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目的了解上海市浦东新区社区不同血脂水平居民的慢性肾病(CKD)的流行情况,为制定该地区相关慢性病预防控制策略提供依据。方法 2008年4-7月从上海市浦东新区随机抽取20~80岁的社区居民5 584人进行问卷调查,收集一般情况和生活方式等信息,抽取空腹血样并采集晨尿,测定血肌酐、尿肌酐及尿微量白蛋白等指标,计算尿白蛋白和肌酐比值(ACR),并依据血清肌酐水平估算肾小球滤过率(e GFR),并测定血脂水平。结果该社区居民CKD和高脂血症的标化患病率分别为11.0%和41.0%。高胆固醇血症、高甘油三酯血症、混合性高脂血症和低高密度脂蛋白血症标化患病率分别为7.7%、33.0%、4.5%和7.1%。CKD患者的高脂血症标化患病率和上述各类血脂异常标化患病率分别为53.4%、10.8%、44.4%、7.6%和10.3%,明显高于非CKD者(分别为39.5%、7.3%、31.3%、4.1%和6.6%),差异均有统计学意义(P<0.01)。调查对象白蛋白尿和CKD患病率随总胆固醇(TC)、甘油三酯(TG)和低密度脂蛋白胆固醇(LDL-C)增加呈升高趋势;随着高密度脂蛋白胆固醇(HDL-C)增加则呈降低趋势,均有统计学意义(P<0.05)。以4项血脂指标的第1百分位组为参照,调整年龄、性别、空腹血糖、收缩压、舒张压、肥胖或超重,logistic回归分析结果显示,TC第2和第4组CKD的调整OR值分别为0.69(95%CI:0.53~0.89)和0.77(95%CI:0.60~0.99);TG第2至第4组的CKD调整OR值分别为1.27(95%CI:1.07~1.66)、1.22(95%CI:1.04~1.59)和1.48(95%CI:1.14~1.91);HDL-C第4组CKD的调整OR值为0.66(95%CI:0.51~0.85)。结论上海市浦东新区成年居民中,高TG血症与CKD高风险关系密切,需重视高脂血症和CKD的早期筛检和干预,避免相关慢性病的发生。
Objective To understand the prevalence of chronic kidney disease (CKD) among residents with different blood lipid levels in the community of Pudong New Area, Shanghai, and to provide the basis for the formulation of prevention and control strategies for chronic diseases in this area. Methods From April to July 2008, 5 584 community residents from 20 to 80 years old were randomly selected from Pudong New Area in Shanghai for questionnaire survey. General information and lifestyle information were collected. Fasting blood samples were collected and morning urine was collected. Serum creatinine, Creatinine and urinary microalbumin, urinary albumin and creatinine ratio (ACR) were calculated, glomerular filtration rate (e GFR) was estimated according to serum creatinine level, and blood lipid level was measured. Results The standardized prevalence of CKD and hyperlipidemia in this community was 11.0% and 41.0% respectively. The prevalence rates of hypercholesterolemia, hypertriglyceridemia, mixed hyperlipidemia and low-density lipoprotein were 7.7%, 33.0%, 4.5% and 7.1%, respectively. The standardized prevalence of hyperlipidemia and normalized dyslipidemia in CKD patients were 53.4%, 10.8%, 44.4%, 7.6% and 10.3%, respectively, which were significantly higher than those of non-CKD patients (39.5 %, 7.3%, 31.3%, 4.1% and 6.6%, respectively). The differences were statistically significant (P <0.01). The prevalences of albuminuria and CKD tended to increase with the increase of total cholesterol (TC), triglyceride (TG) and low density lipoprotein cholesterol (LDL-C). With the increase of high density lipoprotein cholesterol (HDL- C) increased then showed a downward trend, both statistically significant (P <0.05). Based on the first percentile of the four blood lipid indicators, age, sex, fasting blood glucose, systolic blood pressure, diastolic blood pressure, obesity or overweight were adjusted. Logistic regression analysis showed that the adjustment of CKD in TC groups 2 and 4 OR (95% CI: 0.53 ~ 0.89) and 0.77 (95% CI: 0.60 ~ 0.99) respectively. The OR of CKD in group 2 to group 4 were 1.27 (95% CI: 1.07-1.66) 1.22 (95% CI: 1.04-1.59) and 1.48 (95% CI: 1.14-1.91). The adjusted OR of HDL-C group 4 CKD was 0.66 (95% CI: 0.51-0.85). Conclusions Among adults living in Pudong New Area, Shanghai, there is a close relationship between high triglyceridemia and high risk of CKD. Early screening and intervention of hyperlipidemia and CKD should be emphasized to avoid the related chronic diseases.