慢性肾脏病患者尿钙、尿磷排泄与尿尿酸排泄的相关性研究

Study on the correlation between urinary calcium and phosphorus excretion and urinary uric acid excretion in patients with chronic kidney disease

目的本研究通过分析慢性肾脏病(chronic kidney disease,CKD)患者尿钙、尿磷与尿尿酸排泄的相关性,为CKD诊治提供依据。方法选择2015年7月-2018年7月于华东医院肾内科住院的CKD患者421例进行调查研究。根据患者是否有泌尿系结石,分为尿石症组(UL组,363例)和非尿石症组(NUL组,58例),采用多元线性回归分析,研究尿钙、尿磷与尿尿酸排泄的关系。根据尿酸排泄分数(FE_(UA))三分位数,将421例患者分为3组:A组(FE_(UA)<6.35%)、B组(6.35%≤FE_(UA)≤10.14%)和C组(FE_(UA)>10.14%)。比较3组的尿钙、尿磷排泄、血清钙(SCa)、血清磷(SP)、甲状旁腺激素(iPTH)和25羟化维生素D(25-OHD_(3))的差别。结果根据多元线性回归分析,在尿石症组和非尿石症组中,校正混杂因素后,钙排泄分数(FE_(Ca))和磷排泄分数(FE_(P))均与FE_(UA)呈正相关。B组和C组的FE_(Ca)和FE_(P)水平均高于A组(P<0.01)。C组SP和iPTH水平均高于A组(P<0.01),C组SCa和25-OHD_(3)水平低于A组(P<0.05)。结论在CKD患者中,无论是否有泌尿系结石,FE_(Ca)、FE_(P)与FE_(UA)均存在正相关,提示在CKD患者,尿钙、尿磷排泄与尿尿酸排泄存在相关性。

Objective To analyze the correlation between urinary calcium and phosphorus excretion and urinary uric acid excretion in patients with chronic kidney disease(CKD),and to provide the basis for the diagnosis and treatment of CKD.Methods A total of 421 CKD patients hospitalized in the Department of Nephrology of Huadong Hospital from July 2015 to July 2018 were selected for analysis.They were divided into urolithiasis group(UL group,363 cases)and non-urolithiasis group(NUL group,58 cases)according to whether they had urolithiasis or not.Multiple linear regression analysis was used to study the relationship between urinary calcium and phosphorus excretion and urinary uric acid excretion.According to the tertiles of fractional excretion of uric acid(FE_(UA)),421 patients were divided into 3 groups:group A(FE_(UA)<6.35%),group B(6.35%≤FE_(UA)≤10.14%)and group C(FE_(UA)>10.14%).The levels of urinary calcium and phosphorus excretion,serum calcium(SCA),serum phosphorus(SP),parathyroid hormone(iPTH)and 25 hydroxyvitamin D(25-OHD_(3))were compared among the three groups.Results According to multiple linear regression analysis,after adjusting for confounding factors,the fractional excretion of calcium(FE_(Ca))and fractional excretion of phosphorus(FE_(P))were positively correlated with FE_(UA) in UL group and NUL group.The levels of FE_(Ca) and FE_(P) of the group B and group C were higher than those of the group A(P<0.01),the levels of SP and iPTH of the group C were higher than those of the group A(P<0.01)and the levels of SCa and 25-OHD_(3) were lower than those of the group A(P<0.05).Conclusion In CKD patients,whether there are urinary calculi or not,FE_(Ca) and FE_(P) are positively correlated with FE_(UA),which suggests that urinary calcium and urinary phosphorus excretion are correlated with urinary uric acid excretion in CKD patients.