收缩压异常与肾功能下降不同分期的关系

A comparative study on the relationship between elevated systolic blood pressure and different stages of decreased renal function

目的:探讨体检者中收缩压(SBP)异常与肾功能下降不同分期之间的关系,为有效预防慢性肾脏病(CKD)提供决策依据。方法:收集178 617例健康体检者资料,以适合中国人的肾脏病饮食改良(c MDRD)简化公式估计肾小球滤过率(e GFR),根据e GFR水平将研究对象分为4组,通过χ2检验、Logistic回归分析探讨肾功能不同阶段与SBP异常的关系。结果:单因素分析中SBP异常是肾功能下降各阶段的危险因素(P<0.05,OR>1.00);多因素分析中SBP异常在e GFR<60 ml·min-1·1.73 m-2阶段是肾功能下降的危险因素(P<0.05,OR>1.00),在80 ml·min-1·1.73 m-2≤e GFR<90 ml·min-1·1.73 m-2时与肾功能下降存在关联但未表现出对肾脏的危险作用(P<0.05,OR<1.00),而在60 ml·min-1·1.73 m-2≤e GFR<80 ml·min-1·1.73 m-2时不是肾功能下降的影响因素(P>0.05)。结论:随着肾功能损伤阶段的前移,SBP异常所带来的危害可能更多地被肾脏代偿作用减轻或抵消。

Objective： To explore the relationship between abnormal systolic blood pressure（SBP） and different stages of decreased renal function,and to provide the basis for effective prevention of chronic kidney disease（CKD）. Methods： A total of 178 617 people who took part in physical examination in the Central Hospital of Xuzhou from 2006 to 2012 were enrolled in this study and divided into four groups according to estimated glomerular filtration rate（e GFR） levels. e GFR was calculated by modified modification of diet in renal disease（MDRD） formula on the basis of data from Chinese chronic kidney disease patients. The association between elevated SBP and different stages of decreased renal function was assessed by χ2 test and Logistic regression analysis. Results： Univariate analysis showed that elevated SBP was associated with decreased renal function in all stages（P 〈 0. 05,OR 〉1. 00）. In multivariate Logistic regression analysis,elevated SBP was the risk factor for decreased renal function when e GFR 〈 60 ml·min-1·1. 73 m-2（P 〈 0. 05,OR 〉 1. 00）,whereas the risk effect of elevated SBP on decreased renal function was no longer shown when 80 ml·min-1·1. 73 m-2≤e GFR 〈 90 ml·min-1·1. 73 m-2（P 〈 0. 05,OR 〈 1. 00）. In addition,multivariate Logistic regression analysis showed that the relationship between elevated SBP and decreased renal function disappeared when 60 ml·min-1·1. 73 m-2≤e GFR 〈 80 ml·min-1·1. 73 m-2（P 〉 0. 05）. Conclusion： In the early stage of decreased renal function,the damage of elevated SBP is more likely to be reduced or offset by the compensation of kidney.