血清尿酸和踝臂指数联合检测对慢性肾病的筛检作用

Combined measurement of serum uric acid and ankle brachial index for screening of chronic kidney disease

目的了解血清尿酸（serum uric acid,SUA）和踝臂指数（ankle brachial index,ABI）单独与慢性肾病（chronic kidney disease,CKD）的关系。方法本研究选取北京和上海8所大学附属医院年龄≥35岁具有动脉硬化高危因素的内科住院患者3 732例,将其中具有完整基线资料的3 557例作为研究对象。以logistic回归分析评估SUA和ABI与CKD的关系;以ROC曲线探讨二者联合检测对CKD筛检的应用价值。结果 logistic回归分析调整性别、年龄和其他变量后,SUA四分位分组,以Q1为参照,Q2、Q3、Q4的调整OR值及95%CI分别为2.274（95%CI,1.696～3.049）,3.770（95%CI,2.833～5.015）和8.532（95%CI,6.435～11.312）。以正常对照组为参照,PAD临界组、轻度至中度PAD组、重度PAD组的调整OR值及95%CI分别为1.499（95%CI,0.932～2.411）,1.996（95%CI,1.206～3.306）和2.636（95%CI,1.641～4.236）。在全人群、男性和女性中SUA和ABI联合筛检CKD,ROC曲线下AUC分别为0.731、0.734和0.755,相对应的SUA单独筛检ROC曲线下AUC分别为0.702、0.698和0.741。结论 SUA水平升高是CKD的独立危险因素,ABI越低发生CKD的可能性越大。在高危人群中,SUA和ABI联合检测对CKD具有重要的筛检价值。

Objective To evaluate the combined measurement of serum uric acid （SUA） and ankle brachial index （ABI） for screening of chronic kidney disease （CKD）. Methods A total of 3 732 inpatients aged over 35 years and at high risk of atherosclerosis were enrolled from eight university- affiliated hospitals in Beijing and Shanghai. Complete baseline data were obtained from 3 557 of them. Logistic regression analysis was applied to assess the association of SUA and ABI with CKD and ROC curves were performed to evaluate the combined measurement of SUA and ABI for screening of CKD, compared to using SUA alone. Results After multivariable adjustment for age, gender, and other confounders, patients with the second, third and fourth quartile of SUA value had the ORs of 2. 274（95% CI, 1.696-3.049）, 3.770 （95% CI, 2.833 -5.015） and 8. 532（95% CI, 6.435 -11.312） respectively, when the lowest quartile used as reference. Compared to the individuals with an ABI I〉 1.00, the ORs for patients with ABI： 0.91 -0.99, 0.41 -0.90, ~〈0.40 were 1. 499 （95% CI, 0.932-2. 411）, 1. 996（95% CI, 1. 206 -3. 306） and 2. 636（95% CI, 1. 641 -4. 236） after multivariable adjustment. AUCs of ROC curves for combined SUA and ABI to screen for CKD were 0.731, 0. 734, and 0.755 in all population, males and females, respectively ; while the corresponding AUCs for SUA alone were 0. 702, 0.698 and 0. 741, respectively. Conclusion A high SUA level is independently associated with a high risk of CKD. There is an inverse association between ABI and CKD. The combined measurement of SUA and ABI can be more effective for screening of CKD among the people at high risk.