体检人群理想心血管健康状态变化与肾小球滤过率下降的关系

目的：探讨健康体检人群理想心血管健康指标数改变与肾功能演变的关系。方法：采用回顾性队列研究，以837例长沙地区健康体检人群为研究对象。分别收集2008年至2014年健康体检的一般资料、体格检查及血生物化学检查指标。计算6年时间中按美国心脏协会定义的7项理想心血管健康指标数的改变差值和衡量肾功能变化的肾小球滤过率(estimated glomerular fi ltration rate，eGFR)的改变差值。采用多元线性回归分析理想心血管健康指标数的改变差值与eGFR改变差值之间的关系；采用协方差分析比较不同理想心血管健康指标数改变差值下eGFR变化值的水平。结果：2014年理想心血管健康指标数[(3.3±1.4)项]与2008年[(3.2±1.3)项]比较差异无明显统计学意义(P>0.05)；2014年eGFR值[(99.8±22.7) mL/(min.1.73 m2)]比2008年[(104.3±24.9) mL/(min.1.73 m2)]明显降低，差异有统计学意义(P<0.01)。校正年龄、性别、高血压病史、糖尿病史及用药史(降压、降糖和调脂)后，eGFR变化值与理想心血管健康指标数改变差值呈正相关(β=0.701，P<0.01)。随着理想心血管健康状态好转，理想心血管健康指标数改变差值从≥2项，1项，0项，–1项到≤–2项，eGFR变化值下降幅度依次逐渐减少，差异有统计学意义(F=21.71，P<0.01)。结论：理想心血管健康指标数的变化是eGFR改变的独立影响因素，改善理想心血管健康状态有利于延缓肾功能损害。

Association between the changes in ideal cardiovascularhealth status and the decline of glomerular filtration ratesin medical examination people

Objective: To explore the association between the changes in ideal cardiovascular health (CVH) indices and the renal function.Methods: The retrospective cohort study consisted of 837 Chinese individuals from Department ofHealth Management in the Third Xiangya Hospital. The general information, anthropometry and bloodbiochemistry were obtained for all subjects from 2008 to 2014, respectively. The 6-year changes of 7 idealCVH metrics defined by American Heart Association and the estimated glomerular filtration rate (eGFR)were calculated. Linear regression analysis was used to study the association between the changes in theideal CVH metrics and eGFR. Covariance analysis was used to compare the levels of changes in eGFRstratified by variations of the ideal CVH metrics.Results: After 6 years’ follow-up, we did not find significant difference in ideal cardiovascular healthindexes between 2014 and 2008 [(3.3±1.4) items vs. (3.2±1.3) items, respectively] (P<0.05).However, the eGFR in 2014 was significantly lower than that in 2008 [(99.8±22.7) mL/(min.1.73 m2)vs (104.3±24.9) mL/(min.1.73 m2), respectively] (P<0.01). After adjusting for age, sex, history ofhypertension and diabetes, and history of drug usage (antihypertensive, cholesterol-lowering andblood glucose-lowering medication), the changes in ideal CVH metrics were positively associatedwith the changes in eGFR (β=0.701, P<0.01). With the improved change in ideal CVH metricsfrom ≤–2 points, –1 point, 0 point, 1 point to ≥2 points, the magnitude of decline in eGFR wasgradually decreased , with significant difference (F= 21.71, P<0.01).Conclusion: The changes in ideal CVH metrics are an independent risk factor for changes ofeGFR. Positive changes in ideal CVH metrics exert a favorable effect on renal function evolution.