中老年人脉压与肾功能下降的关联研究

  目的  探讨中老年人脉压(pulse pressure, PP)与肾功能下降的关系。  方法  以2015年1月1日—2019年12月31日在重庆医科大学附属第一医院参加健康体检的46 605例中老年人(≥45岁)为研究对象，按其PP水平分为四组(< 40 mm Hg、40~ < 50 mm Hg、50~ < 60 mm Hg、≥60 mm Hg)，采用非条件Logistic回归分析模型分析PP与肾功能下降的关联。  结果  本研究46 605例中老年人年龄为54(48, 60)岁，肾功能下降者占27.37%(其中轻度占26.45%，中重度占0.92%)。与同年龄人群对照组相比，PP < 40 mm Hg和PP≥60 mm Hg组中老年人发生肾功能下降的风险分别升高11%和28%；按年龄分层后，45~ < 60岁中年人仅PP < 40 mm Hg组发生肾功能下降的风险升高13%(OR=1.13, 95% CI: 1.05~1.22)，≥60岁老年人PP为50~ < 60 mm Hg和PP≥60 mm Hg组发生肾功能下降的风险分别升高12%(OR=1.12, 95% CI: 1.02~1.24)和66%(OR=1.66, 95% CI: 1.48~1.86)。限制性立方样条结果提示PP与肾功能下降的关联强度呈非线性关系，中年人PP < 42 mm Hg，老年人PP>55 mm Hg时肾功能下降风险增加。PP与肾功能下降程度关联分析结果显示，中年人仅PP < 40 mm Hg组发生肾功能轻度下降的风险升高13%(OR=1.13, 95% CI: 1.05~1.22)；老年人PP为50~ < 60 mm Hg组发生肾功能轻度下降的风险升高11%(OR=1.11, 95% CI: 1.01~1.23)，PP≥60 mm Hg组发生肾功能轻度和中重度下降的风险分别升高61%(OR=1.61, 95% CI: 1.43~1.81)和179%(OR=2.79, 95% CI: 1.94~4.02)。  结论  PP对肾功能下降及下降程度发生风险的影响在中年人和老年人中并不相同，应特别关注PP减小的中年人和PP增大的老年人的肾功能情况。

Study on the association between pulse pressure and renal function decline among middle-aged and elderly people

  Objective  To explore the association between pulse pressure (PP) and renal function decline among middle-aged and elderly people.  Methods  A total of 46 605 middle-aged and elderly people (aged ≥45 years old) who participated in the physical examination in the First Affiliated Hospital of Chongqing Medical University from January 1, 2015 to December 31, 2019 were selected as the study objects. According to their PP levels, they were divided into four groups (PP < 40 mm Hg, 40- < 50 mm Hg, 50- < 60 mm Hg, and ≥60 mm Hg). Unconditional Logistic regression model was used to analyze the association between PP and renal function decline.  Results  The age of the 46 605 people included in this study was 54(48, 60) years old, and 27.37% of them had renal function decline (26.45% were mild, and 0.92% were moderate-severe). Compared with the same age group, the risk of renal function decline increased by 11% and 28% in PP < 40 mm Hg and PP≥60 mm Hg groups among middle-aged and elderly people, respectively. The results of age stratification analysis showed that among middle-aged people aged 45- < 60 years old, the risk of renal function decline increased by 13% (OR=1.13, 95% CI: 1.05-1.22) only in the PP < 40 mm Hg group, while among elderly people aged ≥60 years old, the risk increased by 12% (OR=1.12, 95% CI: 1.02-1.24) and 66% (OR=1.66, 95% CI: 1.48-1.86) in the PP=50- < 60 mm Hg and PP≥60 mm Hg groups, respectively. Restrictive cubic spline results suggested that the association between PP and renal function decline was non-linear, and the risk of renal function decline increased when PP < 42 mm Hg in middle-aged people and PP>55 mm Hg in elderly people. The results of correlation analysis between PP and different degrees of renal function decline showed that the risk of mild renal function decline was increased by 13% (OR=1.13, 95% CI: 1.05-1.22) only in middle-aged people with PP < 40 mm Hg group, while the risk of mild renal function decline was increased by 11%(OR=1.11, 95% CI: 1.01-1.23) in elderly people with PP=50- < 60 mm Hg group, and the risk of mild and moderate-severe renal function decline was increased by 61%(OR=1.61, 95% CI: 1.43-1.81)and 179%(OR=2.79, 95% CI: 1.94-4.02) in elderly people with PP≥60 mm Hg group, respectively.  Conclusions  The effect of PP on the risk of renal function decline and its degrees was not the same in middle-aged people and elderly people. Special attention should be paid to the renal function of middle-aged people with decreased PP and elderly people with increased PP.