不健康生活方式及吸烟与原发性膜性肾病的关系

doi:10.3969/j.issn.1004-583X.2025.06.006

摘要/Abstract

摘要：

目的本研究旨在探讨不健康生活方式和吸烟对原发性膜性肾病(primary membranous nephropathy,PMN)的影响。方法回顾性分析2016年10月-2023年3月在青岛大学附属医院首次诊断为PMN患者227例(PMN组)和微小病变肾病(minimal change nephropathy,MCD)患者58例(MCD组),所有患者均符合PMN或MCD的病理诊断标准。收集临床资料和问卷数据。另外,纳入其他5家医院2023年1-3月的问卷调查数据(PMN患者77例,MCD患者20例),组成多中心队列(PMN患者共304例,MCD患者共78例)。结果单中心和多中心两组男性、年龄、高血压史、收缩压、舒张压、高盐饮食、高脂饮食、频繁外出就餐(餐馆或外卖)、饮酒史和吸烟史差异均有统计学意义(P<0.05)。在多中心中,两组吸烟累积时间、每日吸烟量和吸烟指数占比差异均有统计学意义(P<0.05),PMN组糖尿病病史、进食夜宵和丰盛晚餐占比均较高(P<0.05)。虽然PMN组胆固醇各项指标皆低于MCD组,但血清氧化低密度脂蛋白和丙二醛水平更高,过氧化氢酶水平更低(P<0.05)。结论不健康的生活方式和吸烟可能参与PMN的发生,并可能产生较高的氧化应激状态。

关键词: 肾小球肾炎, 膜性, 肾病, 脂性, 饮食偏好, 吸烟, 氧化应激

Abstract:

Objective To investigate the effects of unhealthy lifestyle and smoking on primary membranous nephropathy (PMN). Methods A total of 227 PMN patients (PMN group) and 58 minimal change nephropathy (MCD) patients (MCD group) who were first diagnosed in the Affiliated Hospital of Qingdao University from October 2016 to March 2023 were retrospectively analyzed. All patients met the pathological diagnostic criteria of PMN or MCD. Clinical data and questionnaire data were collected. In addition, the questionnaire survey data of five other hospitals from January to March 2023 (77 PMN patients and 20 MCD patients) were included to form a multi-center cohort (304 PMN patients and 78 MCD patients).Results There were significant differences in male gender, age, history of hypertension, systolic blood pressure, diastolic blood pressure, high-salt diet, high-fat diet, frequent eating out (restaurant or takeaway), drinking history and smoking history between the two groups in the single-center and multi-center cohorts (P<0.05). In the multi-center cohort, there were significant differences in the cumulative time of smoking, daily smoking volume and smoking index between the two groups (P<0.05), and the proportion of diabetes history, eating midnight snack and full dinner in PMN group was significantly higher (P<0.05). Although the indexes of cholesterol in PMN group were lower than those in MCD group, the levels of serum oxidized low density lipoprotein and malondialdehyde were higher, and the level of catalase was lower (P<0.05).Conclusion Unhealthy lifestyle and smoking may be involved in the occurrence of PMN and may produce a higher oxidative stress state.

Key words: glomerulonephritis, membranous, nephrosis, lipoid, dietary preference, smoking, oxidative stress

中图分类号:

R692.31

宋晨璐, 亓晓菁, 陈怿鹏, 邢广群. 不健康生活方式及吸烟与原发性膜性肾病的关系[J]. 临床荟萃, 2025, 40(6): 513-518.

Song Chenlu, Qi Xiaojing, Chen Yipeng, Xing Guangqun. Association of poor living habits and smoking with primary membranous nephropathy[J]. Clinical Focus, 2025, 40(6): 513-518.

