Dai Dongxue, Chang Ye, Chen Yintao, Yu Shasha, Guo Xiaofan, Sun Yingxian
Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China.
BMC Cardiovasc Disord. 2017 Jan 13;17(1):24. doi: 10.1186/s12872-016-0459-0.
Left ventricular hypertrophy (LVH) is common and associated with cardiovascular outcomes among patients with known chronic kidney disease (CKD). However, the link between decreased estimated glomerular filtration rate (eGFR) and left ventricular (LV) geometry remains poorly explored in general population. In this study, we examined the gender-specific association between eGFR and LVH in the general population from rural Northeast China.
This survey was conducted from July 2012 to August 2013. A total of 10907 participants (5,013 men and 5,894 women) from the rural Northeast China were randomly selected and examined. LV mass index (LVMI) was used to define LVH (LVMI > 46.7 g/m in women; > 49.2 g/m in men). LV geometry was defined as normal, or with concentric remodeling, eccentric or concentric hypertrophy, according to relative wall thickness (RWT) and LVMI. Mildly decreased eGFR was defined as eGFR ≥ 60 and < 90 ml/min/1.73 m, and moderate-severely decreased eGFR was defined as eGFR < 60 ml/min/1.73 m.
As eGFR decreased, LVH showed a gradual increase in the entire study population. Multivariate analysis revealed a gender-specific relationship between eGFR and LV geometry. Only in men, mildly decreased eGFR was associated with concentric remodeling [odds ratio (OR): =1.58; 95% CI: 1.14-2.20; P < 0.01] and concentric LVH OR = 1.63; 95% CI: 1.15-2.31; P < 0.01). And only in men, moderate-severely decreased eGFR was a risk factor for concentric LVH (OR = 4.56; 95% CI: 2.14-9.73; P < 0.001) after adjusting for confounding factors.
These findings suggested that decreased eGFR was a risk factor for LV geometry in men, and a gender-specific difference should be taken into account in clinical practice.
左心室肥厚（LVH）在已知慢性肾脏病（CKD）患者中很常见，且与心血管结局相关。然而，在一般人群中，估计肾小球滤过率（eGFR）降低与左心室（LV）几何形态之间的联系仍未得到充分研究。在本研究中，我们调查了中国东北农村地区一般人群中eGFR与LVH之间的性别特异性关联。
本调查于2012年7月至2013年8月进行。从中国东北农村地区随机选取10907名参与者（5013名男性和5894名女性）进行检查。左心室质量指数（LVMI）用于定义LVH（女性LVMI>46.7g/m；男性>49.2g/m）。根据相对壁厚度（RWT）和LVMI，将LV几何形态定义为正常、或伴有向心性重构、离心性或向心性肥厚。轻度降低的eGFR定义为eGFR≥60且<90ml/min/1.73m²，中度至重度降低的eGFR定义为eGFR<60ml/min/1.73m²。
随着eGFR降低，整个研究人群中LVH呈逐渐增加趋势。多变量分析显示eGFR与LV几何形态之间存在性别特异性关系。仅在男性中，轻度降低的eGFR与向心性重构相关[比值比（OR）=1.58；95%置信区间（CI）：1.14 - 2.20；P<0.01]以及向心性LVH相关（OR = 1.63；95%CI：1.15 - 2.31；P<0.01）。并且仅在男性中，在调整混杂因素后，中度至重度降低的eGFR是向心性LVH的一个危险因素（OR = 4.56；95%CI：2.14 - 9.73；P<0.001）。
这些发现表明，eGFR降低是男性LV几何形态的一个危险因素，临床实践中应考虑性别特异性差异。
