不同BMI慢性肾脏病患者临床进展危险因素分析

The analysis of clinical facotrs on the progression of chronic kidney diseases with different BMI value

目的探讨不同体重指数(BMI)的慢性肾脏病(CKD)患者临床进展危险因素。方法选取153例肾小球滤过率(eGFR)分期在CKD 1~4期[eGFR≥15 mL/(min·1.73 m^2)]的慢性肾脏病(CKD)患者。依据BMI分为:BMI正常组83例(BMI<25 kg/m^2),超重组70例(BMI≥25 kg/m^2)。收集入组患者的年龄、性别、平均动脉压、血清肌酐、eGFR、空腹血糖、血尿酸、C反应蛋白(CRP)、甘油三酯、胆固醇、24 h尿蛋白定量等实验室指标,并进行统计。结果 2组患者共153例,其中男性占60.78%,女性占39.22%。BMI正常患者(非超重)占54.24%,超重占45.75%。2组间性别、年龄差异无统计学意义。平均动脉压2组间比较差异无统计学意义;原发病方面,超重组患者FSGS多于BMI正常组,2组比较差异有统计学意义。不同BMI患者组间实验室指标比较:超重组患者血尿酸增高、C反应蛋白增高、甘油三酯及胆固醇增高、24 h尿蛋白定量增多,与BMI正常组相比差异均有统计学意义(P<0.05);而超重组患者eGFR、血肌酐、空腹血糖与BMI正常组比较差异无统计学意义(P>0.05)。多元Logisti回归分析显示,2组患者以eGFR为因变量,以年龄、尿酸、CRP、胆固醇、甘油三酯、血糖等为自变量,分析2组eGFR与各指标之间的关系,BMI正常组患者eGFR与尿酸呈负相关性,而超重组患者eGFR与CRP、胆固醇、尿酸均呈负相关性。结论不同BMI慢性肾脏病患者,临床进展危险因素不同,临床应注意控制慢性肾脏病患者的体重、血脂、炎症状态,有益于延缓CKD进展。

Objective To explore the risk factors of clinical progression in patients with chronic kidney disease(CKD)with different body mass index(BMI).Methods 153 patients with CKD whose glomerular filtration rate(EGFR)was graded in CKD1-4(eGFR≥15 ml/min/1.73 m^2)were selected. The CKD group was further divided into two groups according to BMI: BMI<25 kg/m^2(83 patients)and BMI≥25 kg/m^2(70 patients). Age,gender,mean arteria pressure(MBP),serum creatinine(Scr),eGFR,fasting blood-glucose(FBG),uric acid(UA),C-reactive protein(CRP),triglyceride(TG),cholestero(CHOL),24-hour proteinuria were collected and analyzed.Results There were 153 patients in the two groups,60.78%was male and 39.21%was female.54.24%of the patients with normal BMI and 45.75%of them were overweight.There was no statistical difference in gender and age between two groups.There was no significant difference in the mean arterial pressure between the two groups.In terms of primary disease,FSGS in the overweight patients were more than those in normal BMI patients.Compared with those in the BMI normal group(BMI<25 kg/m2),the increase of serum uric acid,C-reactive protein,triglyceride and cholesterol,and the increase of 24-hour urinary protein in the hyperrecombinant patients(BMI≥25 kg/m2) were statistically significant(P<0.05).But the levels of e GFR、Scr、MBP and FBG were not changed in the overweight group compared with normal BMI group.Logistic analysis:UA was negatively correlated with e GFR in the two groups.CRP and CHOL were negatively correlated with e GFR in overweight group.Conclusion Patients with chronic kidney disease of different BMI have various risk factors for clinical progression.Clinical attention should be paid to control the weight,blood lipid and inflammatory status of overweight patients with chronic kidney disease,which is beneficial to delay the progression of CKD.