基于剂量-反应关系的体力活动对血清肌酐水平的影响及其性别差异
Relationship between physical activity and abnormal serum creatinine levels and sex difference by dose-response association

目的:探讨体力活动(PA)对血清肌酐(Scr)水平的影响及其性别差异。方法:采用整群抽样的方法抽取唐山某社区40～60岁的健康个体。PA的评估采用国际体力活动问卷,Scr水平采用酶法测量,男性高于106 μmol/L,女性高于97 μmol/L定义为Scr升高。应用限制性立方样条分析PA与Scr的剂量-反应关系,据此将PA分成4组; 应用非条件logistic回归分析PA与Scr的关系。结果:共2 831例(男1 157例,女1 674例)进入研究,PA与Scr呈非线性的剂量反应关系(P<0.001),按PA(单位为MET-min/周)分成4组,<129.64、129.64～288.00、>288.00～821.50、>821.50,分别为705例、709例、804例、613例。以>288.00～821.50 MET-min/周为参照组,与参照组相比,在总人群中,PA>821.50 MET-min/周与Scr升高有关, OR(95%CI)为1.474(1.132～1.919)(P<0.05); 男性中,PA<129.64或>821.50 MET-min/周均与Scr升高有关,OR(95%CI)分别为1.64(1.18～2.28)和1.59(1.14～2.22)(P均<0.05); 女性中,未发现PA水平与Scr升高的关系。结论:PA与Scr升高呈非线性关系; 高或低PA均可增加Scr异常的风险,但仅见于男性。
Aim: To explore the relationship between physical activity(PA)and the level of serum creatinine(Scr)and sex difference.Methods: Healthy individuals between 40 to 60 years old were recuited by cluster sampling method in Tangshan city; PA was assessed by the international physical activity questionnaire; Scr was measured by enzymic method using fasting blood sample. Definition of elevated Scr was >106 μmol/L in males and >97 μmol/L in females. Restricted cubic spline analysis was used to analyze the dose-response relationship between PA and Scr, and participants were allocated into 4 groups accordingly; unconditional logistics regression analysis was used to explore the relationship between PA and elevated Scr.Results: A total of 2 381 participants(1 157 males,1 674 females)were enrolled in statistical analyses, and were allocated into 4 groups according to the level of PA(MET-min/week), <129.64, 129.64～288.00, >288.00～821.50, >821.50,and the number of participants were 705, 709, 804, and 613, respectively. Compared with reference group(>288.00～821.50)MET-min/week, participants with PA>821.50 MET-min/week had an increased risk for abnormal Scr in total,[OR(95%CI)] was 1.47(1.13-1.92)after adjusting other confounders. Compared with reference group, participants with PA<129.64 MET-min/week and PA> 821.50 MET-min/week had increased risks for elevated Scr in males,[OR(95%CI)] was 1.64(1.18-2.28), 1.59(1.14-2.22). In females, no association was found between PA and elevated Scr(P>0.05).Conclusion: PA is non-linearly associated with Scr. Higher or lower PA may both associate with an increased risk of elevated Scr in middle-aged men