狼疮肾炎患者血尿酸水平变化及临床意义

The change and clinical significance of the serum uric acid levels in patients with lupus nephritis

目的评估狼疮肾炎(lupus nephritis,LN)患者尿酸水平变化,并探讨其与肾脏损伤的关系。方法回顾性分析2015年7月至2017年7月在安徽医科大学第一附属医院经肾脏活检确诊LN的110例病例资料,根据尿酸水平将110例LN患者分为正常尿酸组及高尿酸血症组,收集所有患者年龄、性别、肌酐、尿素氮、尿酸、补体C3、补体C4、免疫球蛋白A、免疫球蛋白M、免疫球蛋白G、抗dsDNA抗体、抗Sm抗体、抗SSA抗体、抗SSB抗体、抗RNP抗体及病理类型等临床病理指标,并对患者活动指数、慢性指数及系统性红斑狼疮疾病活动指数进行评分,比较2组临床特点、实验室指标及肾脏病理之间的差异。结果高尿酸血症组患者肌酐、尿素氮、高血压发生率等临床指标及活动性指数、慢性化指数等肾病理损伤评分均较正常尿酸组升高,估算肾小球滤过率较正常尿酸组降低,差异有统计学意义(P<0.05),但其他因素如年龄、性别、补体C3、补体C4、免疫球蛋白A、免疫球蛋白M、免疫球蛋白G、24h尿蛋白定量、系统性红斑狼疮疾病活动指数评分、抗dsDNA抗体、抗Sm抗体、抗SSA抗体、抗SSB抗体及抗RNP抗体的阳性率在2组之间的差异均无统计学意义(P>0.05)。进一步分析表明LN患者的尿酸水平与肌酐、尿素氮、肾脏病理分型及肾病理损伤评分均呈正相关,而与估算肾小球滤过率呈负相关(P<0.05)。结论 LN患者中合并高尿酸血症者较尿酸正常者的肾脏损伤更为严重,高尿酸血症是反映LN患者预后不良的重要指标。

Objective To observe the serum uric acid levels in patients with lupus nephritis（LN）and explore its relationship with renal damage.Methods A retrospective analysis of the data of110 cases for nephrology renal biopsy and diagnosis of LN patients was made in the First Affiliated Hospital of Medical University of Anhui from January July 2015 to July 2017.The patients were divided into the two groups：LN patients with or without hypemricemia.All patients were collected for clinical pathological indicators,including age,gender,serum creatinine,urea nitrogen,serum uric acid,complement C3,complement C4,immunoglobulin A,immunoglobulin M,immunoglobulin G,24-h urine protein,anti-double-stranded DNA,-Smith,-SSA,-SSB,-RNP antibodies and pathological types,and scored for activity index,chronic index and systemic lupus erythematosus disease activity index.Results The clinical indicators,including the incidence rate of hypertension,level of blood serum creatinine and urea nitrogen,and the renal pathological scores,including acitive index and chronic index,in the LN patients with hyperuricemia group were higher than that in normal uric acid group,and estimate glomerular filtration rate was lower than that in normal uric acid group,the difference was statistically significant（P〈0.05）.However,there was no significant difference between the two groups in the other factors such as age,sex,complement C3,complement C4,immunoglobulin A,immunoglobulin M,immunoglobulin G,24-h urine protein,systemic lupus erythematosus disease activity index score and positive rate of anti-double-stranded DNA,-Smith,-SSA,-SSB,-RNP antibodies（P〈0.05）.Further analysis showed that the level of serum uric acid was positively correlated with serum creatinine,renal pathological classification and renal pathological scores,negatively correlate with estimate glomerular filtration rate（P〈0.05）.Conclusions LN patients with hyperuricemia had more severe renal damage than those in normal uric acid.Hyperuricemia is an important indicator for poor prognosis in patients with LN.