CKD3～5期慢病管理患者肾功能进展速率及影响因素的研究
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摘要
目的:分析不同分期CKD患者肾功能进展速率及相关影响因素。方法:采用t检验分析SCr、BUN、e GFR、ALB、Hb、UA对疾病病程的影响;采用方差分析检验CKD不同分期对疾病进展速率的影响; 2年e GFR下降率评价CKD不同病因进展速率。结果:SCr、BUN、e GFR、Hb与病程进展有关; Hb与CKD3、4期病程进展有关; ALB、UA与病程进展关系不显。多组分析显示SCr、BUN、e GFR、Hb与疾病所处分期有关,ALB、UA无法定论。CKD4期、病因属糖尿病肾病恶化最剧烈。结论:慢性肾脏病的进展速率与所处分期密切相关,以CKD4期进展最为迅速,病因中糖尿病肾病为进展速率之最,慢性肾炎进展相对缓慢。影响因素中病因、生活方式、高血压、蛋白尿、糖尿病、贫血、低密度脂蛋白可影响CKD进展速率,尿酸、高脂血症是否是肾功能迅速恶化的高危因素临床尚无统一定论。
Objective: To analyze the progression rate of renal function of CKD patients and its related influencing factors in different stages. Methods: We analyzed the effects of SCr,BUN,e GFR,ALB,Hb and UA on the course of disease by T test and tested the effects of different stages of CKD on the rate of disease progression by variance analysis. Then we evaluated the progression rate of different etiologies of CKD by the rate of two-year e GFR decline. Results: SCr,BUN,e GFR and Hb were related to the progression of the disease; ALB and UA were not related to the progression of the disease. Multi-group analysis showed that SCr,BUN,e GFR and Hb were related to the period of disease disposition,but ALB and UA could not be conclusive. Stage CKD4 and diabetic nephropathy exacerbated most. Conclusion: The rate of progression of chronic kidney disease is closely related to the period of disposition of the disease. The progression of CKD4 is the fastest. The rate of progression of diabetic nephropathy is the most,and the progression of chronic nephritis is relatively slow. The influencing factors include etiological factor,lifestyle,hypertension,proteinuria,diabetes,anemia and low density lipoprotein. Whether uric acid and hyperlipidemia are the high risk factors for rapid deterioration of renal function has no clinical conclusion yet.
Objective: To analyze the progression rate of renal function of CKD patients and its related influencing factors in different stages. Methods: We analyzed the effects of SCr,BUN,e GFR,ALB,Hb and UA on the course of disease by T test and tested the effects of different stages of CKD on the rate of disease progression by variance analysis. Then we evaluated the progression rate of different etiologies of CKD by the rate of two-year e GFR decline. Results: SCr,BUN,e GFR and Hb were related to the progression of the disease; ALB and UA were not related to the progression of the disease. Multi-group analysis showed that SCr,BUN,e GFR and Hb were related to the period of disease disposition,but ALB and UA could not be conclusive. Stage CKD4 and diabetic nephropathy exacerbated most. Conclusion: The rate of progression of chronic kidney disease is closely related to the period of disposition of the disease. The progression of CKD4 is the fastest. The rate of progression of diabetic nephropathy is the most,and the progression of chronic nephritis is relatively slow. The influencing factors include etiological factor,lifestyle,hypertension,proteinuria,diabetes,anemia and low density lipoprotein. Whether uric acid and hyperlipidemia are the high risk factors for rapid deterioration of renal function has no clinical conclusion yet.
引文
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[17]董杨,程丽静.高尿酸血症对慢性肾脏病的作用及机制研究[J].微循环学杂志,2016,26(1):72-74.
[18]Goicoechea M,Vinuesa S G D,Verdalles U,et al. Effect of Allopurinol in Chronic Kidney Disease Progression and Cardiovascular Risk[J]. Clinical Journal of the American Society of Nephrology Cjasn,2010,5(8):1388-1393.
[19]Liu W C,Hung C C,Chen S C,et al. Association of hyperuricemia with renal outcomes,cardiovascular disease,and mortality[J]. Clinical Journal of the American Society of Nephrology Cjasn,2012,7(4):541.
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[21]张维忠,郭宗琳,钱泉,等. 2578例高脂血症者慢性肾脏病分析[J].现代临床医学,2016,42(1):55-56,58.
[22]王艳秋,秦丽丽,孙广萍,等. 1562例经皮肾穿刺活检患者的临床及病理分析[J].中国全科医学,2015,18(15):1758-1762.
[23]向海燕,刘晔,陈莎莎,等.慢性肾脏病患者肾小球滤过率下降速率与疾病进展的关系[J].肾脏病与透析肾移植杂志,2015,24(6):518-523.
