高尿酸血症与老年慢性肾脏病患者肾功能的相关性研究

The correlation between hyperuricemia and renal function in elderly chronic kidney disease patients

目的:探讨高尿酸血症与老年慢性肾脏病(chronic kidney disease,CKD)患者肾功能的相关性。方法:收集2014年1月至2018年11月我院肾脏科和老年病科诊治的308例CKD1~4期老年患者的临床及随访资料。采用尿酸酶过氧化物酶法检测血尿酸,根据血尿酸水平将患者分为高尿酸血症组(血尿酸≥420μmol/L)和正常尿酸组(血尿酸<420μmol/L),比较2组患者基线临床及预后指标。结果:308例老年CKD患者中伴高尿酸血症者113例(36.7%)。与正常尿酸组相比,高尿酸血症组舒张压、体质量指数、白细胞、三酰甘油及血肌酐均较高,而估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)较低。校正性别、年龄、尿蛋白量、血肌酐等因素后,多元线性回归分析显示尿酸水平与e GFR呈负相关(β=-0.099,P=0.001)。多因素Cox回归分析显示,高尿酸血症独立于性别、年龄、血红蛋白、白蛋白、蛋白尿和eGFR,为老年CKD患者e GFR下降≥30%或终末期肾脏病的独立危险因素[风险比为1.003,95%可信区间:1.000~1.007,P=0.038]。结论:老年CKD患者肾功能与尿酸呈负相关,伴高尿酸血症是老年CKD患者预后不良的独立危险因素。

Objective To investigate the correlation between hyperuricemia and renal function in elderly chronic kidney disease(CKD)patients.Methods The clinical and follow-up data of elderly patients with CKD at stage 1-4 were collected in the Department of Nephrology and Department of Geriatrics of Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 2014 to November 2018.Serum uric acid was measured with uricase-peroxidase assay.The patients were divided into groups according to the serum uric acid level,the hyperuricemia group(serum uric acid≥420μmol/L)and the normal range group(serum uric acid<420μmol/L).The clinical characteristics of patients and risk factors for prognosis were compared between groups.Results Of the 308 elderly CKD patients enrolled in this study,113(36.7%)had elevated serum uric acid level.Compared to patients with the uric acid level within the normal range,patients with hyperuricemia had higher levels of diastolic blood pressure,body mass index(BMI),leukocytes,triglycerides,serum creatinine,and lower estimated glomerular filtration rate(eGFR).Multiple linear regression analyses showed that higher level of serum uric acid was independently negatively related to lower eGFR after adjusting for gender,age,urinary protein,and serum creatinine.Multivariate Cox regression model showed that hyperuricemia was an independent risk factor for eGFR reduction≥30%or end stage renal disease(ESRD)in elderly CKD patients after adjusting for gender,age,hemoglobin,albumin,proteinuria,and eGFR.Conclusions Renal function was negatively correlated with the serum uric acid levle in elderly CKD patients.Hyperuricemia is an independent risk factor for poor prognosis in elderly CKD patients.