急诊

肾功能正常与肾功能受损患者蛋白尿与房颤的发生相关性研究

作者:张楠 曹广慧 来源:急诊界 日期:2017-09-05
导读

         相比于肾功能不全的患者,正常肾功能患者蛋白尿增加显著增加房颤发生的风险。应将蛋白尿视为房颤的独立危险因素。

关键字:  蛋白尿 | 房颤 | 肾功能 

        Association of Proteinuria and Incident Atrial Fibrillation in Patients With Intact and Reduced Kidney Function

        肾功能正常与肾功能受损患者蛋白尿房颤的发生相关性研究

        Background

        Early evidence suggests proteinuria is independently associated with incident atrial fibrillation (AF). We sought to investigate whether theassociation of proteinuria with incident AF is altered by kidney function.

        背景:早期研究表明蛋白尿与发生房颤独立相关。我们将探讨肾功能的改变是否会影响这种关系。

        Measurements and Main Results

        Retrospectivecohort study using administrative healthcare databases in Ontario, Canada(2002–2015). A total of 736 666 patients aged ≥40 years not receiving dialysis and with no previoushistory of AF were included. Proteinuria was defined using the urine albumin-to-creatinine ratio (ACR) andkidney function by the estimated glomerular filtration rate (eGFR). The primary outcome was time to AF.Cox proportional models were used to determine the hazard ratio for AF censoredfor death, dialysis, kidney transplant, or end of follow-up. Fine and Greymodels were used to determine thesubdistribution hazard ratiofor AF,with death as a competing event. Median follow-up was 6 years and 44 809patients developed AF. In adjusted models, ACR and eGFR were associated with AF(P<0.0001).The association of proteinuria with AF differed basedon kidney function (ACR 9 eGFR interaction, P<0.0001). Overt proteinuria(ACR, 120 mg/mmol) was associated with greater AF risk in patients with intact (eGFR,120) versus reduced (eGFR, 30) kidney function(adjusted hazard ratios,4.5 [95% CI, 4.0–5.1] and 2.6 [95% CI, 2.4–2.8],respectively;referent ACR 0 and eGFR 120). Results were similar in competing risk analyses.

        方法及结果:对加拿大安大略2002年至2015年的医疗数据库进行回顾性队列研究。共有736666名大于40岁患者纳入,其没有接受透析或房颤病史。蛋白尿通过ACR定义,肾功能通过eGFR评估。主要结果为发生房颤的时间。中位随访时间为6年,44809名患者发生房颤。在校正模型中,ACR及eGFR与房颤相关(P<0.0001)。肾功能不同时,蛋白尿与房颤发生的关系则不同。肾功能正常患者(ACR, 120mg/mmol)相比于肾功能受损患者(eGFR,30),其显著蛋白尿(ACR, 120mg/mmol)与房颤发生相关性更大(校正风险比值分别为4.5 [95%CI, 4.0–5.1]和2.6 [95%CI, 2.4–2.8])。

        Conclusion

        Proteinuriaincreases the risk of incident AF markedly in patients with intact kidneyfunction compared with those with decreased kidney function. Screening andpreventative strategies should consider proteinuria as an independent riskfactor for AF.

        结论:相比于肾功能不全的患者,正常肾功能患者蛋白尿增加显著增加房颤发生的风险。应将蛋白尿视为房颤的独立危险因素。

        翻译:张楠

        审校:曹广慧

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