社区老年人群蛋白尿及肾功能异常发生率及其影响因素研究

Investigation on the Incidence and Influencing Factors of Proteinuria and Renal Dysfunction in Community-dwelling Elderly Population

背景老年人往往多种慢性病(如糖尿病和高血压)共存,而糖尿病和高血压会导致慢性肾损害,目前针对老年人慢性肾脏病研究较少。目的通过收集社区老年人群健康体检的临床数据,调查老年人群蛋白尿及肾功能异常情况,为社区老年慢性肾脏病的管理提供指导。方法纳入2020—2021年于上海市闵行区颛桥社区卫生服务中心进行体检的13080名老年居民为研究对象,收集研究对象一般资料、体检结果与实验室检查数据。将估算肾小球滤过率(eGFR)<60 mL·min^(-1)·(1.73 m^(2))-1的研究对象纳入肾功能异常组(n=713),将eGFR≥60 mL·min^(-1)·(1.73 m^(2))-1的研究对象纳入肾功能正常组(n=12367);将尿蛋白阳性的研究对象纳入蛋白尿组(n=1690),将尿蛋白阴性的研究对象纳入非蛋白尿组(n=11390);同时将研究对象按照年龄间隔10岁分为60~69岁组(n=6901)、70~79岁组(n=4867)、80~89岁组(n=1128)、≥90岁组(n=184)。采用多因素Logistic回归分析探究研究对象肾功能异常及蛋白尿的影响因素。结果60~69岁组、70~79岁组、80~89岁组、≥90岁组尿蛋白阳性和肾功能异常检出率比较,差异有统计学意义(P<0.05)。60~69岁组、70~79岁组男性尿蛋白阳性检出率高于女性,60~69岁组男性肾功能异常检出率高于女性,80~89岁组男性肾功能异常检出率低于女性(P<0.05)。肾功能异常组年龄、糖尿病比例、高血压比例、血尿素氮(BUN)、血清肌酐(Scr)、三酰甘油(TG)水平高于肾功能正常组,总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血红蛋白(Hb)水平低于肾功能正常组,两组尿微量白蛋白/尿肌酐比值(ACR)比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、高血压、糖尿病、蛋白尿、贫血、高TG血症、低HDL-C血症是肾功能异常的影响因素(P<0.05);男性、糖尿病、肥胖、高TG血症、Scr、BUN是蛋白尿的影响因素(P<0.05)。结论社区60岁以上人群的蛋白尿及肾功能异常检出率较高,且随年龄增大而增加。年龄、高血压、糖尿病、贫血、高TG血症及低HDL-C血症是社区老年人群肾功能异常的危险因素,男性、糖尿病、肥胖、高TG血症、Scr、BUN是社区老年人群蛋白尿的危险因素。

Background The elderly tend to coexist with multiple chronic diseases(such as diabetes and hypertension),while diabetes and hypertension can lead to chronic kidney damage,and fewer studies have been conducted on chronic kidney disease in older adults.Objective To investigate the proteinuria and renal dysfunction in the elderly population and provide guidance for the management of chronic kidney disease in the community-dwelling older adults by collecting the clinical data of physical examination of the elderly residents in community.Methods A total of 13080 elderly residents who underwent physical examination in Zhuanqiao Community Health Service Center of Minhang District,Shanghai from 2020 to 2021 were included as the study objects.General information,physical examination results and laboratory examination data of study objects were collected.Subjects with estimated glomerular filtration rate(eGFR)<60 mL·min^(-1)·(1.73 m^(2))^(-1) were included in the abnormal renal function group(n=713),and subjects with eGFR≥60 mL·min^(-1)·(1.73 m^(2))^(-1) were included in the normal renal function group(n=12367).The subjects with positive urine protein were included in the proteinuria group(n=1690),and the subjects with negative urine protein were included in the non-proteinuria group(n=11390).At the same time,the subjects were divided into 60 to 69 years old group(n=6901),70 to 79 years old group(n=4867),80 to 89 years old group(n=1128)and≥90 years old group(n=184)according to the age interval of 10 years.Multivariate Logistic regression analysis was used to explore the influencing factors of renal dysfunction and proteinuria in the study population.Results There were significant differences in the detection rates of urine protein positive and renal dysfunction in 60 to 69 years old,70 to 79 years old,80 to 89 years old and≥90 years old groups(P<0.05).The detection rate of urinary protein positive in males aged 60 to 69 years and 70 to 79 years was higher than that in females,the detection rate of renal dysfunction in males aged 60 to 69 years was higher than females,and the detection rate of renal dysfunction in males aged 80 to 89 years was lower than females,the difference was statistically significant(P<0.05).Age,the proportion of diabetes and hypertension,blood urea nitrogen(BUN),serum creatinine(Scr)and triglyceride(TG)in the abnormal renal function group were higher than those in the normal renal function group,while total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)and hemoglobin(Hb)in the abnormal renal function group were lower than those in the normal renal function group.There was significant difference in urinary,albumin/creatinine ratio(ACR)between the two groups(P<0.05).Multivariate Logistic regression analysis showed that age,hypertension,diabetes,proteinuria and anemia were the influencing factors of renal dysfunction(P<0.05),while male,diabetes,obesity,hypertriglyceridemia,Scr and BNU were the influencing factors of proteinuria(P<0.05).Conclusion The detection rates of proteinuria and renal dysfunction in the elderly aged 60 years and above are high,which increase with age.Age,hypertension,diabetes,anemia,hypertriglyceridemia and low HDL-C level are risk factors for renal dysfunction in community-dwelling elderly population(P<0.05);male,diabetes,obesity,hypertriglyceridemia,Scr and BUN are risk factors for proteinuria in community-dwelling elderly population.