肾小球滤过率估算值及尿蛋白与老年人发生心血管事件的相关性分析

Correlation analysis of estimate of estimated glomerular filtration rate and the elderly cardiovascular events

目的 探讨肾小球滤过率（eGFR）估算值及尿蛋白与老年人发生心血管事件的相关性。方法 按研究标准纳入2008年1月~2009年12月在塘厦医院进行健康查体和就诊的老年人共270例,根据eGFR将研究对象分为肾功能下降组[eGFR〈60m L/（min·1.73m2）]和肾功能正常组;根据尿常规检查结果将研究对象分为尿蛋白阳性组和尿蛋白阴性组。随访的心血管事件包括心血管性死亡、非致死性心肌梗死、非致死性卒中。结果 平均随访（37.0±4.1）个月,随访期间发生心血管事件51例,其中非致死性卒中19例,非致死性心肌梗死22例,心血管性死亡10例。肾功能正常组心血管事件发生率低于肾功能下降组[10.2%（18/176）vs 35.1%（33/94）,x^2=9.53,P〈0.01]。尿蛋白阴性组心血管事件发生率也显著低于尿蛋白阳性组[15.4%（37/241）vs 48.3%（14/29）,x2=4.36,P〈0.05]。经多因素COX回归分析表明,尿蛋白阳性、eGFR水平是心血管事件的独立危险因素。结论 eGFR下降和尿蛋白阳性是老年人心血管事件的独立危险因素。

Objective To detect the relationship between estimated glomerular filtration rate （ eGFR ） and urinary protein with cardiovascular events in subjects aged 60 years or older. Methods According to the standard,a total of 270 cases for this retrospective prognostic study were drawn from the patient database for routine checkup in Tangxia hospital from January 2008 to December 2009.Based on eGFR,research objects can be divided into decreased renal function group [eGFR 〈 60mL/min 1.73mz] and normal renal function group;At the same time,urinary protein positive group and urinary protein negative group on account of the result of urine routine inspection.Cardiovascular events included cardiovascular death,nonfatal myocardial infarction and nonfatal stroke. Results Mean follow-up （37.0 ± 4.1） months,51 cases of cardiovascular events occurred during follow-up period,including 19 cases of nonfatal stroke,22 cases of nonfatal myocardial infarction and 10 cases of cardiovascular death.Normal renal function group has lower incidence of cardiovascular events than decreased renal function group [10.2% （ 18/176 ） vs 35.1% （ 33/94 ） ,x^2=9.53, P 〈 0.01].Urinary protein negative group＇s incidence of cardiovascular events was significantly lower than urinary protein positive group [15.4% （37/241）vs 48.3% （ 14/29 ）,x^2=4.36,P 〈 0.05].Multivariate Cox regression analysis showed that urinary protein and eGFR level is independent risk factor for cardiovascular events. Conclusion Reduced eGFR and presence of proteinuria is independent risk factor for cardiovascular event in subjects aged 60 years or older.