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链接本文: https://lchc.magtechjournal.com/CN/10.3969/j.issn.1004-583X.2025.06.006

https://lchc.magtechjournal.com/CN/Y2025/V40/I6/513

图/表 6

参考文献 35

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项目	PMN组(n=227)	MCD组(n=58)	t/Z/χ²值	P值
男性[例(%)]	164(72.2)	30(51.7)	9.262	0.002
年龄(年)	49.4±13.1	44.7±18.9	2.200	0.029
24 h尿蛋白(g/24 h)	5.0±3.6	8.2±10.9	-3.638	<0.001
血白蛋白(g/L)	33.5±13.1	27.7±11.9	2.971	0.003
血前白蛋白(mg/L)	280.4±76.0	227.4±71.8	3.998	<0.001
血肌酐(μmol/L)	77.0±23.6	79.6±30.5	-0.686	0.493
血尿素氮(mmol/L)	5.9±2.5	6.2±1.2	-0.196	0.846
血尿酸(μmol/L)	385.0±105.3	382.3±118.5	0.159	0.874
补体C3(g/L)	1.1±0.2	1.3±0.2	-4.280	<0.001
丙氨酸氨基转移酶(U/L)	24.4±16.6	34.9±45.4	-2.815	0.005
天冬氨酸氨基转移酶(U/L)	20.6±11.3	27.7±23.3	-3.197	0.002
红细胞沉降率(mm/h)	27.4±25.0	42.2±25.9	-3.578	<0.001
D-二聚体(g/L)	330(200, 565)	430(310, 565)	-0.317	0.752
血小板(×10⁹/L)	245.5±67.3	248.7±58.6	-0.312	0.755
血红蛋白(g/L)	138.6±17	132.6±21.3	0.774	0.440

项目	PMN组(n=227)	MCD组(n=58)	t/Z/χ²值	P值
男性[例(%)]	164(72.2)	30(51.7)	9.262	0.002
年龄(年)	49.4±13.1	44.7±18.9	2.200	0.029
24 h尿蛋白(g/24 h)	5.0±3.6	8.2±10.9	-3.638	<0.001
血白蛋白(g/L)	33.5±13.1	27.7±11.9	2.971	0.003
血前白蛋白(mg/L)	280.4±76.0	227.4±71.8	3.998	<0.001
血肌酐(μmol/L)	77.0±23.6	79.6±30.5	-0.686	0.493
血尿素氮(mmol/L)	5.9±2.5	6.2±1.2	-0.196	0.846
血尿酸(μmol/L)	385.0±105.3	382.3±118.5	0.159	0.874
补体C3(g/L)	1.1±0.2	1.3±0.2	-4.280	<0.001
丙氨酸氨基转移酶(U/L)	24.4±16.6	34.9±45.4	-2.815	0.005
天冬氨酸氨基转移酶(U/L)	20.6±11.3	27.7±23.3	-3.197	0.002
红细胞沉降率(mm/h)	27.4±25.0	42.2±25.9	-3.578	<0.001
D-二聚体(g/L)	330(200, 565)	430(310, 565)	-0.317	0.752
血小板(×10⁹/L)	245.5±67.3	248.7±58.6	-0.312	0.755
血红蛋白(g/L)	138.6±17	132.6±21.3	0.774	0.440

