血尿酸升高是导致肾功能下降的独立危险因素

Elevated serum uric acid is an independent risk factor for the loss of renal function

目的通过回顾性队列研究,探讨血尿酸水平变化与肾功能的关系。方法通过佛山市第一人民医院的体检系统,提取佛山市一事业单位在2015年至2018年间的体检数据,获取受检者的性别、年龄、血常规、肝功能、血肌酐、尿酸、空腹血糖,观察估算肾小球滤过率(estimated glomerular filtration rate,eGFR)变化(ΔeGFR=eGFR2018-eGFR2015)情况。结果共2505位受检者完成了4年的随访,根据eGFR是否下降将受检者分为ΔeGFR≥0组和ΔeGFR<0组,其中ΔeGFR≥0组共845人,ΔeGFR<0组共1660人,比较发现在ΔeGFR≥0组其基础的尿酸值更高[(349.48±87.62)μmol/L比(325.72±82.58)μmol/L,t=6.669,P<0.001],其尿酸下降的幅度更大[-15.00(-53.50,17.00)μmol/L比15.50(-18.00,49.00)μmol/L,Z=-13.470,P<0.001]。再根据2015年与2018年尿酸水平将受检者分为4组:均为正常组(N-N)、正常变为高尿酸组(N-H)、高尿酸降为正常组(H-N),持续为高尿酸组(H-H),其中N-N组1551例,N-H组299例,H-N组238例,H-H组417例,4组ΔeGFR分别为-1.58(-4.17,1.01)、-3.60(-7.24,-0.98)、-0.20(-3.14,3.27)、-0.96(-4.07,1.93)ml·min^-1·(1.73m^2)-1,N-H组eGFR下降显著高于其余3组(χ^2=103.130,P<0.001)。多因素Logistic回归分析发现,尿酸升高是eGFR下降的独立危险因素(OR=1.739,95%CI1.587~1.906,P<0.001),而间接胆红素(OR=0.968,95%CI0.943~0.993,P=0.013)、血红细胞(OR=0.815,95%CI0.680~0.976,P=0.026)升高是eGFR下降的独立保护因素。结论尿酸升高是肾功能下降的独立危险因素,而良好地控制高血尿酸有助于保护肾功能。

Objective To investigate the relationship between serum uric acid level and renal function decline by retrospective cohort study. Methods Through the physical examination system of the First People's Hospital of Foshan, the physical examination data from 2015 to 2018 of a public institution in Foshan city were obtained. The gender, age, blood cell analysis, liver function, serum creatinine, uric acid, fasting blood glucose were obtained. The change of eGFR (ΔeGFR=eGFR2018-eGFR2015) was analyzed. Results A total of 2505 subjects were followed up for four years. The subjects were divided into ΔeGFR ≥0 group and ΔeGFR<0 group. There were 845 subjects in ΔeGFR ≥0 group, and 1660 subjects in ΔeGFR<0 group. Compared with that in ΔeGFR<0 group, the base-level of uric acid in ΔeGFR ≥ 0 group was higher [(349.48±87.62) μmol/L vs (325.72±82.58) μmol/L, t=6.669, P<0.001], but the rate of uric acid decline was greater [-15.00(-53.50, 17.00) μmol/L vs 15.50(-18.00, 49.00) μmol/L, Z=-13.470, P<0.001]. According to the levels of uric acid in 2015 and 2018, then the subjects were divided into four groups, normal to normal group (N-N, 1551 cases), normal change into high uric acid group (N-H, 299 cases), high uric acid drop to normal group (H-N, 238 cases), and high to high uric acid group (H-H, 417 cases). The ΔeGFR was -1.58(-4.17, 1.01) ml·min^-1·(1.73 m^2)-1 in N-N group, and -3.60(-7.24, -0.98) ml·min^-1·(1.73 m^2)-1 in N-H group, -0.20(-3.14, 3.27) ml·min^-1·(1.73 m^2)-1 in H-N group, -0.96(-4.07, 1.93) ml·min^-1·(1.73 m^2)-1 in H-H group, respectively. The ΔeGFR decreased most significantly in N-H group than the other three groups (χ^2=103.130, P<0.001). Multivariate logistic regression analysis showed that elevated uric acid was an independent risk factor for eGFR decline (OR=1.739, 95% CI 1.587-1.906, P<0.001), while elevated indirect bilirubin (OR=0.968, 95% CI 0.943-0.993, P=0.013), elevated red blood cells (OR=0.815, 95% CI 0.680-0.976, P=0.026) were independent protective factors for eGFR decline. Conclusion Elevated uric acid is an independent risk factor for the decline of renal function. Good control of hyperuricemia is beneficial to the protection of renal function.