The Relationship Between Pulmonary Emphysema and Kidney Function in Smokers
The Relationship Between Pulmonary Emphysema and Kidney Function in Smokers
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DOI：
10.1378/chest.11-1456
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发表时间：
2012-09-01
期刊：
影响因子：
9.6
通讯作者：
Sciurba, Frank C.
中科院分区：
文献类型：
--
作者：
Chandra, Divay;Stamm, Jason A.;Sciurba, Frank C.
背景：据报道，暴露于烟草并伴有气流阻塞的患者肾功能不全的患病率可能会增加。我们假设肾功能不全与肺气肿有关，而不是与FEV 1测量的气流阻塞有关。方法：508名吸烟者完成了胸部CT扫描、肺功能检查、医学问卷调查和血清肌酐测量。使用慢性肾脏病流行病学协作组的方法估计肾小球滤过率（eGFR）。结果：平均年龄为66 ± 7岁，平均eGFR为101 ± 22 mL/min/1.73 m2。单变量和多变量分析显示，放射学测量的肺气肿与eGFR之间存在显著相关性：肺气肿多10%的参与者的eGFR低4.4 mL/min/1.73 m（2）（P = .01），与气流阻塞（FEV 1）、年龄、性别、种族、身高、BMI、糖尿病、高血压、冠状动脉疾病、患者报告的呼吸困难无关，年吸烟量和当前吸烟量。eGFR和FEV 1或定量CT扫描测量气道dimensions.Conclusions：更严重的肺气肿，而不是气流阻塞，与吸烟者的肾功能不全，肾脏疾病的常见危险因素无关。这一发现增加了最近对肺气肿与COPD合并症（包括骨质疏松症和肺癌）之间相关性的观察，这些合并症与FEV 1降低的传统测量无关。肺气肿患者肾功能障碍的机制和临床意义需要进一步研究。胸部2012; 142（3）：655-662
Background: It has been reported that the prevalence of kidney dysfunction may be increased in patients exposed to tobacco with airflow obstruction. We hypothesized that kidney dysfunction would associate with emphysema rather than with airflow obstruction measured by the FEV1.Methods: Five hundred eight current and former smokers completed a chest CT scan, pulmonary function tests, medical questionnaires, and measurement of serum creatinine. Glomerular filtration rates (eGFRs) were estimated using the method of the Chronic Kidney Disease Epidemiology Collaboration. Quantitative determinants of emphysema and airway dimension were measured from multidetector chest CT scans.Results: The mean age was 66 +/- 7 years, and mean eGFR was 101 +/- 22 mL/min/1.73 m(2). Univariate and multivariate analysis showed a significant association between radiographically measured emphysema and eGFR: Participants with 10% more emphysema had an eGFR that was lower by 4.4 mL/min/1.73 m(2) (P = .01), independent of airflow obstruction (FEV1), age, sex, race, height, BMI, diabetes mellitus, hypertension, coronary artery disease, patient-reported dyspnea, pack-years of smoking, and current smoking. There was no association between eGFR and either FEV1 or quantitative CT scan measures of airway dimension.Conclusions: More severe emphysema, rather than airflow obstruction, is associated with kidney dysfunction in tobacco smokers, independent of common risk factors for kidney disease. This finding adds to recent observations of associations between emphysema and comorbidities of COPD, including osteoporosis and lung cancer, which are independent of the traditional measure of reduced FEV1. The mechanisms and clinical implications of kidney dysfunction in patients with emphysema need further investigation. CHEST 2012; 142(3):655-662