CKD2-5期伴高尿酸血症患者行降尿酸治疗后肾功能改善效果及影响

Analysis of renal function improvement effects and influencing factors of CKD2-5 patients combined with hyperuricemia after hypouric acid therapy

目的探讨慢性肾脏病(CKD)2-5期伴高尿酸血症患者行降尿酸治疗后对肾功能改善效果及影响,为后续临床治疗提供有价值的参考依据。方法回顾性选取沈阳市第四人民医院2014年3月~2018年6月收治CKD2-5期伴高尿酸血症患者共264例临床资料,均行规范降尿酸药物治疗6个月;根据入组时eGFR水平进行分组,CKD2-3a期122例设为对照组,CKD3b-5期142例设为观察组;比较两组患者治疗前后血尿酸水平和肾功能相关指标水平,同时分析血尿酸达标和未达标组相关eGFR水平差异及血尿酸eGFR值与deGFR、SUA间关系。结果患者接受降尿酸药物治疗后第1、3及6个月血尿酸、Scr、BUN及eGFR水平均显著优于入组时(P<0.05);两组治疗后血尿酸水平比较差异无显著性(P<0.05);对照组患者治疗后eGFR和deGFR水平均显著优于观察组、治疗前(P<0.05);多重线性回归分析显示,入组时eGFR是影响患者deGFR水平独立影响因素(b=0.178,P=0.03);血尿酸达标组治疗后血尿酸、eGFR及deGFR水平均显著优于血尿酸未达标组(P<0.05)。结论CKD2-5期伴高尿酸血症患者行降尿酸药物治疗后可有效降低蛋白尿,改善肾功能,患者治疗后deGFR水平与入组时eGFR水平密切相关。

Objective To investigate the renal function improvement effects and influencing factors of CKD2-5 patients combined with hyperuricemia after hypouric acid therapy to provide more reference for clinical treatment with follow-up.Methods Clinical data of 264 patients with CKD for 2-5 stage combined with hyperuricemia were retrospectively chosen in the period from March 2014 to June 2018 in Fourth People’s Hospital of Shenyang and divided according to eGFR levels at admission into control group(122 patients)with CKD2-3 a stage and observation group(142 patients)with CKD3 b-5 stage.The levels of serum uric acid and related indicators of renal function before and after treatment of both groups were compared and the difference of eGFR levels between serum uric acid up-to-standard group and non-up-to-standard group and the relationship between eGFR values of serum uric acid and deGFR and SUA were analyzed.Results The levels of serum uric acid,Scr,BUN and eGFR in the first,the third and sixth months after receiving hypouric acid therapy were significantly higher than that at admission(P<0.05).There was no significant difference in the levels of SUA after treatment between the two groups(P>0.05).The levels of eGFR and deGFR of control group were significantly better than that of observation group and before treatment(P<0.05).Multiple linear regression analysis showed that the levels of eGFR was the independent factor affecting the deGFR level of patients at admission(b=0.178,P=0.03).The levels of serum uric acid,eGFR and deGFR after treatment of patients with serum uric acid up-to-standard were significantly higher than serum uric acid non up-to-standard(P<0.05).Conclusion Hypouric acid therapy in the treatment of patients with CKD2-5 stage combined with hyperuricemia can effectively reduce the levels of proteinuria and improve renal function.The levels of deGFR after treatment should be closely related to the levels of eGFR at admission.