:285例CKD患者中吸烟者87例,其中既往吸烟者28例,目前吸烟者59例。吸烟者eGFR显著低于非吸烟者(P<0.001)。多重线性回归分析显示,吸烟与eGFR呈负相关(b=-0.027,P<0.05)。吸烟者肾间质纤维化积分(P<0.001)、肾小管萎缩积分(P<0.01)和血管壁增厚积分(P<0.05)均高于非吸烟者。多因素二元Logistic回归分析提示,吸烟增加了男性CKD患者肾间质纤维化的风险[比值比(OR)=2.544,P<0.05]。结论:吸烟是CKD患者肾功能减退的独立危险因素,吸烟可能加重CKD患者的肾小管-间质及血管病变。

Objective：To explore the effects of smoking on renal insufficiency and kidney pathological lesions in patients with chronic kidney disease（CKD）.Methods：The relations between smoking status and estimated glomerular filtration rate（eGFR）and indexes of kidney pathological lesions as well,in 285 patients with CKD proven by biopsy,were analyzed.Results：There were 87 smokers in the 285 CKD patients,including 28 ex-smokers and 59 current smokers.The estimated glomerular filtration rate（eGFR）of smokers was significantly lower than that of nonsmokers（P〈0.001）.Multiple linear regression analysis revealed that smoking was negatively correlated to eGFR（b=-0.027,P〈0.05）.The renal tubulointerstitial and vascular lesions in smokers were more severe,while index of interstitial fibrosis（P〈0.001）,index of tubular atrophy（P〈0.01）and index of intra-renal vessel wall thickening（P〈0.05）were significantly higher in smokers than those in nonsmokers.Multiple binary logistic regression analyses revealed that smoking increased the risk of interstitial fibrosis（OR=2.544,P〈0.05）in male CKD patients.Conclusions：Smoking is an independent risk factor of renal insufficiency in CKD patients,and it might aggravate renal tubulointerstitial and vascular lesions in CKD patients.