项目	单中心				多中心
项目	PMN组 (n=227)	MCD组 (n=58)	t/χ²值	P值	PMN组 (n=304)	MCD组 (n=78)	t/χ²值	P值
男性[例(%)]	165(72.7)	30(51.7)	9.396	0.002	220(72.1)	40(51.3)	12.385	<0.001
年龄(年)	49.4±13.1	44.7±18.9	2.184	0.030	48.0±13.7	42.8±18.4	2.758	0.006
体质量指数(kg/m²)	25.9±3.6	25.4±4.6	0.847	0.398	25.1±3.9	25.2±4.4	-0.030	0.976
高血压史[例(%)]	125(55.3)	18(31.0)	10.880	0.001	169(55.6)	23(29.5)	16.921	<0.001
收缩压(mmHg)	137.1±17.7	130.1±20.3	2.589	0.010	136.5±17.4	129.5±19.6	3.054	0.002
舒张压(mmHg)	81.1±12.1	76.3±11.3	2.726	0.007	82.7±12.9	78.2±11.9	2.777	0.006
高盐饮食[例(%)]	86(58.5)	17(29.3)	14.178	<0.001	152(67.9)	33(42.3)	15.913	<0.001
糖尿病史[例(%)]	31(13.7)	3(5.2)	3.165	0.075	58(19.0)	5(6.4)	7.182	0.007
高糖饮食[例(%)]	77(36.8)	19(32.8)	0.329	0.566	111(38.7)	28(38.4)	0.003	0.960
高脂血症[例(%)]	202(89.0)	57(98.3)	4.808	0.028	268(88.2)	73(93.6)	1.912	0.167
高甘油三酯血症[例(%)]	78(55.7)	27(52.9)	0.116	0.733	142(65.4)	40(56.3)	1.905	0.168
高胆固醇血症[例(%)]	108(77.7)	51(100.0)	13.592	<0.001	167(77.3)	62(87.3)	3.320	0.068
高脂饮食[例(%)]	101(50.5)	16(27.6)	9.525	0.002	148(54.0)	23(29.9)	14.025	<0.001
餐馆或外卖[例(%)]	54(33.1)	11(19.0)	4.133	0.042	94(40.7)	18(24.7)	6.130	0.013
常进食夜宵[例(%)]	8(12.3)	4(6.9)	1.019	0.313	39(29.3)	10(13.7)	6.347	0.012
规律用餐[例(%)]	155(73.5)	48(82.8)	2.125	0.145	220(76.7)	64(82.1)	1.034	0.309
丰盛晚餐[例(%)]	30(46.2)	18(31.0)	2.944	0.086	85(61.2)	21(26.9)	23.426	<0.001
精神压力[例(%)]	78(37.5)	16(28.6)	1.534	0.216	121(42.5)	30(39.5)	0.219	0.640
经常熬夜[例(%)]	2(18.2)	-	-	-	45(51.7)	10(50.0)	0.019	0.889
夜班多[例(%)]	2(16.7)	-	-	-	35(43.8)	5(29.4)	1.190	0.275

项目	单中心				多中心
项目	PMN组 (n=227)	MCD组 (n=58)	t/χ²值	P值	PMN组 (n=304)	MCD组 (n=78)	t/χ²值	P值
男性[例(%)]	165(72.7)	30(51.7)	9.396	0.002	220(72.1)	40(51.3)	12.385	<0.001
年龄(年)	49.4±13.1	44.7±18.9	2.184	0.030	48.0±13.7	42.8±18.4	2.758	0.006
体质量指数(kg/m²)	25.9±3.6	25.4±4.6	0.847	0.398	25.1±3.9	25.2±4.4	-0.030	0.976
高血压史[例(%)]	125(55.3)	18(31.0)	10.880	0.001	169(55.6)	23(29.5)	16.921	<0.001
收缩压(mmHg)	137.1±17.7	130.1±20.3	2.589	0.010	136.5±17.4	129.5±19.6	3.054	0.002
舒张压(mmHg)	81.1±12.1	76.3±11.3	2.726	0.007	82.7±12.9	78.2±11.9	2.777	0.006
高盐饮食[例(%)]	86(58.5)	17(29.3)	14.178	<0.001	152(67.9)	33(42.3)	15.913	<0.001
糖尿病史[例(%)]	31(13.7)	3(5.2)	3.165	0.075	58(19.0)	5(6.4)	7.182	0.007
高糖饮食[例(%)]	77(36.8)	19(32.8)	0.329	0.566	111(38.7)	28(38.4)	0.003	0.960
高脂血症[例(%)]	202(89.0)	57(98.3)	4.808	0.028	268(88.2)	73(93.6)	1.912	0.167
高甘油三酯血症[例(%)]	78(55.7)	27(52.9)	0.116	0.733	142(65.4)	40(56.3)	1.905	0.168
高胆固醇血症[例(%)]	108(77.7)	51(100.0)	13.592	<0.001	167(77.3)	62(87.3)	3.320	0.068
高脂饮食[例(%)]	101(50.5)	16(27.6)	9.525	0.002	148(54.0)	23(29.9)	14.025	<0.001
餐馆或外卖[例(%)]	54(33.1)	11(19.0)	4.133	0.042	94(40.7)	18(24.7)	6.130	0.013
常进食夜宵[例(%)]	8(12.3)	4(6.9)	1.019	0.313	39(29.3)	10(13.7)	6.347	0.012
规律用餐[例(%)]	155(73.5)	48(82.8)	2.125	0.145	220(76.7)	64(82.1)	1.034	0.309
丰盛晚餐[例(%)]	30(46.2)	18(31.0)	2.944	0.086	85(61.2)	21(26.9)	23.426	<0.001
精神压力[例(%)]	78(37.5)	16(28.6)	1.534	0.216	121(42.5)	30(39.5)	0.219	0.640
经常熬夜[例(%)]	2(18.2)	-	-	-	45(51.7)	10(50.0)	0.019	0.889
夜班多[例(%)]	2(16.7)	-	-	-	35(43.8)	5(29.4)	1.190	0.275

