慢性肾脏病非透析患者高尿酸血症特点分析

Characteristics of hyperuricemia in non-dialysis patients with chronic kidney disease

目的探索慢性肾脏病(CKD)非透析患者高尿酸血症特点。方法收集2010年1月-2012年11月在南京市第一医院肾内科住院的909例非透析的CKD患者的相关资料,根据性别、年龄及CKD分期进行分组并进行回顾性分析。采用单因素方差分析及卡方检验比较组间尿酸水平或高尿酸血症患病率的差别,同时行Pearson相关性分析比较尿酸水平与相关生化指标间关系。结果 CKD 1期至5期患者的高尿酸血症患病率分别为19. 92%、35. 10%、61. 31%、71. 77%、76. 73%、75. 26%,患病率逐渐升高,CKD 3期以后高尿酸血症患病率超过60%;以不同性别进行分组比较,发现在不同CKD分期中,男性高尿酸血症患病率均高于女性;基于年龄进行分层分析,发现随着患者年龄增加,高尿酸血症患病率逐渐升高,其中80岁以上患者的患病率高达55. 38%。对不同CKD分期患者的尿酸水平进行比较,结果发现,CKD 3a期与3b期患者的尿酸水平无显著差别(P> 0. 05),CKD 3a期患者的尿酸水平显著低于4期及5期(P <0. 01),但CKD 3b期与4期及5期患者的尿酸水平无显著统计学差异(P> 0. 05)。对患者的尿酸水平与其他指标进行相关性分析,发现尿酸与血红蛋白、游离三碘甲状腺原氨酸呈负相关(r=-0. 209,P <0. 01; r=-0. 125,P <0. 01);与胱抑素C、β2微球蛋白、血肌酐、年龄呈正相关(r=0. 508,P <0. 01; r=0. 424,P <0. 01; r=0. 381,P <0. 01; r=0. 233,P <0. 01)。结论 CKD非透析患者高尿酸血症患病率随CKD进展及年龄增长而升高,男性CKD患者的高尿酸血症患病率高于女性,高尿酸血症与肾损伤标志物及游离三碘甲状腺原氨酸密切相关。

Objective To explore characteristics of hyperuricemia in non-dialysis patients with chronic kidney disease（CKD）. Methods A retrospective study was conducted on 909 nondialysis patients in Nanjing First Hospital from January 2010 to November 2012 to compare differences in levels of uric acid or frequency of hyperuricemia among different groups by χ^2-test or variance analysis. In addition,we performed pearson analysis to evaluate correlations between hyperuricemia and biochemical indexes. Results The prevalence of hyperuricemia rose in accordance with elevation of CKD stage with higher than 60 percentage from CKD3 to CKD5. Morbidity of hyperuricemia in male group was higher than that in female group. Prevalence of hyperuricemia was elevated with the increase of age with 55. 38 percentage in patients more than 80-year-old. Morbidity of hyperuricemia in CKD3 a showed no significant difference with CKD3 b,but remarkably lower than that in CKD4 and CKD5. Uric acid had a negative correlation with hemoglobin and free thyroxine（r =-0. 209,P〈0. 01; r =-0. 125,P〈0. 01）,but a positive correlation with cystatin C,β2 MG,serum creatinine and age（r = 0. 508,P〈0. 01; r = 0. 424,P〈0. 01; r = 0. 38,P〈0. 01; r =0. 233,P〈0. 01）. Conclusions Prevalence of hyperuricemia rises in accordance with the reduction of kidney function and elevation of age with higher frequency in male patients. Hyperuricemia was related with kidney injury marker and free thyroxine.