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

摘要

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2831例(男1157例,女1674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 alloca-ted 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 in-creased risk for abnormal Scr in total,[OR(95% CI)] was 1.47(1.13-1.92) after adjusting other confounders. Com-pared with reference group, participants with PA <129.64 MET-min/week and PA > 821.50 MET-min/week had in-creased 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 as-sociation 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.