特发性膜性肾病患者血尿酸与肾小管萎缩的关系

Relationship between serum uric acid and tubular atrophy in patients with idiopathic membranous nephropathy

目的探讨特发性膜性肾病(IMN)患者的血尿酸水平与肾小管萎缩的关系。方法选取2010年1月至2017年12月本院收治的200例IMN患者,按是否合并肾小管萎缩分为肾小管萎缩组和非肾小管萎缩组。采用logistic回归分析影响IMN患者肾小管萎缩的相关因素。受试者工作特征(ROC)曲线分析血尿酸对诊断IMN患者肾小管萎缩的价值。曲线拟合分析年龄分层下血尿酸与肾小管萎缩的关系。结果与非肾小管萎缩组相比,肾小管萎缩组尿酸水平偏高(P=0.003)。单因素logistic回归分析发现年龄、体重指数(BMI)、收缩压、舒张压、三酰甘油、肾小球滤过率、血尿酸、小动脉壁增厚、肾小球硬化比例和肾小管间质炎症细胞浸润是肾小管萎缩的危险因素(P<0.05)。多因素logistic回归分析发现,血尿酸是肾小管萎缩的独立危险因素(OR=1.005,P=0.024)。ROC曲线分析血尿酸诊断肾小管萎缩的ROC曲线下面积为61.5%,最佳临界点360 μmol/L。按照年龄中位数分层分析的结果提示在年龄≤42岁时,血尿酸是肾小管萎缩的独立危险因素(OR=1.015,P=0.038)。结论 IMN患者血尿酸与肾小管萎缩密切相关,是肾小管萎缩的独立危险因素,但这种关系只有在年龄低于42岁的人群中。

Objective To investigate the relationship between serum uric acid and tubular atrophy in patients with idiopathic membranous nephropathy(IMN).Methods From January 2010 to December 2017,200 patients with IMN were enrolled and divided into renal tubular atrophy group and non-tubular atrophy group according to the tubular atrophy was combined whether or not.The differences in demographic,laboratory and pathological parameters between the two groups were compared.Univariate and multivariate logistic regression analysis were used to analyze the influencing factors of renal tubular atrophy in IMN patients.HOC curve analysis was used for the value of serum uric acid in the diagnosis of tubular atrophy in patients with IMN.Curve fitting analysis was used for exploring the relationship between serum uric acid and tubular atrophy according age stratification.Results Serum uric acid level was higher in patients with tubular atrophy than in patients without renal tubular atrophy in IMN patients(P=0.003).Univariate logistic regression analysis found that age,BMI,systolic blood pressure,diastolic blood pressure,triglycerides,GFR,serum uric acid,small arterial wall thickening,glomerular sclerosis ratio and tubulointerstitial inflammatory cell infiltration were risk factors for tubular atrophy(P<0.05).Multivariate logistic regression analysis found that serum uric acid was an independent risk factor for tuliular atrophy in patients with IMN(OR=1.005,P=0.024).ROC curve analysis of the area under the ROC curve for diagnosis of renal tubular atrophy by serum uric acid was 61.5%,and the optimal critical point was 360 μLmol/L.The results of stratified analysis by median age(42 years)suggest that serum uric acid is an independent risk factor for tubular atrophy at age≤42 years(OR=1.015,P=0.038).Conclusions Serum uric acid is closely associated with tubular atrophy in patients with idiopathic membranous nephropathy and is an independent risk factor for tubular atrophy,but this independent relationship is only exist in patients younger than 42 years old.