社区慢性肾病患者肾脏大小与肾功能相关性分析

周晓燕; 赵琦; 王娜; 王瑞平; 张越; 郁雨婷; 姜永根; 赵根明

doi:10.11847/zgggws1135234

社区慢性肾病患者肾脏大小与肾功能相关性分析

doi: 10.11847/zgggws1135234

周晓燕^{1, 2},
赵琦²,
王娜²,
王瑞平³,
张越²,
郁雨婷²,
姜永根³,
赵根明^2, ,

1.
浙江省疾病预防控制中心慢病所，杭州 310051
2.
复旦大学公共卫生学院
3.
上海市松江区疾病预防控制中心

基金项目: 国家重点研发计划精准医学重点专项（2017YFC0907001）

详细信息

作者简介:
周晓燕（1992 – ），女，浙江慈溪人，医师，硕士，研究方向：慢性病流行病学

通讯作者:
赵根明，E-mail：gmzhao@shmu.edu.cn

中图分类号: R 181
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- 文章访问数: 304
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- 被引次数: 0
出版历程
- 接收日期: 2021-04-27
- 网络出版日期: 2022-03-23
- 刊出日期: 2022-07-01

Association of kidney size with renal function in community patients with chronic kidney diseases

ZHOU Xiao-yan^{1, 2},
ZHAO Qi²,
WANG Na²,

1.
Chronic Non-communicable Diseases Institute, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province 310051, China

摘要

摘要: 目的分析社区慢性肾病（CKD）患者肾脏大小与肾功能的相关性，为CKD患者的预后评估提供参考依据。方法于2016年6月 — 2017年11月采用随机整群抽样方法在上海市松江区新桥镇抽取9257名20～75岁常住社区居民进行问卷调查、体格检查和实验室检测，通过B超测量其中914例排除单侧肾切除CKD患者的肾脏大小并采用估算的肾小球滤过率（eGFR）衡量其肾功能，采用Pearson相关分析法分析肾脏大小与eGFR的相关性，并应用多因素logistic回归模型和受试者工作特征曲线下面积（AUC）比较不同模型对肾功能下降的预测作用。结果 914例社区CKD患者中，肾功能正常者706例（77.2 %），肾功能下降者208例（22.8 %）；不同组别社区CKD患者比较，总体人群及男性和女性人群中肾功能下降者左肾长径、左肾横径、右肾长径和右肾横径均小于肾功能正常者，差异均有统计学意义（均P < 0.001）；Pearson相关分析结果显示，左肾长径、左肾横径、右肾长径、右肾横径均与eGFR呈正相关（r = 0.278、0.268、0.263、0.134，均P < 0.001），经体表面积校正后左肾大小与eGFR的相关性最为显著（r = 0.411，P < 0.001）；校正肾脏大小联合其他诊断指标构建多因素logistic回归模型，与其他模型相比，模型3（以校正肾脏大小、性别、年龄和有无高尿酸血症为自变量）对肾功能下降的预测作用最强（AUC = 0.836，95 % CI = 0.810 ～ 0.859）。结论社区CKD患者的肾脏大小与肾功能之间具有显著相关性；肾脏大小联合其他相关因素是预测肾功能下降的重要指标，有助于对CKD患者的预后进行评估。
- 肾功能 /
- 肾脏大小 /
- 相关性 /
- 慢性肾病(CKD)患者 /
- 社区
Abstract: Objective To analyze the correlation between kidney size and renal function in community patients with chronic kidney diseases (CKD), and to provide a reference for prognosis evaluation of CKD patients. Methods With random cluster sampling, 9 257 permanent residents aged 20 – 75 years were recruited in a town of Songjiang district, Shanghai for a survey including questionnaire survey, physical examination and laboratory test from June 2016 to November 2017. From 8 207 residents completing the survey, 914 CDK patients without unilateral nephrectomy were identified. Then, the CDK patients′ kidney size were measured with B-mode ultrasonography and estimated glomerular filtration rate (eGFR) was adopted to assess the patients′ renal function. Pearson correlation analysis was used to analyze the relationship between kidney size and eGFR, and multivariate logistic regression and areas under the receiver operating characteristics curve (AUC) were used to compare the efficiency of different models for renal function decline prediction. Results Of all the patients, 706 (77.2%) had normal renal function and 208 (22.8%) had decreased renal function. Compared to those in the patients with normal renal function, significantly shorter length and width of both kidneys were measured in both male and female patients with decreased renal function (all P < 0.001). Pearson correlation analysis revealed significantly positive correlations of left renal length (r = 0.278) and width (r = 0.268), right renal length (r = 0.263) and width (r = 0.134) with eGFR (all P < 0.001) and the correlation between left kidney size and eGFR was the strongest after adjusting for body surface area (r = 0.411, P < 0.001). Multivariate logistic regression models for kidney size-related renal function decline prediction were constructed with corrected kidney size and other diagnostic indicators. Compared with other models, the model 3 with the independent variables of corrected kidney size, gender, age and hyperuricemic state is of strongest efficiency in predicting renal function decline, with an AUC of 0.836 (95% confidence interval: 0.810 – 0.859). Conclusion There is a significant correlation between kidney size and renal function in community CKD patients. Kidney size combined with other related factors are important indicators for predicting the decline of renal function and could be employed to evaluate the prognosis of CKD patients.
- renal function /
- kidney size /
- correlation /
- chronic kidney disease patients /
- community

