成都市高尿酸血症患者慢性肾脏病流行病学调查研究

Epidemiologic study of chronic kidney disease in hyperuricemia of Chengdu

目的分析成都市高尿酸血症患者中慢性肾脏病（chronickidneydisease，CKD）的患病情况及相关危险因素。方法选择2009年9月至2010年12月在成都铁路分局医院进行健康体检且有完整资料的5326名体检者（分散居住在成都市各区），收集所有体检者的性别、年龄、体质量、吸烟、饮酒、既往病史、血液以及尿液的检测结果等，对资料进行分析、对比。结果5326名体检者中有1321例高尿酸血症患者，其中男1187例（患病率28．76％），女134例（患病率10．93％），平均年龄（44．6±10．2）岁。①高尿酸血症患者白蛋白尿、血尿和eGFR下降的患病率分别为14．00％、1．97％和4．69％。1321例高尿酸血症患者中CKD患病率为18．09％，知晓率2．93％。高尿酸血症患者白蛋白尿、eGFR下降和CKD的患病率均明显高于无高尿酸患者；高尿酸血症合并高血脂和（或）糖尿病和（或）高血压患者白蛋白尿、eGFR下降和CKD的患病率均明显高于单纯高尿酸血症患者。②血尿酸每升高60μmol／L，白蛋白尿、eGFR下降和CKD的患病率均明显增加；血尿酸与尿微量白蛋白／肌酐比值呈正相关，血尿酸与eGFR呈负相关。③高血压、糖尿病和体质量指数是白蛋白尿的独立危险因素；高尿酸血症患者中的女性是血尿的独立危险因素；高尿酸血症患者中的女性、年龄和高血压是eGFR下降的独立危险因素；高尿酸血症患者中的女性、高血压、糖尿病和体质量指数是CKD独立的危险因素。结论成都市高尿酸血症患者中，CKD的患病率较普通患者高，与血尿酸的水平有关。控制血压、血糖、尿酸、血脂和体质量指数，可减少CKD的发生和发展。

Objective To identify the prevalence and related risk factors of chronic kidney dis- ease （CKD） in hyperuricemia of Chengdu. Methods 1 321 eligible samples of railway workers with hyperuricemia from Sep. 2009 to Dec. 2010 taken from ＂Health examination data of 5 326 Chengdu urban groups＂ were selected. These data included questionnaire （anamnesis, smoking and drinking）, somatoscopy （blood pressure, body height and body weight）, blood and urine examination indicators （blood sugar, blood lipid, blood uric acid, blood creatinine, urea nitrogen urin microalbumin/urine creatinine ratio and routine urine examination）. Analysis was based on related diagnostic criteria. There were albuminuria （urin microalbumin/urine creatinine ratio 30 mg/g）, reduced estimated glo- merular filtration rate [eGFR60 mL.min-1. （1.73 m2 ）-1] and hematuria （erythrocytes）3/HP in urinary sediment）. Results （1） Prevalence of albuminuria in the hyperuricemia group was 14. 00 %, prevalence of hematuria was 1.97%, prevalence of reduced eGFR was 4. 69%, prevalence of CKD was 18. 09%, and recognition was 2. 93%. Prevalence of albuminuria, reduced eGFR and CKD in the hy- peruricemia group was obviously higher than in non-hyperuricemia group. Prevalence of albuminuria, eGFR and CKD in the group of hyperuricemia complicated with hyperlipidemia and/or diabetes melli- tus and/or hypertension was obviously higher than simple hyperuricemia group. （2） Prevalence of al-buminuria, reduced eGFR and CKD was obviously increased with 60 mol/L uric acid elevated. Urice- mia had a positively linear correlation with urine mieroalbumin/urin creatinine. Uricemia showed a negatively linear correlation with eGFR. （3） Hypertension, diabetes mellitus and BMI were independ- ent risk factors of albuminuria. Female of hyperuricemia was independent risk factors of hematuria. Female of hyperurieemia, age and hypertension were independent risk factors of GFR reduction. Fe- male of hyperuricemia, hypertension, diabetes mellitus and BMI were independent risk factors of CKD. Conclusions The prevalence of CKD was higher than ordinary people in hyperurieemia group of Chengdu, and is related with the level of uric acid. Control of blood pressure, blood glucose, blood u- ric acid, blood fat and BMI helps reduce the occurrence and development of CKD.