老年原发性高血压合并慢性肾脏病的影响因素

Study on the risk factors of essential hypertension complicated with chronic kidney disease in elderly patients

目的了解老年原发性高血压(EH)患者合并慢性肾脏病(CKD)情况,并探讨其影响因素。方法收集2018年3~9月在上海金山工业区社区卫生服务中心参加≥60岁居民健康体检的829例EH患者资料,根据是否合并CKD,分为合并CKD组和非合并CKD组,采用单因素和多因素Logistic回归模型分析EH并发CKD的影响因素。结果老年EH患者中蛋白尿、eGFR下降、CKD检出率分别为23.64%、13.15%、30.64%,女性eGFR下降检出率高于男性,差异有统计学意义(P<0.05)。老年EH合并CKD和非合并CKD患者在糖尿病、超重/肥胖、高尿酸血症发生率和收缩压、舒张压、HDL-C、尿素氮、血清肌酐、血尿酸、eGFR水平及年龄方面比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示:年龄(OR=3.50,95%CI:2.57~4.78)、糖尿病(OR=1.80,95%CI:1.28~2.53)、收缩压≥140 mmHg(OR=2.07,95%CI:1.53~2.81)、高尿酸血症(OR=2.75,95%CI:2.00~3.78)是EH合并CKD的危险因素。结论老年原发性高血压患者的CKD患病率较高,年龄、糖尿病、血压水平、高尿酸血症是CKD的危险因素,因此需要重视CKD早期防治,控制危险因素,遏制CKD进展。

Objective To investigate the prevalence and the risk factors of elderly essential hypertension(EH) complicated with chronic kidney disease(CKD). Methods 829 elderly EH patients who participated in physical examination of residents aged 60 years and over were enrolled at the Community Health Service Center of Jinshan Industrial Zone in Shanghai from March to September 2018. The univariate and multivariate logistic regression analyses were performed to analyze the risk factors of EH with CKD. Results The detection rates of proteinuria, reduced eGFR and CKD in elderly EH patients were 23.64%, 13.15% and 30.64%, respectively. The detection rate of reduced eGFR in females was higher than that in males(P<0.05). There were differences in the incidence of diabetes, hyperuricemia, and overweight/obesity, and in the levels of SBP, DBP, HDL-C, urea nitrogen, serum creatinine, blood uric acid,and eGFR, as well as in the age between CKD group and non-CKD group, and the differences werer statistically significant(P<0.05). The logistic regression analysis showed that age(OR=3.50, 95% CI: 2.57 ~ 4.78), diabetes mellitus(OR=1.80, 95% CI: 1.28 ~ 2.53), systolic blood pressure ≥140 mmHg(OR=2.07, 95% CI: 1.53~ 2.81), and hyperuricemia(OR=2.75, 95% CI: 2.00 ~ 3.78) were risk factors for EH complicated with CKD. Conclusion The prevalence of CKD was high in elderly patients with essential hypertension. EH with CKD was associated with age, diabetes mellitus, blood pressure level and hyperuricemia. Therefore, it is necessary to pay more attention to the early prevention and treatment of CKD, control the risk factors and curb the progress of CKD.