不同分期的慢性肾脏病患者中血尿酸与冠状动脉狭窄程度相关性分析

Relationship between serum level of uric acid and severity of coronary artery stenosis in patients with different-stage of chronic kidney disease

目的评价肾功能损伤不同阶段高尿酸血症[SUA男性〉417μmol／L（7．0mg／m1），女性〉357μmol／L（6．0mg／m1）1与冠状动脉狭窄程度的相关性。方法随机入选北京航天中心医院心脏中心收治的214例经选择性冠状动脉造影检查确诊的冠心病患者，根据eGFR值对慢性肾脏病（CKD）患者进行分组，分析患者的血尿酸值、临床特点、血清肌酐、炎症因子和其他一些代谢相关变量；根据简化的MDRD公式计算估算肾小球滤过率；慢性肾脏疾病定义为eGFR〈60ml／（min·1．73m2）3个月以上，有或无肾脏损伤；根据冠状动脉造影结果计算Gensini评分评价冠状动脉狭窄程度。结果CKD患者占38.3％（82例）。eGFR与冠脉狭窄程度负相关（r=-0．536，P〈0．001）；而CKD患者中血尿酸值与冠状动脉狭窄程度正相关（r=0．26，P=0．001）。CKD的独立危险因素包括：SUA水平（OR=1．22，95％CI1．09～1．37，P〈0．001）、年龄（OR=1．11，95％CI1．10～1．14，P〈0．001）、冠状动脉狭窄程度（OR=0．83，95％C10．79～0．85，P〈0．001）与高血压病史（OR=1．90，95％CI1．40～2．60，P〈0．001）。结论CKD患者中高尿酸血症是促进冠状动脉血管病变加重的重要因素，且在肾脏病的不同阶段均起作用。

Objective High serum uric acid level （SUA） and chronic kidney disease （CKD） are the risk factors that resulted in coronary heart disease （CHD）. It is not clear whether the interaction between SUA and CKD is the risk factor of CHD. This study aimed to assess the correlation between severity of coronary artery stenosis and CKD with different level of SUA [man 〉 417μmol/L （7.0mg/ml）, woman 〉 357μrnol/L （6.0mg/ml）]. Methods A total of 214 randomly selected patients with coronary arteriography-identified CHD who admitted in our center from January 2011 to September 2012 were subjected in this study. The patients with CHD were grouped according to the value of estimated glomerular filtration rate （eGFR）. The patients＇ serum uric acid, clinical features, serum creatinine, inflammatory factors and some metabolism related variables were analyzed, eGFR was calculated with the formula of MDRD. The definition of CKD was defined as whether the patient＇s kidney was impaired or not and GFR 〈 60ml/（min · 1.73m2） for more than 3 months. The severity of coronary artery stenosis was assessed by the result of Gensini scale with coronary angiography. All P values were two-tailed and P 〈 0.05 was deemed statistically significant. Results Among the 214 patients enrolled, 82 cases （38.3%） had CKD. eGFR was negatively correlated with the severity of coronary artery stenosis （r = -0.536, P 〈 0.001）. SUA was positively correlated with the severity of coronary artery stenosis in CKD patients （r = 0.29, P 〈 0.01）. Logistic regression analysis showed that the independent risk factors of CKD were SUA （OR = 1.22, 95% CI 1.09-1.37, P〈0.001）, age （OR= 1.11, 95% CI 1.10-1.14, P〈0.001）, coronary artery stenosis （OR= 0.83, 95% CI 0.79-0.85, P〈 0.001）, and history of hypertension （OR = 1.90, 95% CI 1.40-2.60, P 〈 0.001）. Conclusion Hyperuricemia may be an important factor of aggravating coronary artery stenosis in CKD, and may be involved in every stage of the disease.