臂踝脉搏波传导速度变化对慢性肾脏病的影响

Impact of Changes in Brachial-ankle Pulse Wave Velocity on Chronic Kidney Disease:Results From Kailuan Study Cohort

目的:探讨臂踝脉搏波传导速度(baPWV)变化对估算肾小球滤过率(eGFR)下降、蛋白尿和慢性肾脏病(CKD)的影响。方法:入选2006~2018年开滦研究队列中完成健康体检并行两次baPWV检测的8182例职工为研究对象,并依据两次体检baPWV的变化分为baPWV持续低组(n=3139,两次体检时baPWV均<1400 cm/s)、baPWV降低组(n=567,第一次体检时baPWV≥1400 cm/s但第二次体检时<1400 cm/s)、baPWV升高组(n=1020,第一次体检时baPWV<1400 cm/s但第二次体检时≥1400 cm/s)、baPWV持续高组(n=3456,两次体检时baPWV均≥1400 cm/s)。采用多因素Logistic回归分析探讨baPWV变化对e GFR下降、蛋白尿和CKD的影响。结果:baPWV持续低组、baPWV降低组、baPWV升高组、baPWV持续高组人群eGFR下降的检出率分别为0.88%、1.81%、1.91%、4.33%,蛋白尿的检出率分别为3.69%、5.52%、3.96%、8.66%,CKD的检出率分别为4.27%、6.88%、5.59%、12.04%;组间差异均有统计学意义(P均<0.01)。多因素Logistic回归分析显示,与baPWV持续低组相比,baPWV持续高组eGFR下降、蛋白尿和CKD的OR(95%CI)分别为[1.73(1.01~2.95),P<0.01]、[1.36(0.95~1.93),P>0.05]、[1.42(1.05~1.93),P<0.01]。结论:baPWV增加是e GFR下降和CKD的危险因素。

Objectives:To investigate the impact of changes in brachial-ankle pulse wave velocity(baPWV)on glomerular filtration rate(eGFR)decline,proteinuria and new onset chronic kidney disease(CKD).Methods:A total of 8182 participants who took part in health examination and completed two baPWV tests in the Kailuan study cohort from 2006 to 2018 were selected as the observation cohort.Based on the changes of baPWV during the two health examinations,the participants were divided into four groups:continuous low baPWV group(n=3139,baPWV<1400 cm/s during the two physical examinations),decreased baPWV group(n=567,baPWV≥1400 cm/s at the first physical examination and at the second physical examination baPWV<1400 cm/s),elevated baPWV group(n=1020,baPWV<1400 cm/s at the first physical examination and baPWV≥1400 cm/s at the second physical examination),and continuous high baPWV group(n=3456,baPWV≥1400 cm/s during the two physical examinations).Multivariate logistic regression analysis was used to investigate the impact of baPWV changes on eGFR decline,albuminuria and CKD.Results:The rates of eGFR decline were 0.88%,1.81%,1.91%and 4.33%in the continuous low baPWV group,decreased baPWV group,elevated baPWV group and continuous high baPWV group,respectively.The rates of proteinuria were 3.69%,5.52%,3.96%and 8.66%in the above four groups,respectively.The rates of CKD were 4.27%,6.88%,5.59%and 12.04%in the above four groups,respectively.Compared to continuous low baPWV,multivariate logistic regression analysis showed that continuous high baPWV was independent risk factor for eGFR decline(OR=1.73,95%CI:1.01-2.95,P<0.01)and CKD(OR=1.42,95%CI:1.05-1.93,P<0.01).Conclusions:Increased baPWV is independent predictor for eGFR decline and CKD in this cohort.