绝经前后代谢综合征与慢性肾脏病的相关性

Association of metabolic syndrome with chronic kidney disease in premenopausal and postmenopausal women

目的探讨绝经前后代谢综合征(MS)与慢性肾脏病(CKD)风险的关系。方法于2012年6月~10月对珠海市湾仔社区1346名社区妇女开展横断面调查,获得其个人史、生活方式、身体测量指标、血尿生化指标等,以估算肾小球滤过率(eGFR)小于60 mL/min/1.73 m2或者白蛋白尿诊断CKD,采用国际糖尿病联合会(IDF)关于MS的诊断标准,根据流行病学调查获得自然绝经年龄划分绝经前后状态,分别在绝经前和绝经后妇女中确定MS和CKD的患病率,然后使用SPSS软件(版本19.0)建立logistic回归模型分析绝经前后妇女中MS与CKD关系。结果在调整绝经前妇女潜在混杂因素前后,MS均与CKD显著相关,比值比(OR)分别为3.10(95%CI 1.32~7.28,P=0.009)和4.09(95%CI 1.63~10.32,P=0.003)。当针对糖尿病、高血压及尿酸进行调整时,绝经前妇女中MS和CKD之间没有相关性(OR 1.56,95%CI 0.31~7.63,P=0.592)。未经调整上述因素的分析中,绝经后妇女MS与CKD显著相关(P<0.001)。进一步调整年龄、教育状况、吸烟、身体活动和饮酒情况后,绝经后妇女MS仍与CKD显著相关,OR为2.60(95%CI 1.69~3.99,P<0.001)。当针对糖尿病、高血压及高尿酸进行调整时,绝经后妇女MS和CKD的相关性仍然显著(OR 1.61,95%CI 1.09~2.37,P=0.018)。在绝经后妇女的未调整模型中,较高的血压、较高的血清甘油三酯水平和较高的空腹血糖与CKD显著相关,OR分别是2.77(95%CI 1.57~4.89,P<0.001),1.84(95%CI 1.16~2.90,P=0.009),2.07(95%CI1.30~3.28,P=0.002)。调整年龄、吸烟、饮酒、教育状况及身体活动情况后,较高的血压、血清甘油三酯及空腹血糖仍与绝经后妇女的CKD发病风险显著相关,它们的OR分别为2.28(95%CI 1.22~4.26,P=0.01),1.71(95%CI 1.03~2.86,P=0.039)和2.25(95%CI 1.36~3.73,P=0.002)。结论妇女绝经前后MS与CKD均具有相关性,在绝经前这种相关性依赖于高血糖、高血压或高尿酸,而在绝经后不存在这种依赖性。

Objective To explore the relationship between metabolic syndrome (MS) and the risk for chronic kidney disease (CKD) in premenopausal and postmenopausal women. Methods We conducted a cross-sectional study among 1346 community-based women from June to October 2012 and collected the data of personal history, lifestyle, physical measures and laboratory indicators. The diagnosis of CKD was established for an eGFR of less than 60 mL/min per 1.73 m2 or albuminuria. The diagnosis of metabolic syndrome was based on the International Diabetes Federation Guide. According to an epidemiological survey in Guangdong province, women older than 48.9 years were classified as having a postmenopausal status. The prevalence of MS and CKD was determined in both the premenopausal and postmenopausal women, and the association between MS and CKD was analyzed using logistic regression models. Results MS was significantly correlated with CKD in premenopausal women in both unadjusted analyses (OR=3.10, 95% CI: 1.32-7.28, P=0.009) and in analysis after adjustment for potential confounders (OR=4.09, 95%CI: 1.63- 10.32, P=0.003). When adjusted for diabetes, hypertension, and hyperuricemia, no correlation was found between MS and CKD in premenopausal women (OR=1.56, 95%CI: 0.31-7.63, P= 0.592);in the unadjusted analyses, MS was significantly correlated with CKD in postmenopausal women (P<0.001). After further adjustment for age, education status, current smoking, physical inactivity, and current drinking, MS was still significantly correlated with CKD (OR=2.60, 95% CI: 1.69-3.99, P<0.001). When adjusted for diabetes, hypertension, and hyperuricemia, the correlation between MS and CKD was still significant (OR=1.61, 95% CI: 1.09-2.37, P=0.018). In the unadjusted model, a high blood pressure (OR=2.77, 95%CI: 1.57-4.89, P<0.001), an elevated serum triglyceride level (OR=1.84, 95%CI: 1.16-2.90, P=0.009) and a high fast glucose level (OR=2.07, 95%CI: 1.30-3.28, P=0.002) were all significantly correlated with CKD in postmenopausal women. After adjusting for age, current smoking, current alcohol use, education status and physical inactivity, a high blood pressure (OR=2.28, 95%CI: 1.22-4.26, P=0.01), a high serum triglyceride level (OR=1.71, 95%CI: 1.03-2.86, P=0.039) and a high fast glucose (OR=2.25, 95%CI: 1.36-3.73, P=0.002) were still significantly correlated with CKD in postmenopausal women. Blood pressure, serum triglyceride level, fast glucose, serum HDL cholesterol level and central obesity were not correlated with CKD in either the unadjusted model or adjusted model in premenopausal women (P>0.05). Conclusion MS is correlated with CKD in both premenopausal and postmenopausal women, and the association is dependent on diabetes, hypertension, and hyperuricemia in premenopausal women but not in postmenopausal women.