摘要
背景慢性肾脏病(CKD)严重危害老年人健康与寿命。高血压与CKD密切相关,然而关于老年人血压水平与CKD发生、发展关系的相关研究结论不一致。目的探讨我国长寿地区老年人血压水平与CKD发病风险的关联。方法2021年10月—2022年5月,基于中国老年健康影响因素跟踪调查(CLHLS)子队列——老年健康生物标志物队列研究(HABCS),选取2012年体检并采集生物医学指标的989名老年人为研究对象,收集基线老年人群年龄、性别、身高、体质量、血压、血脂、血糖、血尿常规等指标,并于2014年进行随访监测。采用Cox比例风险回归模型分析血压水平与CKD发病风险的关联。结果989名老年人中位年龄为79(70,88)岁;累积随访2046人年,平均随访时间为(2.07±0.50)年;CKD新发病例共183例,随访期间CKD累积发病率为18.5%〔95%CI(16.1%,21.1%)〕,发病密度为89.4/1000人年。随访过程中,正常血压、正常高值血压、高血压组分别有9.8%(10/102)、14.0%(47/335)、22.8%(126/552)的老年人发生CKD,三组比较,差异有统计学意义(χ^(2)=16.40,P<0.001)。Cox回归结果显示,经调整年龄、性别、BMI、腰围、小腿围、空腹血糖、糖化血清蛋白、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、尿酸、超氧化物歧化酶、维生素D3、白细胞计数、红细胞计数、血小板计数、尿素氮及糖尿病病史后,与正常血压老年人相比,高血压组老年人CKD发病风险较高〔HR(95%CI)=2.28(1.13,4.60)〕;基线收缩压(SBP)≥140 mmHg(1 mmHg=0.133 kPa)的老年人CKD发病风险是基线SBP<120 mmHg老年人的1.83倍〔95%CI(1.02,3.29)〕,基线舒张压(DBP)≥90 mmHg的老年人CKD发病风险是DBP<80 mmHg老年人的1.55倍〔95%CI(1.02,2.35)〕(P<0.05)。结论高血压为老年人CKD发病的独立危险因素,尤其是以收缩压升高为主的老年人增加慢性肾脏病筛查与防治尤为重要。
Background Chronic kidney disease(CKD)is a serious risk to the health and longevity of the elderly,and hypertension is closely related to CKD.However,the studies on the correlation of blood pressure levels with the development and progression of CKD in older adults have shown inconsistent results.Objective To explore the association between blood pressure levels and the risk of CKD among the elderly in longevity areas of China.Methods From October 2021 to May 2022,a total of 989 older adults who underwent physical examination with biomedical indicators collected in 2012 were selected as subjects based on the subcohort of the Chinese Longitudinal Healthy Longevity Survey(CLHLS)-Healthy Aging and Biomarkers Cohort Study(HABCS).Age,gender,height,weight,blood pressure,blood lipid,blood glucose,routine blood and urine indicators were collected at baseline,and follow-up monitoring was conducted in 2014.Cox proportional hazards regression model was used to analyze the association between the blood pressure levels and the risk of CKD.Results A total of 989 subjects were included in the study,with a median age of 79(70,88)years.The cumulative follow-up were 2046 person-years,with an average follow-up time of(2.07±0.50)years.There were 183 new cases of CKD,the cumulative incidence of CKD was 18.5%〔95%CI(16.1%,21.1%)〕,and the incidence density was 89.4/1000 person-years.During the follow-up,9.8%(10/102),14.0%(47/335)and 22.8%(126/552)of the older adults in the normal blood pressure,high normal blood pressure and hypertension groups developed CKD,respectively,and the difference was statistically significant among the three groups(χ^(2)=16.40,P<0.001).The results of Cox regression showed that after adjusting for age,sex,BMI,waist circumference,calf circumference,fasting blood glucose,glycosylated serum protein,total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,uric acid,superoxide dismutase,vitamind3,white blood cell count,red blood cell count,platelet count,blood urea nitrogen and history of diabetes,the older adults in the hypertension group had a higher risk of CKD〔HR(95%CI)=2.28(1.13,4.60)〕than those in the normal blood pressure group;the risk of CKD was 1.83 times〔95%CI(1.02,3.29)〕higher in the older adults with baseline SBP≥140 mmHg(1 mmHg=0.133 kPa)than those with baseline SBP<120 mmHg,and the risk of CKD was 1.55 times〔95%CI(1.02,2.35)〕higher in the older adults with baseline DBP≥90 mmHg than those with baseline DBP<80 mmHg(P<0.05).Conclusion Hypertension is an independent risk factor for CKD in the elderly.It is particularly important to increase screening and prevention of CKD in older adults with predominantly elevated systolic blood pressure.
作者
张云盛
张鹏
靳育静
高鹰
ZHANG Yunsheng;ZHANG Peng;JIN Yujing;GAO Ying(Department of Cardiology,Tianjin Medical University General Hospital Airport Site,Tianjin 300308,China;Department of Rehabilitation Medicine,Tianjin Medical University General Hospital,Tianjin 300052,China;Health Management Center,Tianjin Medical University General Hospital,Tianjin 300052,China)
出处
《中国全科医学》
北大核心
2023年第28期3502-3506,3519,共6页
Chinese General Practice
基金
国家自然科学基金资助项目(72104179)
天津市卫生健康科技项目(KJ20178)
天津市滨海新区卫生健康科技项目(2019BWKQ031)。