项目	单中心				多中心
项目	PMN组 (n=227)	MCD组 (n=58)	t/χ²值	P值	PMN组 (n=304)	MCD组 (n=78)	t/χ²值	P值
饮酒史[例(%)]	99(43.6)	9(15.5)	15.494	<0.001	134(44.2)	14(17.9)	18.028	<0.001
饮酒累积时间(年)	23.7±11.6	25.6±15	-0.435	0.665	21.4±13.2	22.1±13.5	-0.163	0.870
每日消耗酒精(g)	150(100, 250)	200(100, 375)	-0.295	0.769	100(100, 250)	100(75, 325)	-0.432	0.667
饮酒指数	4500(2000, 7500)	4500(2000, 9375)	-0.201	0.841	3000(1500, 7125)	4000(1500, 7600)	-0.453	0.652
吸烟史[例(%)]	105(46.3)	18(31.0)	4.363	0.037	140(45.9)	20(25.6)	10.483	0.001
吸烟累积时间(年)	25.0±13.0	21.6±13.5	0.942	0.348	22.3±14.2	21.4±12.7	0.246	0.806
偶尔[例(%)]	122(57.8)	40(71.4)			165(57.3)	58(76.4)
1~15年[例(%)]	21(10.0)	5(8.9)	3.767	0.152	40(13.9)	5(6.6)	9.280	0.010
>15年[例(%)]	68(30.0)	11(19.6)			83(28.8)	13(17.1)
每日吸烟量(支)	21.1±12.7	21.8±11.7	-0.222	0.825	19.4±12.4	20.9±11.6	-0.513	0.609
偶尔[例(%)]	122(56.5)	40(69.0)			165(57.3)	58(74.4)
1~20支/d[例(%)]	32(14.8)	5(8.6)	3.165	0.205	48(16.7)	6(7.7)	7.938	0.019
>20支/d[例(%)]	62(28.7)	13(22.4)			75(26.0)	14(17.9)
吸烟指数	450(200, 800)	500(110, 800)	0.415	0.679	400(103.8, 800)	400(95, 800)	0.100	0.921
偶尔[例(%)]	122(58.9)	40(71.4)			165(59.1)	58(76.3)
1~400[例(%)]	34(16.4)	7(12.5)	2.970	0.227	52(18.6)	8(10.5)	7.550	0.023
>400[例(%)]	51(24.6)	9(16.1)			62(22.2)	10(13.2)