Abstract: Objective　To analyze the risk factors for progression of renal function in people receiving physical examination，so as to provide a basis for delaying the decline in renal function and improve quality of life.Methods　People who had more than four consecutive physical examinations in Xuzhou Central Hospital from 2005 to 2012 were enrolled in this study.Thirty-seven patients （154 times） with progression of renal function who had decreased eGFR were selected as the case group，and 111 people （447 times） in the same gender，similar age and without eGFR decline as the control group.Gender，age，systolic blood pressure （SBP），diastolic blood pressure （DBP），pulse pressure （PP），serum creatinine （Scr），urea nitrogen，fasting blood glucose （FPG），triacylglycerol （TG），total cholesterol （TC），high density lipoprotein cholesterol （HDL-C），low density lipoprotein cholesterol （LDL-C），plasma viscosity （PV），body mass index （BMI） and other indicators were compared between the two group.Risk factors for progression of renal function were analyzed by multivariate Logistic regression analysis.The proportion of renal function decline in different blood pressure grades was compared by chi-square test.Results　 There were no statistical differences in age，gender，baseline eGFR，Scr，and urea nitrogen between the two groups （P>0.05）.The 8-year average eGFR was significantly lower than control group，the 8-year average Scr and urea nitrogen in the case group was significantly higher than those in the control group（P<0.05）.There were no statistical differences between the two groups regarding PP，FPG，TG，TC，LDL-C and PV （P>0.05）.The SBP，DBP and BMI in the case group were significantly higher than those in the control group （P<0.05）.The HDL-C in the case group was significantly lower than in the control group（P<0.05）.DBP was an independent factor of decreased eGFR in three models of multivariate analysis，〔model 1：OR=1.027，95%CI（1.011，1.044），P<0.05；model 2：OR=1.028，95%CI（1.004，1.053），P<0.05；model 3：OR=1.027，95%CI（1.003，1.052），P<0.05〕，and other factors were not statistically significant in the multiple factors analysis.As the level of hypertension elevated，the proportion of decline in renal function increased（χ2 Linear-by-Linear Association =10.312，P=0.001）.Conclusion　 In this study，we find the DBP is an independent risk factor for progression of renal function.Healthy people should maintain good living habits and DBP to delay renal progression.

Key words: Progression of renal function, Case-control study, Root cause analysis

摘要： 目的　分析健康体检者肾功能进展的危险因素，为延缓肾功能下降，提高人群生命质量提供依据。方法　选取2005—2012年徐州市中心医院体检超过4次者，估算肾小球滤过率（eGFR）有下降趋势且符合肾功能进展者37人154人次为病例组，与其性别相同、年龄相近未见肾功能下降趋势者111人447人次为对照组。比较两组性别、年龄、收缩压（SBP）、舒张压（DBP）、脉压（PP）、血肌酐（Scr）、尿素氮、空腹血糖（FPG）、三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、血浆黏度（PV）、体质指数（BMI）等指标。肾功能进展危险因素采用逐步Logistic回归分析。不同血压分级肾功能进展者所占比例比较采用趋势χ2检验。结果　两组年龄、性别、入组时eGFR、Scr、尿素氮水平比较，差异无统计学意义（P>0.05）；病例组8年平均eGFR低于对照组，8年平均Scr、尿素氮水平高于对照组，差异有统计学意义（P<0.05）。两组PP、FPG、TG、TC、LDL-C、PV水平比较，差异无统计学意义（P>0.05）；病例组SBP、DBP、BMI水平高于对照组，差异有统计学意义（P<0.05）。逐步Logistic回归3种模型中DBP始终为危险因素〔模型1：OR=1.027，95%CI（1.011，1.044），P<0.05；模型2：OR=1.028，95%CI（1.004，1.053），P<0.05；模型3：OR=1.027，95%CI（1.003，1.052），P<0.05〕。随高血压分级升高，肾功能进展者所占比例升高（χ2趋势=10.312，P=0.001）。结论　DBP是肾功能进展的独立危险因素，健康人群应保持良好的生活行为习惯，控制DBP，以延缓肾功能下降。

关键词: 肾功能进展, 病例对照研究, 影响因素分析