Association of kidney size with renal function in community patients with chronic kidney diseases
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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。 -
关键词:
- 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. -
Key words:
- renal function /
- kidney size /
- correlation /
- chronic kidney disease patients /
- community
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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 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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