受教育程度与慢性肾脏病的因果关系:孟德尔随机化研究

Association between education level and chronic kidney disease:A Mendelian randomization study

目的探讨受教育程度与慢性肾脏病(包含慢性肾小球肾炎、肾病综合征、糖尿病肾病、慢性肾衰竭等慢性肾脏病临床诊断)的因果关系,为不同人群防治慢性肾脏病提供针对性指导支持。方法研究采用逆方差加权法(inverse-variance weighted,IVW)、MR-Egger回归、加权中位数法、加权模型4种回归模型对受教育程度与慢性肾脏病的因果关系进行孟德尔随机化分析。结果4种回归模型均显示慢性肾脏病、慢性肾小球肾炎、肾病综合征3种模型,差异无统计学意义(P均>0.05)。糖尿病肾病模型可见除IVW法(OR=0.520,P<0.05)以外的其余3种方法差异无统计学意义,而散点图显示所有方法的总效应值方向一致,差异有统计学意义(P<0.05)。慢性肾衰竭模型IVW法(OR=0.487,P<0.001)、加权中位数法(OR=0.503,P<0.001)显示效应显著,且散点图显示所有方法的总效应值方向一致,差异有统计学意义。结论利用两样本孟德尔随机化方法排除混杂因素和反向因果关联后,得到无偏估计的结果,即受教育程度与总体慢性肾脏病发病无关,但对其中糖尿病肾病、慢性肾衰竭具有反向因果关系。

Objective To explore the causal relationship between educational attainment and chronic kidney disease(including chronic glomerulonephritis,nephrotic syndrome,diabetic nephropathy,chronic renal failure,and other clinical diagnoses of chronic kidney disease),and provide targeted guidance support for different populations in the prevention and treatment of chronic kidney disease.Methods The study used four regression models,random-effects inverse-variance weighted(IVW),MR-Egger regression,weighted median method,and weighted model,to perform Mendelian randomization analysis of the causal relationship between educational attainment and chronic kidney disease.Results All four regression models showed no statistical significance for the three models of chronic kidney disease,chronic glomerulonephritis,and nephrotic syndrome with P>0.05.The diabetic nephropathy model was seen to be statistically significant as the results of the three methods except IVW method(OR=0.520,P<0.05)were not significant,while the scatter plot showed that the direction of the total effect value was the same for all methods.Chronic renal failure model IVW method(OR=0.487,P<0.001),weighted median method(OR=0.503,P<0.001)showed a significant effect and the scatter plot showed that the direction of the total effect value was the same in all methods,which was statistically significant.Conclusion Using two-sample Mendelian randomization method to exclude confounding factors and reverse causal associations,unbiased estimation results were obtained to get that the education level is not related to the overall chronic kidney disease incidence,but has reverse causality for diabetic nephropathy and chronic renal failure among them.