上海一社区人群尿白蛋白／肌酐比值及估算肾小球滤过率异常率流行病学调查

摘要

目的：分析尿白蛋白（Alb）及估算肾小球滤过率（eGFR）在上海一社区老年人群中的分布情况，分析其相关危险因子，为肾脏疾病的诊疗提供流行病学数据。方法随机选取上海市宝山区友谊社区60岁以上居民1154名，收集受访者空腹静脉血和晨尿，计算尿Alb／肌酐（Cr）比值（ACR），并用慢性肾病流行病学协作组（CKD-EPI）方程计算eGFR。以ACR≥30 mg／mgCr、eGFR≤60 mL／（min·1．73 m2）为切点判断Alb尿及肾小球滤过率（ GFR）受损，计算人群患病率并分析不同危险因素与疾病的关系。使用肾脏疾病膳食改良（ MDRD）方程计算eGFR，比较其与CKD-EPI方程计算结果间的差异。结果 1154名60岁以上人群中有13．43％的个体出现Alb尿，29．98％存在GFR受损。随着年龄的上升，ACR和eGFRCKD-EPI的异常率明显上升。 Alb尿组性别构成、年龄、糖尿病患病率和高血压患病率与正常组比较，差异均有统计学意义（其中性别构成P＜0．05，其余项目P均＜0．001）；GFR受损组除年龄和高血压患病率与GFR正常组比较差异有统计学意义（P＜0．001、P＝0．006）外，其他因素差异均无统计学意义（ P＞0．05）。使用MDRD公式计算eGFR会较使用CKD-EPI公式得到更高的eGFR异常率，在高年龄组和ACR正常组内尤为明显。 MDRD方程可能高估了eGFR的异常率，低估了健康人群的eGFR水平，CKD-EPI公式相对更为准确。结论 ACR升高及eGFR异常在老年群体中有着较高的发生率，这一群体需要增加对肾脏疾病及糖尿病和高血压等危险因素的关注。使用公式估算eGFR时需要注意不同公式在不同群体间的差异。%Objective In order to provide the epidemiological data for clinical diagnosis , to analyze the distribution of urinary albumin ( Alb ) and estimated glomerular filtration rate ( eGFR ) in one-community elderly residents of Shanghai and the related risk factors .Methods A total of 1 154 residents were randomly enrolled from Youyi Community, Baoshan District.All of them were ≥60 years old.Fasting blood and first morning urine samples were collected to measure and calculate urinary Alb/creatinine (Cr) ratio(ACR) and eGFR by the Chronic Kidney Disease Epidemiology Collaboration ( CKD-EPI) equation.ACR≥30 mg/mgCr and eGFR≤60 mL/( min· 1.73 m2 ) were used as the cut-off points to define albuminuria and impaired glomerular filtration rate ( GFR ) . The prevalence and relationships between risk factors and disease were analyzed .The eGFR was calculated according to modification of diet in renal disease (MDRD) equation.Difference between the results of CKD-EPI equation and MDRD equation were also compared.Results Overall, 13.43%of the residents had albuminuria , and 29.98%of the residents existed impaired GFR.The abnormal rates of ACR and eGFR CKD-EPI increased with sex, age, prevalence rate of diabetes mellitus , prevalence rate of hypertension showed statistical significance between normal group and albuminuria group ( for sex:P<0.05;for the others:P<0.001).In impaired GFR group, all factors showed no statistical significances except age (P<0.001) and hypertension ( P =0.006) compared with normal group ( P >0.05).Compared with CKD-EPI equation, MDRD equation may get a higher abnormal rate of eGFR .MDRD equation may overestimate the abnormal rate and underestimate the eGFR levels of healthy subjects , especially in the elderly group and ACR normal group .CKD-EPI equation was relatively more accurate .Conclusions The prevalence of increasing ACR and abnormal eGFR is high among the elderly residents .Therefore, these individuals need to pay more attention to kidney disease , diabetes mellitus, hypertension and other risk factors .Clinicians should be aware of the differences of eGFR on the basis of different equations among different populations .