慢性肾病患者中冠心病非传统危险因素的患病率。

The prevalence of nontraditional risk factors for coronary heart disease in patients with chronic kidney disease.

作者信息

Muntner Paul, Hamm L Lee, Kusek John W, Chen Jing, Whelton Paul K, He Jiang

机构信息

Tulane University, New Orleans, Louisiana, USA.

出版信息

Ann Intern Med. 2004 Jan 6;140(1):9-17. doi: 10.7326/0003-4819-140-1-200401060-00006.

DOI:10.7326/0003-4819-140-1-200401060-00006

PMID:14706967

Abstract

BACKGROUND

Risk for coronary heart disease is high among patients with chronic kidney disease.

OBJECTIVE

To compare the prevalence of low apolipoprotein A1 levels and elevated apolipoprotein B, plasma fibrinogen, lipoprotein(a), homocysteine, and C-reactive protein levels by estimated glomerular filtration rate (GFR).

DESIGN

Cross-sectional study.

SETTING

Third National Health and Nutrition Examination survey.

PARTICIPANTS

12 547, 3180, and 744 persons with estimated GFRs of at least 90, 60 to 89, or less than 60 mL/min per 1.73 m2, respectively, who were at least 18 years of age.

MEASUREMENTS

Chronic kidney disease was defined as an estimated GFR of less than 60 mL/min per 1.73 m2 based on the abbreviated Modification of Diet in Renal Disease formula.

RESULTS

After standardization for age, race or ethnicity, and sex, lower estimated GFR (> or =90, 60 to 89, or <60 mL/min per 1.73 m2) was associated with lower average levels of apolipoprotein A1 (1.44, 1.43, and 1.35 g/L) and higher levels of apolipoprotein B (1.03, 1.06, and 1.08 g/L), plasma fibrinogen (8.43, 8.44, and 9.53 micromol/L), homocysteine (8.5, 10.0, and 13.2 micromol/L), and C-reactive protein (3.0, 2.9, and 3.9 mg/L) (P < 0.05 for all values). The multivariate-adjusted odds ratios of an apolipoprotein A1 level of less than 1.2 g/L, a serum lipoprotein(a) level of at least 1.61 micromol/L (> or =45.3 mg/dL), a plasma fibrinogen level of at least 10.35 micromol/L, a serum homocysteine level of at least 15 micromol/L, and a C-reactive protein level of at least 10.0 mg/L for participants with chronic kidney disease compared with those with a GFR of at least 90 mL/min per 1.73 m2 or greater were 1.92 (95% CI, 1.02 to 3.63), 1.82 (CI, 1.06 to 3.13), 1.74 (CI, 1.35 to 2.24), 8.23 (CI, 5.00 to 13.6), and 1.93 (CI, 1.33 to 2.81), respectively.

CONCLUSIONS

Levels of apolipoprotein A1 are decreased and levels of homocysteine, lipoprotein(a), fibrinogen, and C-reactive protein are increased among patients with chronic kidney disease.

摘要

背景

慢性肾脏病患者患冠心病的风险很高。

目的

通过估计肾小球滤过率（GFR）比较载脂蛋白A1水平降低以及载脂蛋白B、血浆纤维蛋白原、脂蛋白(a)、同型半胱氨酸和C反应蛋白水平升高的患病率。

设计

横断面研究。

地点

第三次全国健康和营养检查调查。

参与者

分别有12547例、3180例和744例年龄至少18岁、估计GFR分别至少为90、60至89或低于60 ml/min/1.73 m²的人。

测量

根据简化的肾脏疾病饮食改良公式，慢性肾脏病定义为估计GFR低于60 ml/min/1.73 m²。

结果

在对年龄、种族或族裔以及性别进行标准化后，较低的估计GFR（≥90、60至89或<60 ml/min/1.73 m²）与较低的平均载脂蛋白A1水平（1.44、1.43和1.35 g/L）以及较高的载脂蛋白B水平（1.03、1.06和1.08 g/L）、血浆纤维蛋白原水平（8.43、8.44和9.53 μmol/L）、同型半胱氨酸水平（8.5、10.0和13.2 μmol/L）和C反应蛋白水平（3.0、2.9和3.9 mg/L）相关（所有值P<0.05）。与GFR至少为90 ml/min/1.73 m²或更高的参与者相比，慢性肾脏病患者载脂蛋白A1水平低于1.2 g/L、血清脂蛋白(a)水平至少为1.61 μmol/L（≥45.3 mg/dL）、血浆纤维蛋白原水平至少为10.35 μmol/L、血清同型半胱氨酸水平至少为15 μmol/L以及C反应蛋白水平至少为10.0 mg/L的多变量调整优势比分别为1.92（95%CI，1.02至3.63）、1.82（CI，1.06至3.13）、1.74（CI，1.35至2.24）、8.23（CI，5.00至13.6）和1.93（CI，1.33至2.81）。