蛋白尿对老年人群心脑血管事件及全因死亡的影响

Impact of proteinuria on the risk of cerebrocardiovascular diseases and all-cause mortality in the elderly

摘要:

目的 探讨蛋白尿对老年人群心脑血管事件及全因死亡的影响。方法 本研究为回顾性队列研究,选择参加2006～2007年开滦集团健康体检中年龄≥60岁、无心脑血管等病史、蛋白尿测定资料完整的20 427例职工为观察对象。采用尿常规试纸法检测晨尿,以蛋白尿水平分3组:蛋白尿阴性组(-)17 740例、微量蛋白尿组(±/+)1607例、大量蛋白尿组(≥2+)1080例,随访至2013年12月31日。采用SAS软件对资料进行统计分析。连续性变量组间比较采用方差分析(组间两两比较用SNK法),分类变量组间比较采用χ²检验。Kaplan-Meier 法计算事件发生率。应用Cox比例风险模型评估蛋白尿对心脑血管事件及全因死亡的影响。结果 随访期间共发生心脑血管事件1621例,其中蛋白尿阴性组1326例,微量蛋白尿组162例,大量蛋白尿组133例；共发生全因死亡事件2824例,3组分别为2239例、293例和292例。Cox多因素分析显示,与蛋白尿阴性人群相比,微量蛋白尿组与大量蛋白尿组发生心脑血管事件的风险增加,OR值分别为1.16(95%CI 0.97~1.39)、1.30(95%CI 1.07~1.58),发生全因死亡的风险明显增加,OR值分别为1.32(95%CI 1.16~1.50)、2.02(95%CI 1.77~2.30)。结论 大量蛋白尿是老年人群心脑血管事件和全因死亡的危险因素。

Abstract:

Objective The aim of this study was to evaluate the relationship between proteinuria and cerebrocardiovascular diseases and all-cause mortality among the elderly. Methods This retrospective cohort study enrolled 20427 employers of Kailuan Group who received the 2006-2007 physical examination, the baseline being over 60 years old and no history of stroke and myocardial infarction, and with information for proteinuria test. Proteinuria was measured by urine dipstick test. The subjects were divided into three groups by their proteinuria levels:negative group (-, n=17740), microproteinuria group (±/+, n=1607), and macroproteinuria group (≥2+, n=1080). Follow-up continued till December 31,3. SAS software was used to analyze the data. Variance was used for comparing continuous variables among groups (SNK for the comparison between groups), and chi-square test for comparing categorical variables among groups. The Kaplan-Meier analysis was used to obtain the incidence of events. Cox proportional hazard regression model was used to evaluate the association between exposures and outcomes. Results Altogether, 20427 people were included for the analysis, with 1621 cerebrocardiovascular events and 2824 deaths occurring during the follow-up period. Multivariate analysis adjusted for major traditional cardiovascular risk factors showed a higher risk of cerebrocardiovascular events in microproteinuria group (OR=1.16, 95%CI 0.97-1.39) and macroproteinuria group (OR=1.30,5%CI 1.07-1.58) than negative group. An increased risk of all-cause mortality was also observed in microproteinuria group (OR=1.13,5%CI 1.16-1.50) and macroproteinuria group (OR=2.02, 95%CI 1.77-2.30). Conclusion Macroproteinuria is a risk factor for cerebrocardiovascular events and all-cause mortality in the elderly.