健康人群衰老相关心血管亚临床指标与肾功能的相关性

Relationship between aging-related cardiovascular subclinical biomarkers and glomerular filtration rate in healthy population

摘要:

目的 评价沈阳地区健康人群衰老相关心血管亚临床状态改变及其与肾小球滤过率（GFR）的相关性。方法 在横断面研究中，将沈阳地区505例健康人群按照年龄分为≤60岁组（n＝274）和＞60岁组（n＝231）。进行基本身体状况、血压、血液生化和心血管超声检查。采用左室射血分数（LVEF）评价心脏收缩功能，二尖瓣E峰与A峰的比值（E/A）、二尖瓣减速时间（MV-DT）、左房容积指数（LAVI）评价心脏舒张功能，颈动脉内中膜厚度（IMT）、臂踝指数（ABI）和脉搏波速度（PWV）评价血管结构和僵硬度。采用Cockcroft-Gault公式（GFRCG）、中国改良MDRD公式（GFRMDRD）和CKD-EPI（GFRCKD-EPI）公式计算的GFR评价肾脏功能。结果 在≤60岁组，GFRCG与IMT（r＝-0.238，P＜0.01）和PWV（r＝-0.281，P＜0.01）呈显著负相关。GFRMDRD与LVEF呈显著负相关（r＝-0.221，P＜0.01）。GFRCKD-EPI与IMT（r＝-0.360，P＜0.01）和PWV（r＝-0.327，P＜0.01）呈显著负相关。利用偏相关分析调整年龄、体质量指数、腰臀比、收缩压、舒张压、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇等混杂变量后，GFRCG与LAVI呈显著正相关（r＝0.168，P＜0.05）。GFRMDRD与LVEF呈显著负相关（r＝-0.212，P＜0.01）。GFRCKD-EPI与LAVI呈显著正相关（r＝0.195，P＜0.01），与EA呈显著负相关（r＝-0.137，P＜0.05）。在＞60岁组，GFRMDRD与ABI呈显著正相关（r＝-0.167，P＜0.05），且在调整混杂变量后，该相关依然显著（r＝0.175，P＜0.05）。结论 衰老与肾功能下降、大动脉僵硬度及心脏舒张功能下降密切相关。在健康人群，心血管系统和肾脏存在年龄特异的交互作用。

Abstract:

Objective To evaluate the relationship between aging-related cardiovascular subclinical state and estimated glomerular filtration rate (GFR) in healthy population in Shenyang. Methods In the cross-sectional study, 505 healthy people in Shenyang area were devided into ≤60 years and ＞60 years group. The physical condition, blood pressure, blood biochemical examination and cardiovascular ultrasound were performed. GFR was evaluated by Cockcroft-Gault equation (GFRCG), Chinese modified MDRD formula (GFRMDRD), Chronic Kidney Disease Epidemiology Collaboration equation (GFRCKD-EPI). Cardiac systolic function was assessed by the left ventricular ejection fraction (LVEF). Cardiac diastolic function was assessed by the ratio between mitral E/A ratio, deceleration time of the early mitral velocity (MV-DT), left atrial volume index(LAVI). Vascular structure and stiffness were assessed by carotid intema-media thickness (IMT), ankle brachial index (ABI) and pulse wave velocity (PWV). Results In ≤60 years group, GFRCG was significantly negative correlated with IMT (r＝-0.238, P＜0.01) and PWV (r＝-0.281, P＜0.01). There was significant negative correlation between GFRMDRD and LVEF (r＝-0.221, P＜0.01). GFRCKD-EPI was significantly negatively correlated with IMT (r＝-0.360, P＜0.01) and PWV (r＝-0.327, P＜0.01). After adjusting for age, body mass index (BMI), waist-hip ratio (WHR), blood pressure, blood lipid, and GFRCG was significantly positively correlated with LAVI (r＝0.168, P＜0.05). There was significant negative correlation between GFRMDRD and LVEF (r＝-0.212, P＜0.01). A significant positive correlation of GFRCKD-EPI with LAVI (r＝0.195, P＜0.01), and negative correlation with EA (r＝-0.137, P＜0.05) were observed. In ＞60 years group, GFRMDRD was positively correlated with ABI (r＝-0.167, P＜0.05), which remained significant (r＝0.175, P＜0.05) even after adjusting for confounding variables. Conclusion In aging process, there is decline in renal function, arterial stiffness and cardiac diastolic function. Our results confirm that there is interaction of cardiovascular system and renal function even in healthy people.