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投稿时间：2021-12-20 网络发布日期：2022-06-20
投稿时间：2021-12-20 网络发布日期：2022-06-20
中文摘要: 目的 探讨慢性肾脏病3期（CKD3）患者体质指数（BMI）与肺通气功能障碍指标的关系及在临床预测中的作用。方法 回顾性选取2015年1月至2019年10月在昆明医科大学第一附属医院完成肺功能检查的CKD3患者250例。根据是否合并肺通气功能障碍分为肺通气功能正常组（正常组,n=119）和合并肺通气功能障碍组（合并组,n=131）。分别比较两组患者的临床资料，采用Pearson及Spearman相关分析第1秒用力呼气容积占预计值百分比(FEV1％pred)与BMI及其他指标的关系，ROC曲线评估BMI对CKD3期患者合并肺通气功能障碍的预测价值。进一步将合并组患者分为轻中度障碍组（50%≤FEV1％pred<80%，n=80）、重度及以上障碍组（FEV1％pred<50%，n=51），与正常组（FEV1％pred≥80%，n=119）一起比较三组的临床资料，采用多元Logistic回归分析肺通气功能障碍加重的危险因素。结果 两组患者性别、年龄、吸烟史、慢性支气管炎病史比较差异有统计学意义（P<0.05），正常组患者BMI高于合并组，差异有统计学意义（P<0.05）。FEV1％pred与BMI呈正相关（r=0.217，P<0.05）。BMI的AUC为0.686（95%CI：0.607～0.765，P<0.01），截断值为23.45，预测CKD3期患者发生肺通气功能障碍的灵敏度为66.8%，特异度为62.8％。在轻中度障碍组、重度及以上障碍组年龄大于正常组（P<0.05），但在有障碍的两组比较差异无统计学意义（P＞0.05）；三组有慢性支气管炎病史的患者比例为重度及以上障碍组＞轻中度障碍组＞正常组（P<0.05）；随病情加重，BMI逐渐下降，在三组间比较差异有统计学意义（P<0.05）。多元Logistic回归模型显示BMI（OR=0.898，95%CI：0.822～0.981，P<0.05）及慢性支气管炎病史（OR=0.130，95%CI：0.052～0.324，P<0.01）是CKD3患者肺通气功能障碍加重的独立危险因素。结论 BMI对CKD3患者发生肺通气功能障碍有一定的临床预测价值，对疾病的发展及预后有一定的临床指导意义。
Abstract:Objective To investigate the relationship between body mass index (BMI) and pulmonary ventilation dysfunction in patients with chronic kidney disease stage 3 (CKD3). Methods A total of 250 patients with CKD3 were selected restrospectively, who received pulmonary function testing (PFT) in the First Affiliated Hospital of Kunming Medical University from January 2015 to October 2019. According to whether the patients were complicated with pulmonary ventilation dysfunction, they were divided into normal pulmonary ventilation function group (normal group, n=119) and pulmonary ventilation dysfunction group (combined group, n=131). Pearson and Spearman correlation analysis were used to analyze the associations of forced expiratory volume in first second to predicted value (FEV1%pred) with BMI and other indicators. ROC curve was used to evaluate the predictive value of BMI in CKD3 patients complicated with pulmonary ventilation dysfunction. The patients in combined group were subdivided into mild to moderate disorder group (50%≤FEV1%pred<80%, n=80) and severe and above disorder group (FEV1%pred<50%, n=51) according to FEV1%pred. Multiple Logistic regression was used to analyze the risk factors of exacerbation of pulmonary ventilation dysfunction. Results There were statistical differences in gender, age, smoking history and chronic bronchitis history between two groups (P<0.05). BMI in normal group was higher than that in combined group (P<0.05). FEV1%pred was positively correlated with BMI (r=0.217, P<0.05). In predicting pulmonary ventilation dysfunction in CKD3 patients, the area under the curve (AUC) of BMI was 0.686 (95%CI:0.607-0.765, P<0.01), the cut-off value was 23.45, and the sensitivity and specificity were 66.8% and 62.8%, respectively. The age of patients in combined group was older than that in normal group (P<0.05), and there was no significant difference in age between two subgroups(P>0.05). The proportion of patients with chronic bronchitis was the highest in severe and above disorder group, followed by mild and moderate disorder group and was the lowest in normal group (P<0.05). BMI decreased gradually in the order of severe and above disorder group, mild and moderate disorder group and normal group (P<0.05). Multiple Logistic regression model showed that lower BMI (OR=0.898, 95%CI: 0.822-0.981, P<0.05) and history of chronic bronchitis (OR=0.130, 95%CI: 0.052-0.324, P<0.01) were the independent risk factors for exacerbation of pulmonary ventilation dysfunction in patients with CKD3. Conclusion BMI has a certain clinical predictive value for the occurrence of pulmonary ventilation dysfunction in CKD3 patients and for the development and prognosis of the disease.
keywords: Chronic kidney disease stage 3 Pulmonary ventilation dysfunction Body mass index Forced expiratory volume in first second Chronic bronchitis
文章编号： 中图分类号：R692 文献标志码：A
基金项目:云南省科技计划项目［2017FE467 (-039)］
引用文本：
谭千林,吴艳,张蕴潆,等.慢性肾脏病3期患者BMI与肺通气功能障碍的相关性[J].中国临床研究,2022,35(6):755-760.
谭千林,吴艳,张蕴潆,等.慢性肾脏病3期患者BMI与肺通气功能障碍的相关性[J].中国临床研究,2022,35(6):755-760.