慢性肾脏病患者肾小球滤过率下降速率与疾病发展的相关性分析

Analysis of the correlation between glomerular filtration rate decline rate and disease development in patients with chronic kidney disease

目的探讨慢性肾脏病(CKD)患者的肾小球滤过率(eGFR)的下降速率与疾病进展的相关性,分析疾病进展的影响因素。方法收集2014年1月一2016年10月在解放军第474医院肾病科诊断为CKD的成年患者234例的临床资料,包括年龄、性别、原发疾病、高血压情况、糖尿病情况、血管紧张素转换酶抑制剂/血管紧张素H受体拮抗剂使用情况(ACEI/ARB),血糖水平(GLU)、总胆固醇(TC)、三酰甘油(TG)、尿素氮水平(BUN)、血清肌肝水平(Scr)、白蛋白水平(ALB)、血磷水平(P)、24 h蛋白尿定量等情况。对所有患者进行2年的随访,以患者2年内发展至终末期肾脏病(ESRD)为疾病进展的标准,计算不同eGFR下降率的患者疾病进展情况以及不同原发疾病患者1年和2年的eGFR下降率和疾病进展情况,评估影响患者疾病进展的相关危险因素。结果234例患者2年内共有81例患者评估为疾病进展至ESRD,总ESRD发生率为34.6%,其中eGFR下降率>40%的患者的ESRD发生率显著高于eGFR下降率V40%的患者,差异有统计学意义⑴=4.156,P<0.05);所有患者1年后平均eGFR下降率为12.6%,2年后平均eGFR下降率为24.3%slgA肾炎的患者的1年及2年的eGFR下降率最低,糖尿病肾病的患者的1年及2年的eGFR下降率及2年内ESRD发生率均最高。单因素及多因素Logistic回归分析显示,合并糖尿病、初始eGFR越低、24 h蛋白尿定量越高、2年eGFR下降率>40%、未使用ACEI/ARB是影响CKD患者疾病进展的独立危险因素,差异具有统计学意义(P<0.05)o结枪不同原发疾病的CKD患者的eGFR下降速率存在差异,eGFR下降率越高CKD患者进展至ESRD的风险也越高。

Objective To investigate the correlation between the decline rate of glomerular filtration rate(GFR)and the progression of chronic kidney disease(CKD),and to analyze the influencing factors of disease progression.Methods 234 adult patients with CKD diagnosed in our nephrology department from 2014 to October 2016 were selected・Baseline data of all patients were collected,including age,sex,primary disease, hypertension, diabetes mellitus, angiotensin converting enzyme inhib让or/angiotensin IIreceptor antagonist use (ACEI/ARB) , blood sugar level (GLU) , total cholesterol (TC), triglyceride(TG) , urea nitrogen level (BUN), serum creatinine level (Scr) , albumin water. Levels of ALB, bloodphosphorus (P) , 24h proteinuria and so on. All patients were followed up for 2 years・ The disease progressionof patients with different eGFR reduction rates and the eGFR reduction rates and disease progressionof patients with different primary diseases for 1 and 2 years were calculated, and the risk factors affectingthe disease progression were evaluated. Results A total of 81 patients in 234 patients were assessed as diseaseprogression to ESRD within 2 years・ The total incidence of ESRD was 34.6%・ The incidence of ESRDin patients with eGFR decrease rate >40% was significantly higher than that in patients with eGFR decreaserate <40%・ The difference was statistically significant (X2 =4.156, P VO.O5). Meanwhile, the averagedecrease rate of eGFR in all patients was 12.6% after one year, 24.3% after two years・ The decreaserate of eGFR was less than 20%, and the decrease rate of eGFR was less than 25% in 2 years・ The decreaserate of eGFR in IgA nephritis patients was the lowest in 1 year and 2 years・ The decrease rate of eGFRin diabetic nephropathy patients in 1 year and 2 years and the incidence of ESRD in 2 years were thehighest. Univariate and multivariate logistic regression analysis showed that diabetes mellitus, lower initialeGFR, higher 24-hour proteinuria, lower eGFR in 2 years and no ACEI/ARB were independent riskfactors affecting the progression of CKD patients, with significant difference (P VO.05). Conclusion Thedecrease rate of eGFR was different among CKD patients with different primary diseases・ The higher thedecrease rate of eGFR, the higher the risk of disease progression to ESRD.