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图 1 不同模型预测肾功能下降受试者工作特征曲线图比较

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表 1 不同组别社区CKD患者肾脏大小比较（$\bar x \pm s$）

人群		肾功能正常组	肾功能下降组	t 值	P 值
总体	左肾长径（mm）	98.43 ± 9.02	93.40 ± 8.87	7.096	< 0.001
	左肾横径（mm）	46.38 ± 6.12	42.52 ± 5.94	8.044	< 0.001
	右肾长径（mm）	95.76 ± 9.30	90.50 ± 8.51	7.313	< 0.001
	右肾横径（mm）	42.92 ± 6.48	41.07 ± 5.65	3.723	< 0.001
男性	左肾长径（mm）	102.62 ± 8.68	94.13 ± 8.98	7.442	< 0.001
	左肾横径（mm）	48.76 ± 6.10	43.50 ± 6.11	6.651	< 0.001
	右肾长径（mm）	99.96 ± 11.53	91.09 ± 8.81	6.461	< 0.001
	右肾横径（mm）	45.57 ± 7.40	41.95 ± 5.82	4.319	< 0.001
女性	左肾长径（mm）	97.24 ± 8.76	92.78 ± 8.76	4.915	< 0.001
	左肾横径（mm）	45.71 ± 5.96	41.69 ± 5.69	6.553	< 0.001
	右肾长径（mm）	94.57 ± 8.19	89.99 ± 8.24	5.393	< 0.001
	右肾横径（mm）	42.17 ± 5.99	40.31 ± 5.41	3.031	< 0.001

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表 2 不同模型肾功能下降影响因素多因素logistic回归分析

模型	因素	β	$S_{\bar x}$	Wald χ²值	P 值	OR 值	95 % CI
模型1	校正肾脏大小	– 0.132	0.017	58.799	< 0.001	0.876	0.847～0.906
	男性	0.585	0.182	10.319	0.001	1.794	1.256～2.563
	常数项	1.937	1.101	3.096	< 0.001	398.180
模型2	校正肾脏大小	– 0.125	0.018	47.055	< 0.001	0.883	0.852～0.915
	男性	0.582	0.194	8.964	0.003	1.790	1.223～2.620
	年龄≥60岁	1.842	0.203	82.465	< 0.001	6.308	4.239～9.387
	常数项	2.596	1.075	5.829	0.016	13.405
模型3	校正肾脏大小	– 0.109	0.019	33.307	< 0.001	0.897	0.864～0.931
	男性	0.489	0.202	5.884	0.015	1.631	1.098～2.421
	年龄≥60岁	1.960	0.215	83.303	< 0.001	7.098	4.660～10.813
	有高尿酸血症	1.450	0.215	45.566	< 0.001	4.263	2.798～6.495
	常数项	1.167	1.124	1.078	0.299	3.212

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