合肥市城郊40岁以上人群中估算肾小球滤过率分布特征及影响因素

Estimation of glomerular filtration rate distribution characteristics and influencing factors in population over 40 years old in Hefei community

目的了解合肥市社区40岁以上糖代谢异常人群估算的肾小球滤过率(e GFR)分布情况以及影响因素。方法采用整群抽样、横断面调查方法,选取合肥市蜀山区2个社区40岁以上常住居民4 464例,根据糖耐量结果,分为糖耐量正常(NGT)组2 963例,糖调节受损(IGR)组1 089例,糖尿病(DM)组412例。所有受试者均接受问卷调查、体格检查以及相关的实验室检查。e GFR结果源于肾脏病膳食改良试验(MDRD)公式。分析不同糖代谢人群中的e GFR分布情况,并应用Logistic回归分析方法了解血糖升高人群e GFR的影响因素。结果在NGT组中,e GFR轻度下降比例为32. 9%,中重度下降比例为1. 9%;在IGR组中,e GFR轻度下降比例为42. 8%,中重度下降比例为3. 3%;在DM组中,e GFR轻度下降比例为47. 1%,中重度下降比例为5. 6%。与NGT组比较,IGR组和DM组的e GFR轻度和中重度下降比例均显著增高,差异有统计学意义(P <0. 05)。与IGR组比较,DM组中e GFR轻度下降比例、中重度下降比例也均显著增高,差异有统计学意义(P <0. 05)。多元Logistic回归分析显示,糖代谢异常人群中影响e GFR的危险因素分别有年龄、腰围、低密度脂蛋白胆固醇(LDL-C)、血肌酐(SCr)水平,而高密度脂蛋白胆固醇(HDL-C)则为独立保护因素。结论合肥市社区40岁以上人群中,升高的血糖水平与e GFR下降趋势密切相关。改善脂代谢紊乱,减轻体质量对糖代谢异常人群并发慢性肾脏病的防治具有重要的意义。

Objective To explore the distribution characteristics of estimated glomerular filtration rate(eGFR) and its influencing factors in populations with abnormal glucose metabolism over 40 years old in Hefei community. Methods Using cluster sampling, a cross-sectional survey was carried out in residents over 40 years of age from two communities in Shushan district, Hefei city, a total of 4 464 subjects, who were composed of 2 963 subjects with normal glucose tolerance(NGT), 1 089 subjects with impaired glucose regulation(IGR), and 412 subjects with diabetes, according to the results of glucose tolerance, were included and received questionnaires and physical aminations and related laboratory tests. The eGFR value was calculated according to the kidney disease dietary improvement test(MDRD) formula. The distribution characteristics of eGFR in different glucose metabolism populations was analyzed, and the multiple logistic regression analyses were used to explore the related factors of eGFR in people with abnormal blood glucose. Results In NGT group, the proportion of eGFR with mild decline and moderate to severe declines was 32.9%, 1.9%, respectively. In IGR group, the proportion of eGFR with mild decline and moderate to severe declines was 42.8%, 3.3%, respectively. In DM group, the proportion of eGFR with mild decline and moderate to severe declines was 47.1%, 5.6%, respectively. Compared with NGT group, the proportion of eGFR with mild decline and moderate to severe declines were all significantly higher in IGR group and DM group(P<0.05). Compared with IGR group, the proportion of eGFR with mild decline and moderate to severe declines were all significantly higher in DM group, the difference was statistically significant(P<0.05). The multiple logistic regression analyses showed that age, waist circumference, low density lipoprotein cholesterol(LDL-C), serum creatinine(SCr) levels were independently associated with a statistically significant increase in the risk of decreased eGFR, while high density lipoprotein cholesterol(HDL-C) was an independent protection factor. Conclusion In the population over 40 years old in Hefei community, the increased blood glucose levels were closely correlated with the decreased eGFR values. Improving lipid metabolism disorder and reducing body weight are of great significance in preventing and treating chronic kidney disease in patients with abnormal glucose metabolism.