中老年人脉压与肾功能下降的关联研究

杨雪莹; 田晶; 代巧云; 王永红; 张俊辉; 焦楷磊; 马旭; 赵君

doi:10.16462/j.cnki.zhjbkz.2021.08.015

中老年人脉压与肾功能下降的关联研究

doi: 10.16462/j.cnki.zhjbkz.2021.08.015

1.
100081 北京，国家卫生健康委科学技术研究所人类遗传资源中心
2.
400013 重庆，重庆医科大学附属第一医院健康管理中心

杨雪莹和田晶为共同第一作者

基金项目:

国家重点研发计划 2016YFC1000307

国家卫生健康委科学技术研究所课题 2018NRIFPJ03

国家人口与生殖健康科学数据中心 2005DKA32408

详细信息

通讯作者:
赵君，E-mail: zj@e-health.org.cn

中图分类号: R544; R692
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出版历程
- 收稿日期: 2020-12-30
- 修回日期: 2021-04-02
- 网络出版日期: 2021-08-24
- 刊出日期: 2021-08-10

Study on the association between pulse pressure and renal function decline among middle-aged and elderly people

1.
Human Genetic Resources Center, National Research Institute for Family Planning, Beijing 100081, China
2.
Health Management Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400013, China

YANG Xue-ying and TIAN Jing contributed equally to this article

Funds:

National Key Research and Development Program 2016YFC1000307

Project of National Research Institute for Family Planning 2018NRIFPJ03

National Population and Reproductive Health Science Data Center 2005DKA32408

More Information

Corresponding author: ZHAO Jun, E-mail: zj@e-health.org.cn

摘要

摘要: 目的探讨中老年人脉压(pulse pressure, PP)与肾功能下降的关系。方法以2015年1月1日—2019年12月31日在重庆医科大学附属第一医院参加健康体检的46 605例中老年人(≥45岁)为研究对象，按其PP水平分为四组(< 40 mm Hg、40~ < 50 mm Hg、50~ < 60 mm Hg、≥60 mm Hg)，采用非条件Logistic回归分析模型分析PP与肾功能下降的关联。结果本研究46 605例中老年人年龄为54(48, 60)岁，肾功能下降者占27.37%(其中轻度占26.45%，中重度占0.92%)。与同年龄人群对照组相比，PP < 40 mm Hg和PP≥60 mm Hg组中老年人发生肾功能下降的风险分别升高11%和28%；按年龄分层后，45~ < 60岁中年人仅PP < 40 mm Hg组发生肾功能下降的风险升高13%(OR=1.13, 95% CI: 1.05~1.22)，≥60岁老年人PP为50~ < 60 mm Hg和PP≥60 mm Hg组发生肾功能下降的风险分别升高12%(OR=1.12, 95% CI: 1.02~1.24)和66%(OR=1.66, 95% CI: 1.48~1.86)。限制性立方样条结果提示PP与肾功能下降的关联强度呈非线性关系，中年人PP < 42 mm Hg，老年人PP>55 mm Hg时肾功能下降风险增加。PP与肾功能下降程度关联分析结果显示，中年人仅PP < 40 mm Hg组发生肾功能轻度下降的风险升高13%(OR=1.13, 95% CI: 1.05~1.22)；老年人PP为50~ < 60 mm Hg组发生肾功能轻度下降的风险升高11%(OR=1.11, 95% CI: 1.01~1.23)，PP≥60 mm Hg组发生肾功能轻度和中重度下降的风险分别升高61%(OR=1.61, 95% CI: 1.43~1.81)和179%(OR=2.79, 95% CI: 1.94~4.02)。结论 PP对肾功能下降及下降程度发生风险的影响在中年人和老年人中并不相同，应特别关注PP减小的中年人和PP增大的老年人的肾功能情况。
- 中老年人 /
- 脉压 /
- 肾功能下降 /
- 估计肾小球滤过率
Abstract: Objective To explore the association between pulse pressure (PP) and renal function decline among middle-aged and elderly people. Methods A total of 46 605 middle-aged and elderly people (aged ≥45 years old) who participated in the physical examination in the First Affiliated Hospital of Chongqing Medical University from January 1, 2015 to December 31, 2019 were selected as the study objects. According to their PP levels, they were divided into four groups (PP < 40 mm Hg, 40- < 50 mm Hg, 50- < 60 mm Hg, and ≥60 mm Hg). Unconditional Logistic regression model was used to analyze the association between PP and renal function decline. Results The age of the 46 605 people included in this study was 54(48, 60) years old, and 27.37% of them had renal function decline (26.45% were mild, and 0.92% were moderate-severe). Compared with the same age group, the risk of renal function decline increased by 11% and 28% in PP < 40 mm Hg and PP≥60 mm Hg groups among middle-aged and elderly people, respectively. The results of age stratification analysis showed that among middle-aged people aged 45- < 60 years old, the risk of renal function decline increased by 13% (OR=1.13, 95% CI: 1.05-1.22) only in the PP < 40 mm Hg group, while among elderly people aged ≥60 years old, the risk increased by 12% (OR=1.12, 95% CI: 1.02-1.24) and 66% (OR=1.66, 95% CI: 1.48-1.86) in the PP=50- < 60 mm Hg and PP≥60 mm Hg groups, respectively. Restrictive cubic spline results suggested that the association between PP and renal function decline was non-linear, and the risk of renal function decline increased when PP < 42 mm Hg in middle-aged people and PP>55 mm Hg in elderly people. The results of correlation analysis between PP and different degrees of renal function decline showed that the risk of mild renal function decline was increased by 13% (OR=1.13, 95% CI: 1.05-1.22) only in middle-aged people with PP < 40 mm Hg group, while the risk of mild renal function decline was increased by 11%(OR=1.11, 95% CI: 1.01-1.23) in elderly people with PP=50- < 60 mm Hg group, and the risk of mild and moderate-severe renal function decline was increased by 61%(OR=1.61, 95% CI: 1.43-1.81)and 179%(OR=2.79, 95% CI: 1.94-4.02) in elderly people with PP≥60 mm Hg group, respectively. Conclusions The effect of PP on the risk of renal function decline and its degrees was not the same in middle-aged people and elderly people. Special attention should be paid to the renal function of middle-aged people with decreased PP and elderly people with increased PP.
- Middle-aged and elderly people /
- Pulse pressure /
- Renal function decline /
- Estimated glomerular filtration rate

