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目的评价老年人体质量指数(BMI)、腰围、颈围等肥胖指标与慢性肾脏病(CKD)的关系。方法 2013年8-9月,整群选取上海浦东新区≥65岁老年人2076人,横断面调查身高、体质量、腰围、颈围、血清肌酐以及CKD其他危险因素。采用慢性肾脏病流行病学协作组公式(CKD-EPI)计算估算的肾小球滤过率(eGFR)。比较根据BMI临床分组,腰围和颈围四分位分组的CKD[定义为eGFR≤60mL/(min·1.73m2)]患病情况;多因素Logistic回归分析老年人肥胖指标与CKD的相关性。结果女性随着BMI、腰围、颈围水平升高,CKD检出率升高(均P趋势<0.05)。以CKD为因变量,3项肥胖指标分别作为自变量建模,调整年龄、吸烟、饮酒、总胆固醇、糖尿病、三酰甘油、服用降压药等因素后,进行Logistic回归分析,结果显示男性BMI与CKD无相关(P=0.32),腰围和颈围与CKD相关(均P<0.05),女性BMI、腰围和颈围与CKD发生相关(均P<0.05)。进一步将3项肥胖指标纳入同一模型进行分析,结果显示,仅在男性人群中,颈围与CKD呈正相关,颈围每升高1个标准差(2.8cm),CKD风险增加78%(95%CI1.21~2.62,P<0.01)。结论与BMI或腰围相比,颈围可能与老年男性CKD的关系更密切。
Objective To evaluate the relationship between body mass index (BMI), waist circumference, neck circumference and other obesity indicators and chronic kidney disease (CKD) in the elderly. METHODS: From August to September 2013, 2,076 elderly people aged 65 or older in Shanghai Pudong New Area were enrolled in the study. Height, body mass, waist circumference, neck circumference, serum creatinine and other risk factors of CKD were investigated in a cross section. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collagen Group Formula (CKD-EPI). The prevalence of CKD [defined as eGFR≤60 mL / (min · 1.73 m 2)] was compared according to the BMI clinical grouping, waist circumference, and cervical quartile; multivariate logistic regression was used to analyze the association between obesity indicators and CKD in the elderly. Results With the increase of BMI, waist circumference and neck circumference, the detection rate of CKD increased (both P <0.05). Taking CKD as the dependent variable and three obesity indicators as independent variables, Logistic regression analysis was conducted after adjusting for age, smoking, drinking, total cholesterol, diabetes, triglyceride, antihypertensive drugs and other factors. The results showed that male BMI No correlation was found between CKD and CKD (P = 0.32), waistline and neck circumference were associated with CKD (all P <0.05), and BMI, waist circumference and neck circumference were associated with CKD (all P <0.05). Three obesity indicators were further included in the same model for analysis. The results showed that neck circumference was positively correlated with CKD only in men, and the risk of CKD increased by 78% (95% CI1.21 ~ 2.62, P <0.01). Conclusion Compared with BMI or waist circumference, neck circumference may be more closely related to CKD in elderly men.