C-反应蛋白甘油三酯葡萄糖指数的累积变化与肾功能快速下降的发生率之间的关联：一项全国性的前瞻性队列研究

摘要(中文译文)

快速肾功能下降（RKFD）是慢性肾脏病的早期指标和肾衰竭的前兆，然而早期检测具有挑战性。炎症和代谢失衡可能导致肾损伤，而C反应蛋白-甘油三酯葡萄糖指数（CTI）同时反映了这两个因素。本研究旨在探讨中老年人CTI累积变化（cuCTI）与RKFD风险的关联。我们分析了来自2011年和2015年中国健康与养老追踪调查（CHARLS）中6，888名45岁及以上个体的数据。采用多因素logistic回归模型，探讨cuCTI、CTI控制水平与RKFD风险之间的关联。我们还使用限制性立方样条（RCS）模型分析剂量-反应模式，并基于性别、教育程度、吸烟、饮酒、高血压、糖尿病、血脂异常和CKD分期进行亚组分析。对原始数据集、插补数据集和合并数据集进行敏感性分析，以确保结果的稳健性。一项使用国家健康与营养调查（NHANES）数据的补充横断面分析，采用加权线性回归和RCS模型检验了CTI与eGFR之间的关联。在四年期间，262名参与者（3.8%）发生RKFD。cuCTI升高和CTI控制不佳与更高的RKFD风险相关，cuCTI每增加一个单位，风险增加18%（OR = 1.18，95% CI：1.13-1.22）。CTI持续偏高或上升者面临最大风险。剂量-反应曲线表明，RKFD风险随cuCTI升高呈线性增加，亚组分析显示各组结果一致。敏感性分析证实了这些关联在不同数据集中的稳定性。使用NHANES数据的补充分析也观察到类似的关联，较高的CTI水平与较低的eGFR相关。较高的累积CTI水平与快速肾功能下降风险增加相关，且该关联在CTI水平持续偏高者中最为显著。监测长期炎症和代谢状态可能有助于识别中老年人中肾功能下降的高风险个体。

Abstract

Rapid kidney function decline (RKFD) is an early indicator of chronic kidney disease and a precursor to kidney failure, yet early detection is challenging. Inflammation and metabolic imbalance may cause kidney damage, and the C-reactive protein-triglyceride glucose index (CTI) represents both factors. This study aims to explore the associations of cumulative changes of CTI (cuCTI) with RKFD risk in middle-aged and older adults. We analyzed data from 6,888 individuals aged 45 and older from the 2011 and 2015 China Health and Retirement Longitudinal Study (CHARLS). Using multivariate logistic regression models, we explored the association between cuCTI, CTI control levels, and RKFD risk. We also used restricted cubic spline (RCS) models for dose-response patterns and conducted subgroup analyses based on sex, education, smoking, alcohol use, hypertension, diabetes, dyslipidemia, and CKD stage. Sensitivity analyses were performed on original, imputed, and pooled datasets to ensure robust results. A supplementary cross-sectional analysis using National Health and Nutrition Examination Survey analysis (NHANES) data examined the association between CTI and eGFR using weighted linear regression and RCS models. Over a four-year period, 262 participants (3.8%) developed RKFD. Increased cuCTI and poor CTI control were linked to a higher RKFD risk, with each one-unit cuCTI increase raising the odds by 18% (OR = 1.18, 95% CI: 1.13-1.22). Those with consistently high or rising CTI faced the greatest risk. The dose-response curve indicated a linear increase in RKFD risk with higher cuCTI, and subgroup analyses showed consistent results across all groups. Sensitivity analyses confirmed the stability of these associations across datasets. Similar associations were observed in the supplementary analysis using NHANES data, with higher CTI levels associated with lower eGFR. Higher cumulative CTI levels were associated with an increased risk of rapid kidney function decline, and the association was most pronounced among individuals with persistently high CTI levels. Monitoring long-term inflammatory and metabolic status may help identify individuals at risk of renal function decline in middle-aged and older adults.

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