胱抑素 C 估算肾小球滤过率和蛋白尿与韩国人群全因和心血管疾病死亡率独立相关：Dong-gu 研究。
Cystatin C-based estimated GFR and albuminuria are independently associated with all-cause and CVD mortality in Korean population: The Dong-gu Study.
机构信息
Department of Preventive Medicine, Chonnam National University Medical School, 264, Seoyang‑ro Hwasun‑eup, Hwasun, Jeollanam-do, 58128, Republic of Korea; Gwangju-Jeonnam Regional Cardiocerebrovascular Center, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
Department of Preventive Medicine, Chonnam National University Medical School, 264, Seoyang‑ro Hwasun‑eup, Hwasun, Jeollanam-do, 58128, Republic of Korea.
出版信息
Maturitas. 2021 Jan;143:178-183. doi: 10.1016/j.maturitas.2020.10.016. Epub 2020 Nov 2.
OBJECTIVE
To assess the associations among the estimated glomerular filtration rate (eGFR), albumin to creatinine ratio (ACR), and all-cause and CVD mortality rate and to compare the performances of eGFR, eGFR, and eGFR using receiver operating characteristic (ROC) analysis in Korean adults aged ≥ 50 years.
METHODS
Of the 9,260 subjects who participated in the baseline survey of a prospective longitudinal study conducted in Korea, 9,009 (men: 3,574 (39.7%); women: 5,435 (60.3%)) were included in this analysis after the exclusion of 217 subjects with missing eGFR and 34 subjects with missing ACR data.
MAIN OUTCOME MEASURE
The associations of eGFR and ACR with all-cause and CVD mortality were investigated using Cox proportional hazards models that included sex, age, waist circumference, smoking, alcohol intake, degree of physical activity, hypertension, diabetes, systolic blood pressure, log-HbA, total cholesterol, log-triglyceride, log-HDL and log-ACR or eGFR.
RESULTS
After adjustment for covariates, independent associations were found between all-cause mortality and the eGFR (mL/min per 1.73 m) [HR 1.23, 95% confidence interval (CI) 1.05-1.43 for 60-89 vs. ≥ 90; HR 1.87, 95% CI 1.49-2.34 for 45-59 vs. ≥ 90; HR 2.38, 95% CI 1.77-3.20 for 30-44 vs. ≥ 90; HR 2.82, 95% CI 1.89-4.23 for <30 vs. ≥ 90] and ACR (μg/mg creatinine) [HR 1.09, 95% CI 0.88-1.34 for Q2 vs. Q1; HR 1.34, 95% CI 1.10-1.63 for Q3 vs. Q1; HR 1.49, 95% CI 1.22-1.81 for Q4 vs. Q1]. In addition, independent associations of CVD mortality with the eGFR and ACR were significant. In the comparison of eGFR performance, the ROC-plot AUC for all-cause mortality was significantly greater for the eGFR than for the eGFR and eGFR.
CONCLUSION
The eGFR and ACR were associated independently with all-cause and CVD mortality after adjustment for covariates, including the eGFR and ACR. In addition, the ROC-plot AUC for all-cause mortality was greater for the eGFR than for the eGFR and eGFR in Korean adults aged ≥ 50 years.
目的
评估估算肾小球滤过率（eGFR）、白蛋白与肌酐比值（ACR）与全因和心血管疾病死亡率之间的关联，并通过接收者操作特征（ROC）分析比较 eGFR、eGFR 和 eGFR 在≥50 岁韩国成年人中的表现。
方法
在韩国进行的一项前瞻性纵向研究的基线调查中，有 9260 名受试者参加，排除了 217 名 eGFR 缺失和 34 名 ACR 数据缺失的受试者后，共有 9009 名受试者（男性：3574 名（39.7%）；女性：5435 名（60.3%））纳入本分析。
主要观察指标
使用包含性别、年龄、腰围、吸烟、饮酒、身体活动程度、高血压、糖尿病、收缩压、log-HbA、总胆固醇、log-甘油三酯、log-HDL 和 log-ACR 或 eGFR 的 Cox 比例风险模型，调查 eGFR 和 ACR 与全因和心血管疾病死亡率的相关性。
结果
在调整协变量后，发现全因死亡率与 eGFR（mL/min per 1.73 m）之间存在独立关联[60-89 岁 vs. ≥90 岁的 HR 为 1.23，95%置信区间（CI）为 1.05-1.43；45-59 岁 vs. ≥90 岁的 HR 为 1.87，95%CI 为 1.49-2.34；30-44 岁 vs. ≥90 岁的 HR 为 2.38，95%CI 为 1.77-3.20；<30 岁 vs. ≥90 岁的 HR 为 2.82，95%CI 为 1.89-4.23]和 ACR（μg/mg 肌酐）[Q2 与 Q1 相比的 HR 为 1.09，95%CI 为 0.88-1.34；Q3 与 Q1 相比的 HR 为 1.34，95%CI 为 1.10-1.63；Q4 与 Q1 相比的 HR 为 1.49，95%CI 为 1.22-1.81]。此外，CVD 死亡率与 eGFR 和 ACR 之间的独立关联也具有统计学意义。在比较 eGFR 性能时，eGFR 与 eGFR 和 eGFR 相比，全因死亡率的 ROC 曲线 AUC 显著更大。
结论
在调整包括 eGFR 和 ACR 在内的协变量后，eGFR 和 ACR 与全因和心血管疾病死亡率独立相关。此外，在≥50 岁的韩国成年人中，eGFR 与 eGFR 和 eGFR 相比，全因死亡率的 ROC 曲线 AUC 更大。
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