上海浦东新区不同血脂水平居民慢性肾病研究

Study of chronic kidney disease in residents with different blood lipid levels in Pudong New Area of Shanghai

目的了解上海市浦东新区社区不同血脂水平居民的慢性肾病（CKD）的流行情况，为制定该地区相关慢性病预防控制策略提供依据。方法2008年4—7月从上海市浦东新区随机抽取20～80岁的社区居民5584人进行问卷调查，收集一般情况和生活方式等信息，抽取空腹血样并采集晨尿，测定血肌酐、尿肌酐及尿微量白蛋白等指标，计算尿白蛋白和肌酐比值（ACR），并依据血清肌酐水平估算肾小球滤过率（eGFR），并测定血脂水平。结果该社区居民CKD和高脂血症的标化患病率分别为11．0％和41．0％。高胆固醇血症、高甘油三酯血症、混合性高脂血症和低高密度脂蛋白血症标化患病率分别为7．7％、33．0％、4．5％和7．1％。CKD患者的高脂血症标化患病率和上述各类血脂异常标化患病率分别为53．4％、10．8％、44．4％、7．6％和10．3％，明显高于非CKD者（分别为39．5％、7．3％、31．3％、4．1％和6．6％），差异均有统计学意义（P〈0．01）。调查对象白蛋白尿和CKD患病率随总胆固醇（TC）、甘油三酯（TG）和低密度脂蛋白胆固醇（LDL-C）增加呈升高趋势；随着高密度脂蛋白胆固醇（HDL-C）增加则呈降低趋势，均有统计学意义（P〈0．05）。以4项血脂指标的第1百分位组为参照，调整年龄、性别、空腹血糖、收缩压、舒张压、肥胖或超重，logistic回归分析结果显示，Tc第2和第4组CKD的调整OR值分别为0．69（95％CI：0．53～0．89）和0．77（95％C1：0．60—0．99）；TG第2至第4组的CKD调整OR值分别为1．27（95％叫：1．07-1．66）、1．22（95％C1：1．04～1．59）和1．48（95％CI：1．14—1．91）；HDL—C第4组CKD的调整OR值为0．66（95％CI：0．51-0．85）。结论上海市浦东新区成年居民中，高TG血症与CKD高风险关系密切，需重视高脂血症和CKD的早期筛检和干预，避免相关慢性病的发生。

Objective To investigate the morbidity of chronic kidney disease （CKD） in residents with different blood lipid levels in Pudong New Area of Shanghai and to provide the base for controlling related chronic diseases. Methods The investigation was performed by questionnaire in 5 584 residents （20-80 years old） from the communities of Pudong New Area in Shanghai during April to July of 2008. The data of general information and life-style were collected. The fasting blood samples and a morning urine samples were collected to measure the levels of creatinine in blood and urine, the levels of urinary micro-albumin. The urinary albumin to creatinine ratio （ACR） and glomerular filtration rate （GFR） were calculated. Also the blood lipid level was detected. Results The age standardized morbidities of CKD and hyperlipidemia were 11.0% and 41.0%, respectively. The age standardized morbidities of hypercholesterolemia, hypertriglyeeridemia, mixed hyperlipidemia and low-high density lipoprotein hyperlipidemia were 7.7%, 33.0%, 4.5 % and 7.1%, respectively. The age standardized morbidities of above kinds of hyperlipidemia in subjects with CKD were 53.4%, 10.8%, 44.4%, 7.6% and 10.3%, which were significantly higher those （39.5%,7.3%,31.3%,4.1% and 6.6% ） in non -CKD subjects （P〈0.01）. The morbidities of albuminuria and CKD increased with TC, TG and LDL-C; the morbidities of albuminuria and CKD decreased with HDL-C （P〈0.05）. According to the first quartile of four lipid measurements, after adjusting age, sex, fasting blood glucose, systolic pressure, diastolic pressure, obesity and overweight, logistic regressive analysis showed that the adjusted OR values of CKD for the second and fourth quartiles of TC were 0.69 （95%CI：0.53-0.89） and 0.77 （95%CI： 0.60-0.99） ,P〈0.01 or P〈0.05; the adjusted OR values of CKD for the 2nd-4th quartiles ofTG werel.27 （95%CI： 1.07-1.66）, 1.22 （95%CI： 1.04-1.59） and 1.48 （95%CI： 1.14-1.91 ）,P〈0.05 or P〈0.01; the adjusted OR value of CKD for the 4th quartile of HDL-C was 0.66 （95%CI：0.51-0.85 ）,P〈0.01. Conclusion Hypertriglyceridemia is closely associated with high risk of CKD in adult residents in Pudong New Area of Shanghai. Early screening and treatment of hyperlipidemia and CKD should be attended to prevent related chronic diseases.