Pinto-Sietsma S J, Mulder J, Janssen W M, Hillege H L, de Zeeuw D, de Jong P E
Department of Internal Medicine, Division of Nephrology, University Hospital Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
Ann Intern Med. 2000 Oct 17;133(8):585-91. doi: 10.7326/0003-4819-133-8-200010170-00008.
Smoking induces albuminuria and accelerates progression to renal failure in persons with diabetes, but little is known about the relation between smoking and renal function in nondiabetic persons.
To investigate whether smoking is related to albuminuria and abnormal renal function in nondiabetic persons.
Cross-sectional study.
Groningen, The Netherlands.
7476 participants in the PREVEND (Prevention of REnal and Vascular ENd stage Disease) Study.
Microalbuminuria and high normal albuminuria were defined as urinary albumin excretion of 30 to 300 mg/24 h and 15 to 30 mg/24 h, respectively. Elevated or decreased glomerular filtration rate (GFR) was defined as a creatinine clearance that exceeded or was less than two times the standard deviation of the mean value in nondiabetic, nonsmoking participants who had an albumin excretion of 0 to 15 mg/24 h, adjusted for age and sex.
Current smokers had a higher median albumin excretion than nonsmokers and were more likely to have microalbuminuria and high normal albuminuria with elevated or decreased GFR. After adjustment for several potential confounding factors, persons who smoked 20 or fewer cigarettes/d and persons who smoked more than 20 cigarettes/d, respectively, showed a dose-dependent association between smoking and high normal albuminuria (relative risk, 1.33 [95% CI, 1.10 to 1.61] and 1.98 [CI, 1.49 to 2.64]), microalbuminuria (relative risk, 1.92 [CI, 1.54 to 2.39] and 2.15 [CI, 1.52 to 3.03]), elevated GFR (relative risk, 1. 82 [CI, 1.31 to 2.53] and 1.84 [CI, 1.12 to 3.02]), and decreased GFR (relative risk, 1.53 [CI, 1.04 to 2.24] and 1.83 [CI, 1.05 to 3. 20]), respectively. Quitting smoking was associated only with microalbuminuria.
Smoking is associated with albuminuria and abnormal renal function. However, these associations are less pronounced or absent in former smokers.
吸烟可导致糖尿病患者出现蛋白尿，并加速其肾衰竭进程，但对于非糖尿病患者吸烟与肾功能之间的关系知之甚少。
研究非糖尿病患者吸烟是否与蛋白尿及肾功能异常有关。
横断面研究。
荷兰格罗宁根。
PREVEND（预防肾和血管终末期疾病）研究中的7476名参与者。
微量白蛋白尿和高正常白蛋白尿分别定义为尿白蛋白排泄量为30至300mg/24小时和15至30mg/24小时。肾小球滤过率（GFR）升高或降低定义为肌酐清除率超过或低于尿白蛋白排泄量为0至15mg/24小时的非糖尿病、非吸烟参与者平均值标准差的两倍，并根据年龄和性别进行调整。
当前吸烟者的尿白蛋白排泄中位数高于非吸烟者，且更有可能出现微量白蛋白尿和高正常白蛋白尿，同时伴有GFR升高或降低。在对多个潜在混杂因素进行调整后，每天吸烟20支或更少的人和每天吸烟超过20支的人，吸烟与高正常白蛋白尿（相对危险度分别为1.33[95%可信区间，1.10至1.61]和1.98[可信区间，1.49至2.64]）、微量白蛋白尿（相对危险度分别为1.92[可信区间，1.54至2.39]和2.15[可信区间，1.52至3.03]）、GFR升高（相对危险度分别为1.82[可信区间，1.31至2.53]和1.84[可信区间，1.12至3.02]）以及GFR降低（相对危险度分别为1.53[可信区间，1.04至2.24]和1.83[可信区间，1.05至3.20]）之间均呈剂量依赖性关联。戒烟仅与微量白蛋白尿有关。
吸烟与蛋白尿及肾功能异常有关。然而，这些关联在前吸烟者中不太明显或不存在。
