系统性炎症综合指数与慢性肾脏病之间关系的横断面研究

伊世华; 张强; 路秀云; 王新伟; 王冰

doi:10.16766/j.cnki.issn.1674-4152.004168

系统性炎症综合指数与慢性肾脏病之间关系的横断面研究

doi: 10.16766/j.cnki.issn.1674-4152.004168

1.
黑龙江省中医药科学院肾病三科，黑龙江哈尔滨 150036
2.
中国人民解放军联勤保障部队第九六二医院中医风湿科，黑龙江哈尔滨 150048
3.
哈尔滨医科大学附属第二医院中医科，黑龙江哈尔滨 150086
4.
黑龙江省中医药科学院肝胆脾胃病科

基金项目:

黑龙江省卫生健康委科研课题 2022212101102

详细信息

通讯作者:
王冰，E-mail：940066276@qq.com

中图分类号: R692
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出版历程
- 收稿日期: 2024-12-11
- 网络出版日期: 2025-11-17

A cross-sectional study on the relationship between the comprehensive index of systemic inflammation and chronic kidney disease

1.
Department of Nephrology, Heilongjiang Academy of Chinese Medicine, Harbin, Heilongjiang 150036, China

摘要

摘要: 目的慢性肾脏病(CKD)是一种以肾功能逐渐减退为特征的疾病，影响患者的生活质量并增加死亡风险，已成为公共卫生负担。系统性炎症综合指数(AISI)是一种血液综合性炎症指标，与CKD之间的关系尚未得到验证，本研究旨在评估AISI与CKD之间的关系。方法本研究提取NHANES(2009—2018年)的数据，纳入成人参与者9 557例，其中CKD患者912例(9.54%)。纳入性别、年龄、种族、教育、收入支出比、BMI、吸烟、饮酒、高血压、糖尿病、代谢综合征、心血管疾病及实验室检验指标等协变量，评估无CKD和CKD参与者的差异，通过多元logistic回归模型评估AISI与CKD风险的关系，通过限制性立方样条分析线性和非线性关系，通过ROC、DCA、校准曲线评估模型预测能力，并进行亚组分析。结果 CKD患者的AISI高于无CKD参与者[251.14(170.39，403.65)vs. 236.05(157.08，363.51)，P=0.004]；AISI较高的参与者患CKD的风险显著增加(OR=1.112，95% CI：1.040~1.188，P=0.002)；AISI与CKD患病风险呈正相关线性关系(P for overall < 0.001；P for nonlinear=0.465)，当AISI超过中位数值(237.30)时，CKD患病风险显著上升；构建的最终模型稳健，AUC为0.737(95% CI：0.718~0.756，P < 0.001)；亚组分析表明性别在AISI与CKD风险关联中可能有调节作用。结论 AISI作为炎症综合指标，与CKD发生风险相关，在AISI较高的人群中风险更大。该指标可能作为CKD风险筛查的有效工具，为高危人群的早期预警提供支持。
- 慢性肾脏病 /
- 系统性炎症综合指数 /
- 横断面研究 /
- 多元逻辑回归 /
- 限制性立方样条
Abstract: Objective Chronic kidney disease (CKD) is characterized by a progressive decline in renal function, which has a detrimental effect on patients ' quality of life, increases mortality risk, and poses a significant public health burden. The aggregate index of systemic inflammation (AISI), a composite biomarker derived from blood cell counts, has not yet been definitively associated with CKD. This cross-sectional study was conducted with the objective of investigating the association between AISI levels and CKD prevalence in a cohort that is nationally representative. Methods A total of 9 557 adults from the NHANES 2009-2018 were analyzed, with 912 (9.54%) meeting CKD diagnostic criteria. The following covariates were included in the study: age, gender, race, education, income, poverty ratio, BMI, smoking, drinking, hypertension, diabetes, metabolic syndrome and biomarkers. Multivariable logistic regression models, adjusted for demographic and clinical confounders, were employed to assess the associations between AISI quartiles and CKD risk. Restricted cubic splines were utilized to evaluate linearity, while the ROC, DCA and calibration assessed the model ' s performance. Results Participants with CKD exhibited significantly higher median AISI values compared to non-CKD individuals [251.14 (170.39, 403.65) vs. 236.05 (157.08, 363.51), P=0.004]. Elevated AISI levels were found to be independently associated with increased risk of CKD (OR=1.112, 95% CI: 1.040-1.188, P=0.002). A linear dose-response relationship was observed (P for overall < 0.001; P for nonlinear=0.465), with CKD risk rising markedly above the cohort median AISI (237.30). The final model demonstrated strong predictive accuracy AUC value of 0.737(95% CI: 0.718-0.756, P < 0.001). Subgroup analyses further suggested gender-specific modifications of the association between the AISI and CKD. Conclusion As a composite inflammatory biomarker, AISI has been demonstrated to exhibit a dose-dependent association with the risk of CKD, particularly at elevated levels. These findings lend support to the hypothesis that the test has the potential utility for population-level CKD risk stratification and for the early identification of high-risk individuals.
- Chronic kidney disease /
- Systemic inflammation index /
- Cross-sectional study /
- Multivariate logistic regression /
- Restricted cubic splines

