时间-平均血尿酸水平与新发慢性肾脏病的关系研究

Association between time-mean serum uric acid levels and chronic kidney disease

目的 研究普通成人血尿酸水平在肾功能损害进展中的作用,探讨时间-平均血尿酸水平升高与慢性肾脏病(CKD)的关系。方法 回顾性分析2011年1月1日至2016年12月31日每年参与全面体检且初始肾功能正常的5 701例普通成人的临床资料。采集所有体检者的基线特征指标,并于随访期间每年测定1次血尿酸水平及估计肾小管滤过率(e GFR),按基线血尿酸和时间-平均血尿酸水平分为4分组,通过二元logistic回归分析和Cox比例风险模型等统计学方法评估不同分组与CKD之间的关系。结果 在6年随访时间里,共有249例体检者进展为CKD。多因素校正的logistic回归分析发现,新发CKD的风险随着时间-平均血尿酸水平升高而增大,与对照的第1组相比,第2~4组的相对危险度(OR)分别为2.709(95%CI:1.836~5.293)、3.754(95%CI:1.898~7.428)、7.462(95%CI:3.694~15.073)。同时,调整潜在混杂因素后的Cox比例风险模型显示,基线血尿酸和时间-平均血尿酸水平的升高均会增大CKD的发生风险,第4个基线血尿酸四分位数的风险比(HRs)为1.689(95%CI:1.058~2.696),第4个时间-平均血尿酸四分位数的HRs为6.320(95%CI:3.285~12.159)。结论 普通成人基线血尿酸及时间-平均血尿酸水平的升高均与肾功能损害及新发CKD具有独立相关性。

Objective To investigate the association between time-mean serum uric acid（SUA） levels and chronic kidney disease（CKD）. Methods Clinical data of 5 701 subjects undergoing annually health check-up between January 2011 and December 2016 were retrospectively analyzed. All participants had an estimated glomerular filtration rate（e GFR） 60 ml/min/1.73 m2 at baseline. The uric acid and e GFR were assessed every year in the follow-up period. The subjects were classified into 4 groups according the sex-specific quartiles of time-mean SUA values. The risk of new development of CKD among different stratified groups was evaluated. Results During 6 years of follow-up, 249（4.4%） participants developed CKD. Multivariate analysis showed that compared to the reference, the odds ratio（OR） for the new cases of CKD increased with higher time-mean SUA levels（OR=2.709, 95%CI：1.836-5.293, OR=3.754, 95%CI：1.898-7.428 and OR=7.462,95%CI：3.694-15.073, for the second, third and fourth quartiles respectively; all P〈0.05）. Multivariate Cox proportional hazard model after adjustment for potential confounders showed that the adjusted HRs of highest quartile vs. lowest quartile for baseline and time-mean uric acid were 1.689（95% CI：1.058-2.696） and 6.320（95% CI：3.285-12.159）, respectively. Conclusion The Increasing of baseline SUA and time-mean SUA value is independently associated with increased likelihood for e GFR decline and incidence CKD in the general population.