原发性高尿酸血症的不同分型与临床特征的相关性分析

目的 探讨不同分型的原发性高尿酸血症(HUA)患者的临床特征.方法 纳入原发性HUA患者251例,根据尿酸排泄分数(FEUA)将HUA分为排泄障碍型(FEUA<7%)、混合型(7%≤FEUA≤12%)和生成过多型(FEUA>12%)3组,对3组进行回顾性观察性研究.采用多元二分类logistic回归及多元线性回归校正混杂因素以评价不同分型HUA的临床特点差异.结果多元二分类logistic回归分析显示,与排泄障碍组比较,混合组和生成过多组伴发血脂异常的风险比分别为0.42(95%CI:0.19~0.93,P=0.03),0.30(95%CI:0.12~0.78,P=0.01);生成过多组伴发脂肪肝的风险比为0.24(95%CI:0.09~0.64,P=0.01);与排泄障碍组比较,混合组和生成过多组出现近端肾小管损伤的风险比分别为3.00(95%CI:1.31~6.68,P=0.01)、7.78(95%CI:2.31~26.22,P=0.001).多元线性回归分析显示,混合组和生成过多组的eGFR分别较排泄障碍组低12.79ml/(min·1.73m^2)(95%CI:-21.23^-4.34,P=0.003)、11.70ml/(min·1.73m^2)(95% CI:-21.43 ^-1.96,P=0.02).结论 不同分型HUA有着不同的临床特征,排泄障碍型更多合并血脂异常,生成过多型较少合并脂肪肝,混合型及生成过多型近端肾小管损伤、肾功能受损风险较排泄障碍型更高.

Objective To explore the clinical characteristics of HUA in different subtypes.Methods A total of 251 patients with HUA were enrolled and divided into three groups according to the FEUA.HUA was clinically classified into the urate underexcretion subtype(FEUA<7%),the combined subtype(7%≤FEUA≤12%)and the overproduction subtype(FEUA>12%).Linear and logistic regression analyses were performed to evaluate the clinical difference among the subtypes after multivariable adjustments.Results Compared to the underexcretion subtype,the combined subtype and the overproduction subtype resulted lower risks of dyslipidemia at 0.42(95%CI:0.19~0.93,P=0.03),0.30(95%CI:0.12—0.78,P=0.01)respectively,and the overproduction subtype resulted a lower risk of fatty liver at 0.24(95%CI:0.09~0.64,P=0.01).Compared to the underexcretion subtype,the combined subtype and the overproduction subtype resulted higher risks of proximal tubular damage at 3.00(95%CI:1.31?6.68,P=0.01),7.78(95%CI:2.31?26.22,P=O-OOl)respectively.The decrease in eGFR was 12.79ml min^- 1 1.73m^-2(95%CI:—21.23—4.34,P=0.003)in the combined subtype and 11.70ml min ^-1 1.73m^-2(95%CI:—21.43?—1.96,P=0.02)in the overproduction subtype after adjustment.Conclusion Different subtypes have different characteristics.The urate underexcretion subtype is more commonly associated with dyslipidemia.The overproduction subtype is less commonly associated with fatty liver.The combined and the overproduction subtype resulted higher risks of proximal tubular damage and renal hypoflinction.