【作者】 陆晨；

【导师】 刘晓城；

【作者基本信息】 华中科技大学 ， 内科学， 2010， 博士

【摘要】 目的：了解乌鲁木齐市天山区成年慢性肾脏病(CKD)的流行病学特征。方法：以分层多级整群抽样法,对乌鲁木齐市天山区4个社区的2131名35岁以上常住居民进行问卷调查、体格检查和实验室检查。结果：在2131名资料完整的居民中,经年龄、性别校正后,白蛋白尿的患病率为2.63%(95%CI：1.78%-3.48%)；血尿的患病率为7.43%(95%CI: 6.11%-8.75%)；肾功能下降的患病率为1.72%(95%CI：1.08%-2.35%)。该人群CKD的患病率为9.99%(95%CI：8.47%-11.55%),知晓率为2.44%。多因素Logistic回归显示：白蛋白尿、血尿、年龄增加10岁、高尿酸血症与肾功能下降独立相关；血尿、肾功能下降与白蛋白尿独立相关；白蛋白尿、肾功能下降、女性与血尿独立相关。结论：在我国西部大城市中,成人CKD的患病率为9.99%,知晓率为2.44%,CKD的危险因素与我国大城市及西方发达国家类似。目的：探讨乌鲁木齐市天山区成人慢性肾脏病社区干预模式及效果评价。方法：以流行病学调查确定的CKD患者及高危人群为对象,将CKD患者及高危人群设定为干预组,非CKD人群为对照组,对照组进行基础干预,干预组进行基础干预加综合干预,干预期为2年并对干预效果进行评价。结果：对照组中接受健康教育、对CKD及其他慢性非传染性疾病的知晓率、对CKD危险因素的认知率等描述指标经干预和随访后,差异有统计学意义(P<0.05)；而吸烟、体育锻炼和对其它疾病控制情况等描述性指标经干预和随访后,差异无统计学意义(P>0.05)。在9项检测指标中通过干预和随访后,差异无统计学意义(P>0.05)。干预组中对CKD及其他慢性非传染性疾病的知晓率、对CKD危险因素的认知程度和服药依从性等描述性指标经干预和随访后,差异有统计学意义(P<0.05)；在接受健康教育和对CKD并发症的认知率,部分差异无统计学意义(P>0.05),部分差异均有统计学意义(P<0.05)。而吸烟、体育锻炼、饮食依从性、对CKD的干预率、对CKD的控制和对其它疾病控制情况等6项描述性指标经干预和随访后,差异无统计学意义(P>0.05)。血脂和血尿酸经干预和随访后,差异均有统计学意义(P<0.05)；血糖部分差异无统计学意义(P>0.05),部分差异均有统计学意义(P<0.05)；其余6项检测指标通过不同的干预和多次随访后,差异无统计学意义(P>0.05)。结论：通过对对照组实施基础干预和对干预组实施基础干预加综合干预,显示出社区综合干预模式是防治CKD的有效措施。更多还原

【Abstract】 Objective:To investigate the prevalence of chronic kidney disease (CKD) and risk factors in the adult population in Tianshan district of UrumqiMethods:2131 residents from 4 communities in Tianshan district of Urumqi city were randomly selected by using a stratified, multistage sampling. All residents were interviewed and tested for morning spot urine of albumin to creatinine ratio (ACR) (abnormal:≥30 mg/g); morning spot urine dipstick of hematuria (abnormal:> 3 red blood cells/Hp or greater) and pyuria (abnormal:> 5 White blood cells/Hp) confirmed by urine microscopy; Reduced renal function-estimated glomerular filtration rate (e GFR) by abbreviated MDRD equation eGFR[abnormal:< 60 ml-min-1?(1.73 m2)-1]. The associations of kidney damage indicators with age, gender, hypertension, diabetsmellitus, smoking, income, education, cholesterol, triglyceride and smoking were detected by questionnaire and physical examination.Results:Eligible data of 2131 subjects were collected in the study.. After the adjustment of age and gender componen, the prevalence of albuminuria was detected in 2.63%(95%CI:1.78%-3.48%) of subjects, hematuria in 7.43%(95%CI:6.11%-8.75%) and reduced renal function in 1.72%(95%CI:1.08%-2.35%). Approximately 9.99% (95%CI:8.47%-11.55%) subjects had at least one indicator of kidney damage. Multivariate logistic regression display:Albuminuria, hematuria, age and hyperuricemia were independently associated with reduced renal function. Hematuria and reduced renal function were independently associated with albuminuria. Albuminuria, reduced renal function and female were independently associated with hematuria.Conclusions:The prevalence of chronic kidney disease is 9.99%and the recognition rate is 2.44%in urban adult population in western china. The risk factors of CKD in adult population in Urumqi city are similar with the metropolis in China and the developed countries. Population-based studies evaluating the prevalence of kidney damage in different communities have been limited in developing countries. We conducted a population-based screening study in Uygur people of Urumqi that aimed to identify the prevalence and associated risk factors of chronic kidney disease (CKD) in Uygur populations.Methods. We interviewed 2576 residents (>18 years) from four districts of Urumqi from June 2007 to January 2009 and tested for haematuria, albuminuria and reduced renal function. Associations between age, gender, smoking, diabetes mellitus, hypertension, hyperuricaemia and kidney damage were examined.Results. There were 2576 subjects enrolled in this study. After standardization for age, the prevalence of albuminuria, haematuria and reduced estimated glomerular filtration rate (eGFR) was3.58%,2.26%and 1.03%, respectively. Approximately 5.65%of the sample population had at least one indicator of kidney damage. Age, diabetes mellitus, hypercholesteremia, hyperuricaemia and hyperlipidaemia were independently associated with CKD.Conclusions, In the general uygur adult population from Urumqi,5.65%has either proteinuria, haematuria and/or reduced eGFR, indicating the presence of kidney damage, with an awareness of only 1.05%. The high prevalence and low awareness of CKD in this population suggest an urgent need for CKD prevention programmes in Uygur people. Objective:To set up the community intervention model for chronic kidney disease (CKD) and evalute the effect of the model.Methods:The CKD patients and non-CKD participants were divided into invention group and control group randomly based on the database of CKD which was established according to the epidemiological study. The comprehensive intervention was conducted on the all participants for one year, then the effect of intervention was evaluated.Results:After the comprehensive intervention, the awareness rate of chronic kidney disease in non-CKD participants increased by 48.7%, while the CKD patients increased by 33.48%; The percence of smoking in non-CKD participants decreased by 18.04%, while the CKD patients decreased by 30.02%; The recognition rate of rish factors and complication of CKD, compliance with dietary and pharmologic therapy were increased significantly, and the differences showed statistically significant (P<0.05); After comprehensive intervention, both of the systolic blood pressure and the diastolic blood pressure were decreased significantly (P<0.05).Conclusions:The community intervention is an effective measure for the prevention and control of chronic kidney disease.更多还原