Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong, 250062, China.
Department of Community, Lanshan District People Hospital, Linyi, Shandong, 276002, China.
Sci Rep. 2019 Feb 14;9(1):2051. doi: 10.1038/s41598-018-38470-x.
The aim of this study was to investigate the associations between carotid wall shear stress (WSS) and renal function impairment (RFI) and albuminuria in aging adults. A total of 1,447 subjects aged 60 years and older with normal estimated glomerular filtration rate (eGFR ≥ 60 mL·min·1.72 m) and albumin/creatinine ratio (ACR < 30 mg·g) were enrolled between April 2007 and October 2009 in the Shandong area, China. Carotid WSS was assessed at baseline, and eGFR, which is based on serum creatinine and cystatin C, and ACR were assessed at baseline and at the annual follow-up visits. After an average of 62.9 months of follow-up, the reduction in eGFR and the increase in ACR were significantly higher in the Q group than the Q group, as classified by either the interquartile of the mean WSS or the interquartile of the peak WSS after adjustment for multi-variabilities, including the average blood pressures at every annual visit and baseline eGFR and ACR. For groups classified by mean WSS, the hazard ratios (95% confidence intervals) were 3.45 (1.36-8.75, p = 0.008) in the incident RFI and 3.24 3.22 (1.37-7.57, p = 0.009) in the incident albuminuria for the Q group compared with the Q group. Similar results were observed among groups classified by peak WSS. The Q group was associated with endothelial dysfunction and inflammation with respect to the Q group as classified by mean or peak WSS. The results indicate that carotid WSS plays an important role in RFI and albuminuria progression in aging adults. Lower WSS was associated with a higher risk of RFI and albuminuria compared with higher WSS.
本研究旨在探讨颈动脉壁切应力（WSS）与肾功能损害（RFI）和白蛋白尿在老年人群中的关系。共纳入 2007 年 4 月至 2009 年 10 月中国山东地区年龄在 60 岁及以上、估算肾小球滤过率（eGFR≥60mL·min·1.72m）正常且白蛋白/肌酐比值（ACR<30mg·g）正常的 1447 例患者。在基线时评估颈动脉 WSS，在基线和每年随访时评估基于血清肌酐和胱抑素 C 的 eGFR 和 ACR。在平均 62.9 个月的随访后，无论是根据平均 WSS 的四分位数还是根据调整后的多变量（包括每年就诊时的平均血压以及基线时的 eGFR 和 ACR）后的峰值 WSS 的四分位数对 Q 组和 Q 组进行分类，Q 组的 eGFR 下降和 ACR 升高均明显高于 Q 组。对于根据平均 WSS 分类的组，与 Q 组相比，Q 组的新发 RFI 的风险比（95%置信区间）为 3.45（1.36-8.75，p=0.008），新发白蛋白尿的风险比为 3.24（3.22-1.37-7.57，p=0.009）。在根据峰值 WSS 分类的组中也观察到了类似的结果。与根据平均或峰值 WSS 分类的 Q 组相比，Q 组与内皮功能障碍和炎症有关。结果表明，颈动脉 WSS 在老年人 RFI 和白蛋白尿进展中起重要作用。与较高的 WSS 相比，较低的 WSS 与 RFI 和白蛋白尿的风险增加相关。
