青年无症状高尿酸血症患者血清NGAL水平与肾功能损害的关系

Relationship of serum ngal levels with kidney impairment in young patients with asymptomatic hyperuricemia

目的探讨青年无症状高尿酸血症(HUA)患者中性粒细胞明胶酶相关脂质运载蛋白(NGAL)血清水平与其肾功能损害的关系。方法连续性纳入2017年3^(-1)2月青年无症状HUA患者261例(病例组),同期随机选取青年健康对照86例(对照组),采用多元线性回归分析血清NGAL水平与相关生化指标[即血清尿酸(UA)、血清尿素(Urea)、肌酐(Cr)、胱抑素C(CysC)、肾小球滤过率(eGFR)和尿微量清蛋白与肌酐比值(ACR)]水平的关系程度,多项logistic回归分析NGAL异常率与肾功能分期(G1、G2和G3a期)和清蛋白尿分组(Ⅰ、Ⅱ和Ⅲ组)的关系。结果病例组血清NGAL水平(151.0μg/L)高于对照组(100.8μg/L),差异有统计学意义(Z=9.476,P<0.05);病例组肾功能减退(eGFR<60mL·min^(-1)·1.73m-2)和清蛋白尿(ACR≥30mg/gCr)的发生率(6.1%和7.7%),与对照组相比,差异有统计学意义(χ~2=4.221和5.653,P<0.05)。6个相关生化指标中,仅ACR、UA和eGFR与NGAL关系密切(r=0.214、0.179和-0.110,P<0.05),但相互之间关系密切程度的差异均无统计学意义(Z=0.478~1.402,P>0.05)。经多项logistic回归分析,NGAL异常是患者肾功能减退和清蛋白尿的危险因素[优势比(OR)=3.618、4.319,校正OR=2.657、5.814]。结论无症状HUA患者存在一定程度的肾损伤,且与UA水平关系密切。血清NGAL水平异常,可以作为患者肾功能损害的预测因子,控制NGAL升高有利于防止疾病向CKD进展。

Objective To investigate the relationship of serum neutrophil gelatinase associated lipocalin（NGAL）levels with kidney impairment in young patients with asymptomatic hyperuricemia（HUA）.Methods 261 young patients with asymptomatic HUA from March to December in 2017 were continuously included as the case group,and 86 young health controls in the same period were randomly selected as the control group.The degree of relationship between serum NGAL levels and related biochemical indexes,including serum uric acid（UA）,serum urea（Urea）,creatinine（Cr）,Cystatin C（CysC）,glomerular filtration rate（eGFR）and urinary microalbumin creatinine ratio（ACR）levels,were analyzed by multivariate liner regression,and the relationship between NGAL abnormal rate and kidney function stages（G1,G2 and G3 astage）and albuminuria groups（Ⅰ,Ⅱ and Ⅲ group）were analyzed by multivariate logistic regression.Results The serum NGAL levels in the patient group（151.0μg/L）were higher than in the control group（100.8μg/L）,their difference was statistically significant（Z=9.476,P〈0.05）.The incidences of kidney dysfunction（eGFR60 mL·min^（-1）·1.73 m-2）and albuminuria（ACR≥30 mg/gCr）in the patient group（6.1% and 7.7%）,had a statistically significant difference compared with the control group（χ~2=4.221 and 5.653,P〈0.05）.Of these6 related biochemical indexes,only ACR,UA and eGFR were closely related to NGAL（r=0.214,0.179 and-0.110,P〈0.05）,but in the degree of close relationship,the difference had no statistical significance between each other（Z=0.478^（-1）.402,P〈0.05）.After multivariate logistic regression analysis,abnormal NGAL showed to be the risk factor of kidney dysfunction and albuminuria（OR=3.618 and 4.319,adjusted OR=2.657 and 5.814）.Conclusion In asymptomatic HUA patients,there is a certain degree of kidney injury,which is closely related to the UA level.Abnormal serum NGAL level can be served as predictors of kidney dysfunction and albuminuria in patients,and controlling NGAL elevation is beneficial to prevent disease progression to CKD.