[2]Lambers Heerspink H J,Tighiouart H,Sang Y,et al. GFR decline and subsequent risk of established kidney outcomes:a Meta-analysis of37 randomized controlled trials.[J]. American Journal of Kidney Diseases,2014,64(6):860-866.
[3]Inker L A,Lambers Heerspink H J,Mondal H,et al. GFR decline as an alternative end point to kidney failure in clinical trials:a Meta-analysis of treatment effects from 37 randomized trials[J]. American Journal of Kidney Diseases,2014,64(6):848-859.
[4]Levey A S,Inker L A,Matsushita K,et al. GFR decline as an end point for clinical trials in CKD:a scientific workshop sponsored by the National Kidney Foundation and the US Food and Drug Administration.[J]. American Journal of Kidney Diseases,2014,64(6):821-835.
[5]廖兵,黎琦,石宏斌,等.慢性肾脏病患者治疗依从性对肾功能进展的影响[J].中国临床研究,2013,26(3):232-233.
[6]Zhan S,Ho S C. Meta-analysis of the effects of soy protein containing isoflavones on the lipid profile[J]. American Journal of Clinical Nutrition,2005,81(2):397-408.
[7]Zhou J,Yuan W J. Effects of soy protein containing isoflavones in patients with chronic kidney disease:A systematic review and Meta-analysis[J]. Clinical Nutrition,2016,35(1):117-124.
[8]张红梅,徐佳美,常立阳,等.不同低蛋白饮食延缓CRF进程的临床研究[J].中国中西医结合肾病杂志,2010,11(6):502-505.
[9]Tang W H W,Wang Z,Kennedy D J,et al. Gut Microbiota-Dependent Trimethylamine N-Oxide(TMAO)Pathway Contributes to Both Development of Renal Insufficiency and Mortality Risk in Chronic Kidney Disease[J]. Circulation Research,2015,116(3):448-455.
[10]Lekawanvijit S. Role of Gut-Derived Protein-Bound Uremic Toxins in Cardiorenal Syndrome and Potential Treatment Modalities[J]. Circulation Journal,2015,79(10):2088-2097.
[11]熊扬眉,丁国华,石明,等.慢性肾脏病患者24 h尿蛋白定量与贫血的关系研究[J].中国全科医学,2017,20(22):2739-2745.
[12]Grossman C,Dovrish Z,Korenmorag N,et al. Diabetes mellitus with normal renal function is associated with anaemia[J]. Diabetes,2014,30(4):291-296.
[13]Bonakdaran S,Gharebaghi M,Vahedian M. Prevalence of anemia in type 2 diabetes and role of renal involvement[J]. Saudi Journal of Kidney Diseases&Transplantation,2011,22(2):286-290.
[14]Pappa M,Dounousi E,Duni A,et al. Less known pathophysiological mechanisms of anemia in patients with diabetic nephropathy[J]. International Urology&Nephrology,2015,47(8):1365-1372.
[15]Thorp M L,Johnson E S,Yang X,et al. Effect of anaemia on mortality,cardiovascular hospitalizations and end-stage renal disease among patients with chronic kidney disease[J]. Nephrology,2010,14(2):240-246.
[16]张敏,高秀,刘建华,等.慢性肾功能不全患者肾功能恶化的影响因素分析[J].山东医药,2010,50(29):34-35.
[17]董杨,程丽静.高尿酸血症对慢性肾脏病的作用及机制研究[J].微循环学杂志,2016,26(1):72-74.
[18]Goicoechea M,Vinuesa S G D,Verdalles U,et al. Effect of Allopurinol in Chronic Kidney Disease Progression and Cardiovascular Risk[J]. Clinical Journal of the American Society of Nephrology Cjasn,2010,5(8):1388-1393.
[19]Liu W C,Hung C C,Chen S C,et al. Association of hyperuricemia with renal outcomes,cardiovascular disease,and mortality[J]. Clinical Journal of the American Society of Nephrology Cjasn,2012,7(4):541.
[20]Odden M C,Amadu A R,Smit E,et al. Uric Acid Levels,Kidney Function,and Cardiovascular Mortality in US Adults:National Health and Nutrition Examination Survey(NHANES)1988-1994 and1999-2002[J]. American Journal of Kidney Diseases,2014,64(4):550-557.
[21]张维忠,郭宗琳,钱泉,等. 2578例高脂血症者慢性肾脏病分析[J].现代临床医学,2016,42(1):55-56,58.
[22]王艳秋,秦丽丽,孙广萍,等. 1562例经皮肾穿刺活检患者的临床及病理分析[J].中国全科医学,2015,18(15):1758-1762.
[23]向海燕,刘晔,陈莎莎,等.慢性肾脏病患者肾小球滤过率下降速率与疾病进展的关系[J].肾脏病与透析肾移植杂志,2015,24(6):518-523.