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图 1 中老年人脉压与肾功能下降风险的剂量-反应关系

Figure 1. Dose-response relationship between pulse pressure and renal function decline in middle-aged and elderly people

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表 1 研究对象基本特征比较[n(%)]

Table 1. The comparison of the basic characteristics of the study objects [n(%)]

变量	肾功能正常(n=33 851)	肾功能下降(n=12 754)	χ²值	P值
体检年份(年)			186.03	< 0.001
2015	2 055(6.07)	794(6.23)
2016	5 188(15.33)	2 564(20.10)
2017	6 172(18.23)	2 402(18.83)
2018	8 101(23.93)	2 631(20.63)
2019	12 335(36.44)	4 363(34.21)
人群			4 435.66	< 0.001
中年人	27 883(82.37)	6 637(52.04)
老年人	5 968(17.63)	6 117(47.96)
性别			576.52	< 0.001
男	17 801(52.59)	8 287(64.98)
女	16 050(47.41)	4 467(35.02)
超重/肥胖			87.57	< 0.001
否	19 047(56.56)	6 558(51.71)
是	14 626(43.44)	6 124(48.29)
高血压			309.82	< 0.001
否	26 260(77.58)	8 889(69.70)
是	7 591(22.42)	3 865(30.30)
糖尿病			29.00	< 0.001
否	31 465(94.05)	12 011(95.35)
是	1 991(5.95)	586(4.65)
血脂异常			17.60	< 0.001
否	22 223(66.01)	8 104(63.92)
是	11 445(33.99)	4 574(36.08)
PP(mm Hg)			647.56	< 0.001
< 40	5 534(16.35)	1 719(13.48)
40~ < 50	13 694(40.45)	4 284(33.59)
50~ < 60	9 694(28.64)	3 685(28.89)
≥60	4 929(14.56)	3 066(24.04)

