【摘要】 目的 探讨美国成人血清超长链饱和脂肪酸（very long chain saturated fatty acids, VLCSFAs）水平与慢性肾脏病（chronic kidney disease, CKD）之间的关系，为CKD防治提供新的视角。方法 利用2011–2014年美国国家健康与营养调查（National Health and Nutrition Examination Survey, NHANES）数据，排除<20岁的个体，缺少血肌酐、尿素氮、尿白蛋白肌酐比（unrine albumin creatine ratio, uACR）及其他共变量数据者。利用CKD-EPI(2009)公式计算估算肾小球滤过率（estimated glomerular filtration rate, eGFR）。通过加权多变量逻辑回归、极致梯度提升树（XGboost）机器学习模型和亚组分析研究VLCSFAs与CKD之间的独立关系。限制性立方样条（restricted cubic spline, RCS）用于检验非线性关联。结果 本研究共分析了4 164名参与者。CKD组与非CKD组在血清VLCSFAs的水平上差异有统计学意义（P<0.05）。在完全调整模型中，加权多变量逻辑回归显示，随着血清VLCSFAs水平的增加，CKD的风险呈现下降趋势，尤其是二十二烷酸、二十三烷酸和木质素酸对CKD风险的降低效果显著[二十二烷酸：比值比（odds ratio, OR）=0.17,95%置信区间（confidence interval,CI）:0.06～0.43,P<0.001；二十三烷酸：OR=0.02,95%CI:0.002～0.15,P<0.001；木质素酸：OR=0.13,95%CI:0.04～0.40,P<0.001]。通过RCS分析，进一步发现了VLCSFAs与CKD之间不存在非线性关联。建立XGboost机器学习模型发现对CKD风险相对重要性最大的是二十三烷酸。亚组分析提示二十二烷酸、二十三烷酸和木质素酸仅对合并高血压的CKD参与者风险有保护作用，而对合并糖尿病、冠心病或脑卒中的CKD参与者风险无影响。结论 美国成人循环VLCSFAs的增加与CKD风险降低相关。需要进一步的大规模前瞻性研究验证该结论。更多还原

【Abstract】 Objective To investigate the relationship between very long chain saturated fatty acids(VLCSFAs)levels in the serum of American adults and chronic kidney disease(CKD), thereby providing new insights for the prevention and treatment of CKD. Methods Using data from the 2011–2014 National Health and Nutrition Examination Survey(NHANES), individuals under 20 years of age and those lacking serum creatinine, blood urea nitrogen, urine albumin-to-creatinine ratio(uACR), or other covariate data were excluded. Estimated glomerular filtration rate(eGFR) was calculated using the CKD-EPI(2009) equation. The independent relationship between VLCSFAs and CKD was examined using weighted multivariate logistic regression, the XGBoost machine learning model,and subgroup analyses. Restricted cubic splines(RCS) were used to test for nonlinear associations. Results A total of 4 164 participants were analyzed. Serum VLCSFAs levels differed significantly between the CKD and non-CKD groups(P <0.05). In fully adjusted models, weighted multivariate logistic regression revealed a decreasing trend in CKD risk with increasing serum VLCSFAs levels, particularly for docosanoic acid, tricosanoic acid, and lignoceric acid, which significantly reduced CKD risk(docosanoic acid: odds ratio [OR] = 0.17, 95% CI: 0.06-0.43, P < 0.001; tricosanoic acid:OR = 0.02, 95% CI: 0.002-0.15, P < 0.001; lignoceric acid: OR = 0.13, 95% CI: 0.04-0.40, P < 0.001). RCS analysis showed no nonlinear association between VLCSFAs and CKD. The XGBoost machine learning model identified triacontanoic acid as the most important factor for CKD risk. Subgroup analysis indicated that docosanoic acid, tricosanoic acid, and lignoceric acid exerted protective effects only in CKD participants with concomitant hypertension, while showing no impact on those with diabetes, coronary heart disease, or stroke. Conclusion Elevated circulating VLCSFAs levels in US adults are associated with reduced CKD risk. Further large-scale prospective studies are needed to validate these findings.更多还原