东日本大地震后避难对慢性肾脏病发病率的影响：福岛健康管理调查
The impact of evacuation on the incidence of chronic kidney disease after the Great East Japan Earthquake: The Fukushima Health Management Survey.
作者信息
Hayashi Yoshimitsu, Nagai Masato, Ohira Tetsuya, Satoh Hiroaki, Sakai Akira, Ohtsuru Akira, Hosoya Mitsuaki, Kawasaki Yukihiko, Suzuki Hitoshi, Takahashi Atsushi, Sugiura Yoshihiro, Shishido Hiroaki, Takahashi Hideto, Yasumura Seiji, Kazama Junichiro James, Hashimoto Shigeatsu, Kobashi Gen, Ozasa Kotaro, Abe Masafumi
机构信息
Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.
Department of Nephrology and Hypertension, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, 960-1295, Japan.
出版信息
Clin Exp Nephrol. 2017 Dec;21(6):995-1002. doi: 10.1007/s10157-017-1395-8. Epub 2017 Mar 15.
BACKGROUND
About 146,000 people were forced into long-term evacuation due to the nuclear power plant accident caused by the Great East Japan Earthquake in 2011. Disaster is known to induce hypertension in survivors for a certain period, but it is unclear whether prolonged disaster stress influences chronic kidney disease (CKD). We conducted an observational cohort study to elucidate the effects of evacuation stress on CKD incidence.
METHODS
Participants were individuals living in communities near the Fukushima nuclear power plant, aged 40-74 years without CKD as of their 2011 general health checkup (non-evacuees: n = 9780, evacuees: n = 4712). We followed new-onset CKD [estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m or proteinuria] using general annual health checkup data from 2012 to 2014. Association between evacuation and CKD incidence was analyzed using the Cox proportional hazard model.
RESULTS
Mean age of the participants at baseline was 65 years, 46.7% were men, and baseline eGFR was 75.7 ml/min/1.73 m. During the mean follow-up period of 2.46 years, CKD incidence rate was 80.8/1000 and 100.2/1000 person-years in non-evacuees and evacuees, respectively. Evacuation was a significant risk factor of CKD incidence after adjusting for age, gender, obesity, hypertension, diabetes, dyslipidemia, smoking, and baseline eGFR [hazard ratio (HR): 1.45; 95% confidence interval (CI) 1.35-1.56]. Evacuation was significantly associated with the incidence of eGFR <60 ml/min/1.73 m (HR: 1.48; 95% CI 1.37-1.60), but not with the incidence of proteinuria (HR: 1.21; 95% CI 0.93-1.56).
CONCLUSION
Evacuation was a risk factor associated with CKD incidence after the disaster.
背景
2011年东日本大地震引发核电站事故，约14.6万人被迫长期撤离。众所周知，灾难会在一定时期内导致幸存者患高血压，但长期的灾难压力是否会影响慢性肾脏病（CKD）尚不清楚。我们开展了一项观察性队列研究，以阐明撤离压力对CKD发病率的影响。
方法
研究对象为居住在福岛核电站附近社区、年龄在40 - 74岁且在2011年常规健康检查时无CKD的个体（未撤离者：n = 9780，撤离者：n = 4712）。我们利用2012年至2014年的常规年度健康检查数据追踪新发CKD [估计肾小球滤过率（eGFR）<60 ml/min/1.73 m²或蛋白尿]情况。采用Cox比例风险模型分析撤离与CKD发病率之间的关联。
结果
参与者基线时的平均年龄为65岁，男性占46.7%，基线eGFR为75.7 ml/min/1.73 m²。在平均2.46年的随访期内，未撤离者和撤离者的CKD发病率分别为80.8/1000人年和100.2/1000人年。在调整年龄、性别、肥胖、高血压、糖尿病、血脂异常、吸烟和基线eGFR后，撤离是CKD发病的一个显著风险因素[风险比（HR）：1.45；95%置信区间（CI）1.35 - 1.56]。撤离与eGFR <60 ml/min/1.73 m²的发病率显著相关（HR：1.48；95% CI 1.37 - 1.60），但与蛋白尿的发病率无关（HR：1.21；95% CI 0.93 - 1.56）。
结论
撤离是灾难后与CKD发病率相关的一个风险因素。
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