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表 2 中老年人脉压与肾功能下降的多因素Logistic回归分析模型分析

Table 2. Multivariate Logistic regressive model analysis of the association between pulse pressure and renal function decline in middle-aged and elderly people

人群	PP (mm Hg)	单因素分析		多因素分析
人群	PP (mm Hg)	OR(95% CI)值	P值	OR^a(95% CI)值	P值
中老年人(n=46 605)	40~49	1.00		1.00
	< 40	0.99(0.93~1.06)	0.828	1.11(1.04~1.19)	0.003
	50~ < 60	1.22(1.15~1.28)	< 0.001	1.02(0.96~1.07)	0.583
	≥60	1.99(1.88~2.10)	< 0.001	1.28(1.18~1.37)	< 0.001
中年人(n=34 520)	40~49	1.00		1.00
	< 40	1.11(1.03~1.19)	0.007	1.13(1.05~1.22)	0.001
	50~ < 60	0.97(0.91~1.04)	0.394	0.99(0.92~1.06)	0.729
	≥60	0.89(0.81~0.97)	0.012	0.96(0.86~1.07)	0.425
老年人(n=12 085)	40~49	1.00		1.00
	< 40	0.94(0.80~1.09)	0.401	0.94(0.80~1.10)	0.433
	50~ < 60	1.06(0.96~1.16)	0.253	1.12(1.02~1.24)	0.023
	≥60	1.46(1.33~1.61)	< 0.001	1.66(1.48~1.86)	< 0.001
注：^a调整因素为体检年份、年龄(总研究人群中调整)、性别、超重/肥胖、高血压、糖尿病、血脂异常。

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表 3 中老年人脉压与不同程度肾功能下降的多因素Logistic回归分析模型分析

Table 3. Multivariate Logistic regression analysis of the association between pulse pressure and different degrees of renal function decline in middle-aged and elderly people

人群	PP (mm Hg)	肾功能轻度下降				肾功能中重度下降
人群	PP (mm Hg)	OR(95% CI)值	P值	OR^a(95% CI)值	P值	OR (95% CI)值	P值	OR^a(95% CI)值	P值
中老年人(n=46 605)	40~ < 50	1.00		1.00		1.00		1.00
	< 40	1.00(0.94~1.06)	0.947	1.11(1.04~1.19)	0.003	0.76(0.49~1.17)	0.212	0.95(0.62~1.47)	0.831
	50~ < 60	1.20(1.14~1.26)	< 0.001	1.01(0.96~1.07)	0.684	1.93(1.46~2.54)	< 0.001	1.26(0.94~1.67)	0.117
	≥60	1.90(1.80~2.02)	< 0.001	1.25(1.16~1.35)	< 0.001	6.03(4.67~7.78)	< 0.001	2.24(1.64~3.07)	< 0.001
中年人(n=34 520)	40~ < 50	1.00		1.00		1.00		1.00
	< 40	1.11(1.03~1.19)	0.007	1.13(1.05~1.22)	0.001	0.97(0.51~1.85)	0.928	1.07(0.56~2.04)	0.842
	50~ < 60	0.97(0.91~1.03)	0.33	0.99(0.92~1.06)	0.703	0.97(0.80~2.23)	0.267	1.34(0.65~1.88)	0.711
	≥60	0.87(0.79~0.96)	0.004	0.95(0.85~1.05)	0.316	2.48(1.41~4.34)	0.002	1.57(0.82~3.01)	0.174
老年人(n=12 085)	40~ < 50	1.00		1.00		1.00		1.00
	< 40	0.94(0.80~1.09)	0.433	0.94(0.80~1.11)	0.471	0.94(0.80~1.09)	0.599	0.85(0.47~1.54)	0.583
	50~ < 60	1.06(0.96~1.16)	0.343	1.11(1.01~1.23)	0.037	1.06(0.96~1.16)	0.15	1.35(0.95~1.90)	0.091
	≥60	1.46(1.33~1.61)	< 0.001	1.61(1.43~1.81)	< 0.001	1.46(1.33~1.61)	< 0.001	2.79(1.94~4.02)	< 0.001

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