高尿酸血症肾损害社区流行病学调查及其危险因素分析

Community-based screening of hyperuricemia and related risk factors of CKD in Chinese

目的通过社区人群筛查了解国内现阶段城市原住居民中高尿酸血症及其相关肾损害患病现状,并探讨相关危险因素在国内社区人群发生高尿酸血症肾损害中的意义。方法选择桂林市城区原住居民集中的象山社区,对年龄在18～75岁之间居民4075人进行横断面筛查。结果社区人群高尿酸血症总患病率为19.1%,其中男性高尿酸血症患病率(22.9%)显著高于女性(15.9%),P<0.001。高尿酸血症人群中慢性肾脏病(CKD)患病率(30.5%)显著高于尿酸正常人群(19.0%),P<0.001。男性高尿酸血症人群CKD患病率(34.3%)显著高于同性别正常血尿酸人群(21.2%),P<0.001,发病风险为正常尿酸人群的1.516倍;也显著高于女性高尿酸血症人群(25.9%),P<0.001,CKD发病风险为女性高尿酸血症人群的1.496倍。高尿酸血症合并CKD人群中38.4%仅为微量白蛋白尿,34.6%为微量白蛋白尿+GFR下降,27.0%为单纯GFR下降。结论高尿酸血症是CKD重要危险因素,高尿酸血症患病率显著增加是CKD患病率增高的重要原因,且轻度增高的血尿酸即增加CKD患病率。男性比女性更易受尿酸损害而发生CKD。微量白蛋白尿是单纯高尿酸血症发生肾损害的早期诊断标志和干预靶点。

Objective By means of community-based screening,to detect the changed prevalence of hyperuricemia and study hyperuricemia-related risk factors of CKD in Chinese,meanwhile to investigate the pathogenesis of hyperuricemia-associated renal damage in the urban residents. Methods 18-75 years old population（n=4 075）in the original residents of Guilin,Xiangshan community were screened by means of cross-sectional study. Blood pressure was measured at 8-9 AM. Urine samples were collected at 9-10 AM. Urine albumin and creatinine were determined and ACR was calculated. Fasting venous blood was collected to evaluate blood uric acid,serum creatinine,and eGFR was calculated. CKD was diagnosed according to KDIGO. Results The prevalence of hyperuricemia in the community population was 19.1% in all residents, and was significant higher in male residents （22.9%）than in female （15.9%）,P〈0.001. The incidence of CKD was 30.5% and 19.0% respectively in populations with and without byperuricemia, P〈0.001. The incidence of CKD in male residents with hyperuricemia was significant higher than the males without hyperuricemia and females with hyperuricemia ,P〈0.001. In the 38.4% of residents with hyperuricemia and renal damage, CKD appeared with only micro-albuminuria;in the 34.6% of residents with CKD appeared with micro-albuminuria and descended GFR;in remained 27.0% of residents with CKD appeared with only descended GFR. Conclusions It is shown that the incidence of hyperuricemia has markedly increased in Chinese urban residents. It has become a very important risk factor of CKD in China and responsible for the increasing of CKD prevalence. Slightly elevated blood uric acid also increase the incidence of CKD. Hyperuricemia seems to result in more CKD in male residents than in females. It is suggested in the study that micro-albuminuria may be an early marker and intervention target of hyperuricemia-associated CKD.