高尿酸血症在高血压患者肾动脉病变进展中的意义

Significance of hyperuricemia in progression of renal artery disease in patients with hypertension

目的探讨高尿酸血症在高血压患者肾动脉病变进展中的意义。方法回顾性分析2003年12月至2014年3月首都医科大学附属北京安贞医院159例高血压住院患者的临床资料,研究肾动脉病变进展及肾功能不全进展的相关因素。结果入选患者159例,随访时间为50(24,71)个月。随访发现有23例患者出现肾动脉病变进展。经Cox风险比例回归模型分析,肾动脉狭窄(比值比=4.359,95%置信区间:1.436~13.237,P=0.009)和高尿酸血症(比值比=4.369,95%置信区间:1.370~13.935,P=0.013)为肾动脉病变进展的预测因素。10年累积肾动脉病变进展的发生率在不合并高尿酸血症的患者为27.3%,在合并高尿酸血症的患者为71.6%;在不合并肾动脉狭窄的患者为31.2%,而在合并肾动脉狭窄的患者为71.7%。有36例患者出现了肾功能不全进展。经Cox风险比例回归模型分析,高尿酸血症是预测肾功能不全进展的因素(比值比=2.603,95%置信区间1.058~6.404,P=0.037)。肾动脉病变进展与肾功能不全进展相关(r=0.169,P=0.036)。结论高尿酸血症与肾动脉粥样硬化病变的进展相关。肾动脉粥样硬化病变的进展也与肾功能不全的进展相关。

ObjectiveTo investigate the significance of hyperuricemia in progression of renal artery disease in patients with hypertension.MethodsClinical data of 159 hospitalized patients with hypertension in Beijing Anzhen Hospital, Capital Medical University from December 2003 to March 2014 were retrospectively analyzed. Related factors of progression of renal artery disease and renal insufficiency were analyzed. ResultsDuring 50（24, 71） months of follow-up, 23 patients had renal artery disease progression. Cox proportional hazards model analysis showed that renal artery stenosis[odds ratio（OR）=4.359, 95% confidence interval（CI）： 1.436-13.237, P=0.009] and hyperuricemia（OR=4.369, 95%CI： 1.370-13.935, P=0.013） were predictors of renal artery disease progression. The 10-year cumulative incidence of renal artery disease progression was 27.3% in patients without hyperuricemia and 71.6% in patients with hyperuricemia; it was 31.2% in patients without renal artery stenosis and 71.7% in patients with renal artery stenosis. There were 36 patients having renal insufficiency progression. Cox proportional hazards model analysis showed that hyperuricemia was an predictive factor of renal insufficiency progression（OR=2.603, 95%CI： 1.058-6.404, P=0.037）. Renal artery disease progression was significantly associated with renal insufficiency progression（r=0.169, P=0.036）. ConclusionsHyperuricemia is associated with progression of renal artery atherosclerotic disease. Progression of renal artery atherosclerotic disease is associated with progression of renal insufficiency.