利用交叉滞后通径分析研究血压与肾小球滤过率之间的时间因果关系

目的了解血压(blood pressure,BP)与肾小球滤过率(estimated glomerular filtration rate,eGFR)之间的因果关系。方法于2013年1-8月在辽宁省大洼、彰武和辽阳县农村地区采用多阶段随机整群抽样方法建立了心血管疾病研究队列,并于2015年8月-2016年1月对其中6893名35岁及以上农村居民进行随访调查。采用交叉滞后通径分析模型描述BP与eGFR在高血压和非高血压人群中的因果关系。结果 6893名农村居民(女性占52.3%;平均年龄52.39±10.10岁)的平均随访时间为(28.74±3.47)个月。对于高血压患者,eGFR与收缩压(systolic BP,SBP)相互影响,但eGFR先于SBP发生变化eGFR→SBP的路径系数ρ1=-0.112,P<0.001;SBP→eGFR的路径系数ρ2=-0.070,P<0.001;ρ1 vs ρ2,P=0.044];eGFR单向影响舒张压(diastolic BP,DBP)。对于非高血压人群,eGFR与SBP相互影响,无先后之分;eGFR与DBP不相互影响。结论农村高血压患者eGFR和血压是相互作用的,且仅存在eGFR升高先于SBP升高。农村非高血压人群eGFR和SBP是相互作用的,且没有先后顺序之分,eGFR和DBP之间无因果关系。

Application of Cross-lagged Panel Analysis to Explore the Temporal Relationship between Estimated Glomerular Filtration Rate and Blood Pressure

Objective The study intends to understand the causal relationship between blood pressure(BP) and estimated glomerular filtration rate(eGFR).Methods We established a cardiovascular disease study cohort selected with multi-stage stratified random cluster-sampling in Dawa,Zhangwu and Liaoyang counties of Liaoning province from January to August 2013 and conducted a follow-up survey of 6893 rural residents aged ≥35 years from August 2015 to January 2016.The causal relationship between BP and eGFR was described by the cross-lagged panel analysis among hypertensive and non-hypertensive.Results The mean follow-up time of 6893 rural participants(52.3% for women;mean age 52.39 ± 10.10 years) was 28.74(SD,3.47) months.For hypertensive patients,eGFR interacts with SBP(Systolic BP,SBP),and eGFR changed before SBPthe path coefficient of eGFR→SBP was ρ1=-0.112,P<0.001;the path coefficient of SBP→eGFR was ρ2=-0.070,P<0.001;ρ1 vs ρ2,P=0.044];The causal relationship between eGFR and DBP(Diastolic BP,DBP) was one-directional.While for non-hypertensive population,eGFR and SBP interact with each other without prioritization;there is no interaction between eGFR and DBP.Conclusion The causal relationship between eGFR and BP was two-directional in rural hypertensive individuals,and only eGFR changes precedes SBP.The causal relationship between eGFR and SBP was two-directional and had no sequence in rural non-hypertensive individuals;while,there is no causal relationship between eGFR and DBP.