年龄相关肾功能下降的影响因素及其与颈动脉内膜中层厚度的关系
Influencing factors of age-related renal function decline and their association with carotid intima-media thickness

摘要：目的 探讨基本健康对象伴随年龄增高的肾功能下降的影响因素及其与颈动脉内膜中层厚度的关系。方法 选取在我院检查、年龄大于40岁的基本健康对象218例(男96例，女122例)，依年龄分为成年组(年龄<65岁)和老年组(年龄≥65岁)，根据评估肾小球滤过率(eGFR)将人群分为肾功能正常组[eGFR≥90mL/(min？1.73m2)]和肾功能下降组[60mL/(min？1.73m2)≤eGFR<90mL/(min？1.73m2)]，检测血肌酐、尿酸、尿素氮、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、纤维蛋白原、N端脑钠肽前体等。超声检测颈总动脉内膜中层厚度。结果 老年组eGFR较成年组低，eGFR与年龄呈负相关(r=－0.578，P<0.001)。非条件Logistic回归分析表明尿酸是年龄相关的肾功能下降的独立影响因素(OR=1.008)。多重逐步回归分析显示eGFR与颈动脉内膜中层厚度呈负相关，尿酸与颈动脉内膜中层厚度无关；经校正年龄因素后未发现eGFR与颈动脉内膜中层厚度独立关联。结论 随年龄增高eGFR下降，尿酸水平升高是年龄相关的肾功能下降的独立影响因素。年龄相关的eGFR下降对颈动脉内膜中层厚度的影响在一定程度上是有限的。
ABSTRACT: Objective To explore influencing factors of age-related renal function decline and the association of age-related renal changes with carotid intima-media thickness in apparently healthy individuals. Methods A total of 218 apparently healthy individuals (96 males and 122 females) aged ≥40 were enrolled and divided into adult group (<65 years) and aged group (≥65 years). The individuals were divided into two groups according to estimated glomerular filtration rate (eGFR). Serum creatinine, uric acid, urea nitrogen, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fibrinogen and N terminal pro-brain natriuretic peptide were measured. Their carotid artery intima-media thickness (CIMT) was measured by means of B-mode ultrasonography. Results The eGFR of the aged group was lower than that of the adult group. The level of eGFR exhibited a significant negative correlation with age (r=-0.578, P<0.001). Unconditioned logistic regression analysis revealed that uric acid was an independent risk factor of age-related decline in eGFR (OR=1.008). The multiple regression analysis revealed that eGFR was inversely correlated with CIMT. Uric acid was not associated with CIMT. With further adjustment for age, there was no independent association between eGFR and CIMT. Conclusion As age increases, eGFR decreases. The change of serum uric acid level is an independent risk factor of age-related renal decline in apparently healthy individuals. With age-related decline in eGFR, carotid artery intima-media thickness increases. The impact of age-related renal function decline on carotid intima-media thickness may be somewhat limited