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图 1 限制性立方样条模型拟合曲线和风险模型评价

Figure 1. Restricted cubic spline model fitting curve and risk model evaluation

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表 1 参与者临床特征比较

Table 1. Comparison of clinical characteristics of participants

项目	总数(n=9 557)	无CKD组(n=8 645)	CKD组(n=912)	统计量	P值
年龄[M(P₂₅, P₇₅), 岁]	39.00(29.00，49.00)	39.00(29.00，49.00)	46.00(34.00，54.00)	8.242^a	< 0.001
性别[例(%)]				15.126^b	< 0.001
男性	4 691(50.02)	4 305(50.76)	386(41.53)
女性	4 866(49.98)	4 340(49.24)	526(58.47)
种族[例(%)]				20.738^b	< 0.001
墨西哥裔	1 388(10.11)	1 265(10.06)	123(10.72)
非西班牙裔白人	3 462(62.65)	3 186(63.46)	276(53.38)
非西班牙裔黑人	1 946(10.73)	1 670(10.04)	276(18.68)
其他种族	2 761(16.50)	2 524(16.44)	237(17.21)
教育年限[例(%)]				7.606^b	< 0.001
＜9年	1 615(12.11)	1 413(11.68)	202(17.08)
9~11年	2 144(21.98)	1 931(21.84)	213(23.66)
＞11年	5 798(65.90)	5 301(66.48)	497(59.26)
收入支出比[M(P₂₅, P₇₅)]	2.89(1.37，5.00)	2.96(1.42，5.00)	2.24(1.06，4.48)	-4.699^a	< 0.001
BMI[M(P₂₅, P₇₅)]	27.70(23.90, 32.30)	27.60(23.90, 32.00)	29.60(24.70, 35.20)	4.886^a	< 0.001
饮酒[例(%)]	4 028(45.47)	3 659(45.64)	369(43.59)	0.704^b	0.400
吸烟[例(%)]	3 756(41.09)	3 356(40.62)	400(46.53)	5.907^b	0.018
合并症[例(%)]
高血压	3 867(38.81)	3 292(36.99)	575(59.68)	73.430^b	< 0.001
糖尿病	2 480(24.55)	2 122(23.68)	358(34.42)	26.947^b	< 0.001
代谢综合征	1362(13.80)	1157(13.33)	205(19.24)	14.131^b	< 0.001
心血管疾病	55(4.99)	436(4.45)	115(11.25)	68.720^b	< 0.001
实验室指标[M(P₂₅, P₇₅)]
葡萄糖(mg/dL)	2.80(2.50，3.10)	2.80(2.50，3.10)	2.90(2.61，3.20)	7.846^a	< 0.001
总胆固醇(mg/dL)	91.00(84.00，99.00)	90.00(84.00，98.00)	93.00(85.00，110.00)	4.738^a	< 0.001
低密度脂蛋白(mg/dL)	126.00(110.00，144.00)	125.00(110.00，143.00)	131.00(115.00，153.00)	4.980^a	< 0.001
甘油三酯(mg/dL)	7.10(6.80，7.40)	7.10(6.80，7.40)	7.20(6.90，7.50)	2.778^a	0.007
高密度脂蛋白(mg/dL)	189.00(165.00，216.00)	189.00(164.00，216.00)	196.00(167.00，226.00)	3.222^a	0.002
血肌酐(mg/dL)	0.83(0.71，0.97)	0.83(0.71，0.96)	0.84(0.69，1.09)	2.606^a	0.011
肾小球滤过率(mL/min)	99.86(87.43，110.76)	100.20(88.43，111.04)	96.49(61.13，108.92)	-6.888^a	< 0.001
尿酸(mg/dL)	5.20(4.40，6.20)	5.20(4.30，6.10)	5.60(4.40，6.70)	4.280^a	< 0.001
AISI[M(P₂₅, P₇₅)]	237.29(157.50，367.28)	236.05(157.08，363.51)	251.14(170.39，403.65)	2.958^a	0.004
AISI四分位数组[例(%)]				2.863^b	0.043
Q1(<157.50)	2 389(21.97)	2 188(22.26)	201(18.69)
Q2(157.50~237.30)	2 389(25.86)	2 179(25.95)	210(24.80)
Q3(237.30~367.29)	2 389(25.71)	2 175(25.86)	214(24.10)
Q4(＞367.29)	2 390(26.46)	2 103(25.94)	287(32.42)
注：^a为Z值，^b为χ²值。

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表 2 CKD参与者的加权多元logistic回归模型

Table 2. Weighted multiple logistic regression model for CKD participants

特征	模型1		模型2		模型3
特征	OR(95% CI)	P值	OR(95% CI)	P值	OR(95% CI)	P值
AISI	1.198(1.128~1.269)	< 0.001	1.217(1.146~1.291)	< 0.001	1.112(1.040~1.188)	0.002
AISI四分位数
Q2	1.049(0.857~1.284)	0.642	1.156(0.939~1.421)	0.171	1.116(0.898~1.387)	0.321
Q3	1.071(0.876~1.310)	0.504	1.174(0.954~1.445)	0.130	1.079(0.867~1.342)	0.494
Q4	1.486(1.229~1.796)	< 0.001	1.626(1.333~1.984)	< 0.001	1.279(1.032~1.584)	0.024
P for trend		< 0.001		< 0.001		0.039
注：AISI四分位数分组以Q1为参照。模型1未调整协变量；模型2调整了性别、年龄、种族、教育、收入支出比和BMI；模型3调整了性别、年龄、种族、教育、收入支出比、BMI、饮酒、吸烟、高血压、糖尿病、代谢综合征、心血管疾病、葡萄糖、总胆固醇、低密度脂蛋白、甘油三酯、高密度脂蛋白、尿酸、血肌酐、肾小球滤过率。

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表 3 亚组分析情况

Table 3. Subgroup analysis situation

亚组	OR (95% CI)	P值	P for interaction
Overall	1.172(1.091~1.250)	< 0.001
年龄			0.828
< 60岁	1.153(1.032~1.296)	0.013
≥60岁	1.175(1.078~1.286)	0.001
性别			0.009
男性	1.280(1.171~1.403)	< 0.001
女性	1.074(0.962~1.185)	0.223

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