| 张笑,张梅,李纯,于梦婷,王丽敏.中国居民高血压病程和慢性肾脏病的关联研究[J].中华流行病学杂志,2025,46(1):26-32 |
| 中国居民高血压病程和慢性肾脏病的关联研究 |
| Association between hypertension duration and chronic kidney disease in residents in China |
| 收稿日期:2024-04-11 出版日期:2025-01-11 |
| DOI：10.3760/cma.j.cn112338-20240411-00187 |
| 中文关键词: 高血压病程 慢性肾脏病 |
| 英文关键词: Hypertension duration Chronic kidney disease |
| 基金项目:国家重点研发计划（2021YFC2500201）；中国疾病预防控制中心青年科学基金（2023A202） |
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| 中文摘要: |
| 目的 探讨中国居民高血压病程与慢性肾脏病风险的关联。方法 研究对象来源于2018年中国慢性病及危险因素监测中18~74岁的对象。根据研究对象自报的高血压首诊年龄/年月及调查时年龄计算得到高血压病程，并将其分为0（血压正常人群）、0.1~、5.0~、10.0~、≥15.0年。测量血肌酐、尿微量白蛋白、尿肌酐水平，将估算肾小球滤过率<60 ml·min-1·（1.73 m2）-1和（或）尿微量白蛋白/尿肌酐≥30 mg/g的研究对象判定为患慢性肾脏病。考虑群内相关性后用多因素logistic回归分析高血压病程与慢性肾脏病风险间的关联。结果 最终纳入140 662名。在总人群中调整了包括血压在内的混杂因素后，与血压正常人群相比，高血压病程0.1~、5.0~、10.0~、≥15.0年组慢性肾脏病OR值分别为1.16（95%CI：1.09~1.23）、1.33（95%CI：1.20~1.48）、1.33（95%CI：1.18~1.49）、1.43（95%CI：1.29~1.60）。在已诊断高血压人群中慢性肾脏病风险与高血压病程间仍存在正向关联。限制性立方样条结果显示，慢性肾脏病OR值在高血压病程0.1~4.9年时增长最快，随后逐渐进入平台期。高血压病程与慢性肾脏病风险的关联在高血压首诊年龄<45岁人群中更强，5.0~、10.0~、≥15.0年组较0.1~年组的OR值分别为1.38（95%CI：1.04~1.84）、1.22（95%CI：0.91~1.65）、1.47（95%CI：1.04~2.07）。而在高血压首诊年龄≥45岁人群中，相应的OR值分别为1.08（95%CI：0.98~1.19）、1.08（95%CI：0.97~1.21）、1.16（95%CI：1.02~1.32）。结论 中国居民中高血压病程与慢性肾脏病风险间呈正向关联，且这一关联独立于血压水平。早期诊断高血压和长期控制血压可能是高血压相关慢性肾脏病二级预防的有效策略。 |
| 英文摘要: |
| Objective To evaluate the association between hypertension duration and risk for chronic kidney disease in residents in China. Methods Participants aged 18-74 years from the sixth round of China Chronic Disease and Risk Factor Surveillance in 2018 were included. The age/date at hypertension diagnosis was reported by them, and hypertension duration was calculated based on the age at diagnosis and the age at survey. The hypertension duration was calculated as 0 year (i.e., normotensive participants), 0.1- year, 5.0- years, 10.0- years, and ≥15.0 years. Serum creatinine, urinary albumin, and urinary creatinine levels were measured, and chronic kidney disease was diagnosed when glomerular filtration rate was <60 ml·min-1·(1.73 m2)-1 and/or urine albumin-to-creatinine ratio was ≥30 mg/g. Multivariable logistic regression analysis, which took intra-group correlation into account, was used to evaluate the association of hypertension duration with chronic kidney disease. Results A total of 140 662 residents were finally included in the analysis. After adjusting the confounders, including blood pressure, the odds ratio of chronic kidney disease was 1.16 (95%CI: 1.09-1.23), 1.33 (95%CI: 1.20-1.48), 1.33 (95%CI: 1.18-1.49), and 1.43 (95%CI: 1.29-1.60) in study subjects with hypertension durations of 0.1-4.9 years, 5.0-9.9 years, 10.0-14.9 years, and ≥15.0 years, respectively, in comparison with normotensive people. This result was further supported by the positive association between hypertension duration and chronic kidney disease in people with previously diagnosed hypertension. The results of restricted cubic spline suggested that the risk for chronic kidney disease showed a steep increase within 0.1- 4.9 years after hypertension diagnosis, then showed neither increase nor decrease. The above association seemed to be stronger in those with hypertension diagnosed age <45 years. Compared with those with hypertension duration of 0.1-4.9 years, the odds ratio was 1.38 (95%CI: 1.04-1.84), 1.22 (95%CI: 0.91-1.65), and 1.47 (95%CI: 1.04-2.07) in those with hypertension durations of 5.0-9.9 years, 10.0-14.9 years, and ≥15.0 year, respectively. In those with hypertension diagnosis at ≥45 years, the corresponding odds ratio was 1.08 (95%CI: 0.98-1.19), 1.08 (95%CI: 0.97-1.21), and 1.16 (95%CI: 1.02-1.32), respectively. Conclusions Hypertension duration is positively associated with the risk for chronic kidney disease in residents in China, and this association is independent of blood pressure level. Early diagnosis of hypertension and long-term control of blood pressure are effective strategies for secondary prevention of hypertension-related chronic kidney disease. |
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