累积血压暴露与新发慢性肾脏病的关系

Association between cumulative exposure to blood pressure and new-onset chronic kidney disease

目的探讨累积血压（CHITIBP）暴露与新发慢性肾脏病（CKD）之间的关系。方法本研究为前瞻性队列研究，以参加开滦集团2006年至2007年度健康体检的101510名在职及离退休员工为观察对象，分别于2008—2009年度、2010—2011年度、2012-2013年度对该人群进行了第2、第3、第4次健康体检，检测该人群尿蛋白及血肌酐水平。排除基线资料缺失、CKD患者，排除随访过程中因各种原因未参加体检、资料缺失、新发CKD者后，共27809例纳入研究。按照累积血压暴露得分5分位法分组：Q1组〈3．70分；Q2组：3．70—6．16分；Q3组：6．17—8．45分；Q4组：8．46-10．95分；Q5组≥10．96分。采用多因素Logistic回归分析方法，分析cumBP暴露水平与新发CKD的关系。结果Q1～Q5组人群新发CKD的发病率依次为2．59％、3．11％、4．19％、5．81％、7．73％，组间比较差异有统计学意义（P〈0．01）。随着cumBP暴露水平的增加，CKD的检出率呈上升趋势。多因素Logistic回归分析结果显示，在校正年龄、性别、受教育程度、收入水平、吸烟情况、饮酒情况、体重指数、空腹血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血尿酸及c反应蛋白等因素后，与Q1组相比，Q2～Q5组人群新发CKD的风险增加，OR值（95％ CI）依次为1．08（O．86～1．35）、1．26（1．01～1．58）、1．57（1．27～1．95）、1．78（1．43～2．21），趋势检验P值〈0．01。性别分层后上述趋势依然存在。eumBP暴露水平每增加1分，总人群中CKD的发病风险增加6％（趋势检验P值〈0．01），男性发病风险增加8％（趋势检验P值〈0．01），女性增加3％（趋势检验P值=0．12）。结论随着累积血压暴露水平的增高，CKD的发病风险增加，男性人群更为显著。

Objective To investigate the association between cumulative exposure blood to pressure （cure BP） and new-onset chronic kidney disease （CKD）. Methods In this prospective cohort study, 101 510 employees of Kailuan Group receiving annual health examination during 2006 to 2007 were observed. The participants received the second, third, and fourth annual health examinations during 2008 to 2009, 2010 to 2011, and 2012 to 2013 year respectively. Their urinary and serum creatinine were tested, and participants with incomplete SBP, DBP data and CKD were excluded. Further excluding those who somehow failed to take annual health examination, with incomplete data, or new-onset CKD 27 809 participants were selected in the analysis. According to cure BP exposure quintile grouping： Q1 〈 3.70 scores; Q2： 3.70- 6.16 scores; Q3： 6.17- 8.45 scores; Q4： 8.46- 10.95 scores; Q5 ≥ 10.96 scores. Multivariate Logistic regression was used to analyze the association between cam BP level and new-onset CKD by eum BP exposure quintile grouping. Results The rise of cum BP exposure level caused the increased incidence of CKD. The incidences of CKD in the five quintile groups were 2.59%, 3.11%, 4.19%, 5.81%, and 7.73% respectively （P〈 0.01）. Compared with Q1 group, multivariate logistic regression analysis showed that after the adjustment of age, gender, education, income, smoking, drinking, BMI, FBG, TC, TG, LDL, HDL, UA and CRP, the incidences of CKD gradually increased in the Q2, Q3, Q4, and Q5 cure BP quintile groups, and 0R（95%C1） values were 1.08（0.86- 1.35）, 1.26（1.01 - 1.58）, 1.57（1.27 - 1.95）, 1.78（1.43 - 2.21） respectively （P for trend 〈 0.01）. Similar results were obtained in different genders. For each single point increase of cum BP exposure level, the incidence of CKD increased 6% in the general population （P for trend 〈 0.01）, increased 8% in male （P for trend 〈 0.01）, and 3% in female （P for trend=0.12）. Conclusion As the cumulative exposure to blood pressure increases, the risk of CKD incidence rises, especially in men.