老年人基线脉压水平对远期肾功能的影响

目的研究脉压水平对老年人群远期肾功能的影响。方法用前瞻性队列研究法,选择开滦集团年龄≥60岁健康体检者9695例,以脉压水平分为:脉压<40mm Hg(1mm Hg=0.133kPa,1组)972例、40⁴9mm Hg(2组)2393例、5049mm Hg(2组)2393例、50⁵9mm Hg(3组)2553例、脉压≥60mm Hg(4组)3777例,以估算肾小球滤过率(eGFR)<60ml/(min·1.73m2)为肾功能受损。随访2459mm Hg(3组)2553例、脉压≥60mm Hg(4组)3777例,以估算肾小球滤过率(eGFR)<60ml/(min·1.73m2)为肾功能受损。随访24⁶3(50.84±4.83)个月,用Kaplan-Meier法及多因素Cox回归模型分析脉压对远期肾功能的影响。结果 1组、2组、3组和4组肾功能受损分别为11例、71例、81例和189例(1.1%vs3.0%vs 3.2%vs 5.0%,P<0.01)。校正传统危险因素后,与1组比较,其他3组发生肾功能受损的相对风险分别为2.67(95%CI:1.3363(50.84±4.83)个月,用Kaplan-Meier法及多因素Cox回归模型分析脉压对远期肾功能的影响。结果 1组、2组、3组和4组肾功能受损分别为11例、71例、81例和189例(1.1%vs3.0%vs 3.2%vs 5.0%,P<0.01)。校正传统危险因素后,与1组比较,其他3组发生肾功能受损的相对风险分别为2.67(95%CI:1.33⁵.38,P<0.01)、2.98(95%CI:1.495.38,P<0.01)、2.98(95%CI:1.49⁵.96,P<0.01)和4.90(95%CI:2.505.96,P<0.01)和4.90(95%CI:2.50⁹.63,P<0.01)。结论脉压是老年人远期肾功能受损事件的独立危险因素,脉压升高,远期新发肾功能受损增加。

Effect of pulse pressure on long-term kidney function in the elderly

Objective To study the effect of PP on long-term kidney function in the elderly.Methods A total of 9695 healthy people with their age≥60years who underwent physical examination in our hospital were divided into PP<40mm Hg group(group 1,n=972),PP=40-49 mm Hg group(group 2,n=2393),PP=50-59 mm Hg group(group 3,n=2553),and PP≥60mm Hg group(group 4,n=3777).Impaired kidney function was defined when the eGFR was<60ml/(min·1.73m2).The elderly were followed up for 24-63(50.84±4.83)months.The effect of PP on long-term kidney function was analyzed using the Kaplan-Meier method and multivariate Cox proportional hazard regression model.Results Impaired kidney function was detected in 352 of the followed up elderly,namely in 11 of group 1,in 71 of group 2,in 81 of group 3,and in189 of group 4(1.1%vs 3.0%vs 3.2%vs 5.0%,P<0.01).After adjustment for traditional risk factors,the relative risk coefficient was 2.67(95%CI:1.33-5.38),2.98(95%CI:1.49-5.96),and 4.90(95%CI:2.50-9.63),respectively,in groups 2-4,which was higher than that in group1(P<0.01).Conclusion PP is an independent risk factor for impaired kidney function in the elderly.New kidney funtion impairment increases with the increasing PP.